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Chemical Peels

At Dermcare we offer two main lines of chemical peels: superficial- and medium-depth. In general, chemical peels are an excellent choice for the treatment of sun-damage, fine lines, sun-spots, and wrinkles. Laser treatments can often provide a similar effect on the skin, however, chemical peels tend to be a more cost-effective option. Chemical peels work by causing non-selective injury to the various layers of the skin. After injuring the skin, the body will repair the skin by generating new skin cells along with boosting new collagen development in the dermis. Superficial peeling of the skin, with a Jessner’s peel, for example, can work to reduce excess pigmentation (melasma and/or sun spots, post-inflammatory hyperpigmentation), fine lines, and acne vulgaris. Generally, a series of 3 peels is completed separated by 4 weeks of rest time. Peeling usually starts around 3-4 days after the chemical peel, and is generally mild light and flaky. Medium-depth chemical peels are completed with either trichloroacetic acid (TCA) alone and/or in combination with Jessner’s solution. These peels are generally performed once and may be repeated up to 4-6 months later. Since these chemical peels are deeper than the superficial peels, one can expect more improvements in pigment, fine lines, and collagen generation than with a Jessner and/or glycolic acid (another superficial agent) peel alone. At the same time, one can expect more downtime and side-effects from a medium-depth peel. For example, it is typical after a medium-depth peel to have tight brown skin lasting several days, followed by significant peeling, redness, and swelling. The medium-depth peels may increase the risk of skin pigmentation as a side effect. To counteract this, it is common to have started a skin-care program with retinol and sun-protection months in advance leading up to the peel. The superficial peeling agent we use is the Jessner’s classic formula. For medium-depth peels we use either trichloroacetic acid (TCA) alone or in combination with Jessner’s peel.

 

Jessner’sTCA 25/35% Jessner’s
Mild photoagingPhotodamage
Sunspots (lentigines)Actinic keratoses
Blackheads (comedonal acne)Seborrheic (macular) keratoses
Indicated forPost-inflammatory hyperpigmentationMelasma
Blackheads (comedonal acne)Comedonal acne
MelasmaPost-inflammatory hyperpigmentation
Great for exfoliationWrinkles/fine-line reduction
FrequencyMultiple peels are usually necessaryVaries on the individual
MonthlyTypically, one or two per year
What to expectMild stinging and burning during the application of the solution. Use a fan to help reduce the discomfortSevere stinging and burning where a fan and ice pack is used to alleviate the symptoms during the procedure.
DuringVaseline/Aquaphor/Eucerin will be applied to the skin once the peel has been completed – the skin may appear white (frosting)** Pt is given an antiviral and antifungal for preventative purposes (Fluconazole 150mg once and Valtrex 1g for 7 days)***
The next few days following the peel, your skin will start to peel. Advise patients to not pick at the skin as it is peelingFacial swelling and redness begins almost immediately and will worsen in the first 48 hours. Can be severe enough to close the eyelids
The patient will need to apply Vaseline or Aquaphor multiple times a day post-peel to avoid the skin drying outDay 4-8: expect the formation of brownish crust with the new skin underneath that may appear like a sunburn.
AfterSunscreen must be applied daily while your skin is healing. Gentle cleanser.Pt to wait a minimum of 10 days before applying any cosmetics to the face unless there are open wounds.
Post-op: 2-4 weeks the skin will start to be fully resolved. Pt is given bleach bath handout just in case.
ProcedureThe face is wiped with acetone or alcohol pads to cleanse the face Once the face is wiped, a 2×2 is used to apply the Jessner’s solution Afterwards, Aquaphor or Eucerin is applied to calm the skin down and an ice pack is given to the patient.Face is wiped with acetone or alcohol pads to cleanse the face Once the face is wiped, a 2×2 is used to apply the Jessner’s solution Once the face has dried, a 2×2 is then used to apply the TCA 25% or TCA 35% Afterwards, the healing ointment is applied to the patient’s face.

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