Chemical peel

1. 11/26/2018
Chemical peel
American board of Aesthetic medicine.

2. Chemical peel
✤ Repairs damaged skin.
✤ Slow the aging process.
✤ Rejuvenation, optimal skin for chronological age.

3. Rejuvenation of skin
✤ Smooth
✤ Firm
✤ Radiant
✤ Even color tone.

4. Exfoliation
✤ Removal of outer layer of skin.
✤ Promotes quicker turnover of skin.
✤ Baby turnover in <1 month.
✤ 18-20’s turnover skin in 28 days.
✤ Stimulated fibroblasts activity.

5. Mechanism of chemical peeling.
✤ New outer layer of skin is formed.
✤ Smoother.
✤ Radiant.
✤ Uniform texture.
✤ Even color tone.
✤ More taut.

6. Indications
✤ Photo damage, dyschromia, and hyperpigmentation.
✤ Solar lentigines.
✤ Sun spots/agespots/liverspots and freckles.
✤ Melasma
✤ Actinic keratosis.
✤ Fine lines and wrinkles.
✤ Large pores.
✤ Uneven skin tone/color.

7. Indications
✤ Laxity.
✤ Dryness
✤ Roughness
✤ Keratosis pyloris.

8. Where
✤ Can peel practically anywhere’s!

9. Depth of peeling.
✤ Superficial epidermis
✤ Medium superficial to mid dermis.
✤ Deep, mid dermis to deeper.

10. Depth of peel
✤ Deeper peel has quicker effects. Increase complications and
side effects.
✤ PIH.
✤ Prolonged redness.
✤ Increase swelling.
✤ Scaring
✤ Hypopigmentation.

11. Depth of peel
✤ Factors affecting depth of peel.
✤ Chemical or chemical mixture.
✤ Concentration
✤ pH
✤ Contact time.
✤ Skin thickness.
✤ Skin preparation.

12. Depth of penetration
✤ Epidermis glycolic, salicylic, TCA and phenol.
✤ Upper dermis Glycolic, salicylic, TCA and phenol.
✤ Mid dermis TCA and phenol.
✤ Deep dermis
✤ TCA, phenol.

13. What to tell your patients.
✤ Superficial peel.
✤ Mild to moderate burning sensation.
✤ Medium moderate to severe burning sensation and pain.
✤ Tolerable for most patients with encouragement.
✤ Deep, severe pain for 2 days and may require IV
sedation or even GA.

14. Chemical peel agents
✤ Glycolic acid.
✤ TCA trichloroacetic acid.
✤ Salicylic acid.
✤ Lactic acid usually in a mixture
✤ Resorcinol usually in a mixture.

15. Chemical peeling agents
✤ Alpha hydroxy acid AHA derived from plant sources.
✤ Glycolic acid sugar cane.
✤ Malic acid Apple.
✤ Tartaric acid grape.
✤ Citric acid, citrus
✤ Lactic acid sour milk
✤ Beta hydroxy acid salicylic acid.

16. Glycolic acid
✤ Depth very superficial to superficial.
✤ Indications mild photo damage, enlarged pores, mild fine
lines.
✤ Concentration 20 to 70%.
✤ Endpoints mild to moderate erythema and no frosting.
✤ Requires neutralization. Cool water, wash off/ wipe off.
✤ Neutralizer HCO3 spray directly to treated area.

17. Salicylic acid
✤ Depth superficial.
✤ Indications slightly deeper exfoliation than glycolic,
acne and rosacea.
✤ Formulations 20 to 25%.
✤ Endpoints erythema and frosting.
✤ No neutralization.

18. Jessner
✤ Depth superficial
✤ Indications acne, photo damage, dyschromia, melasma.
✤ Endpoints erythema and frosting.
✤ Formulation by volume, salicylic acid 14%, lactic acid
14% and resorcinol 14%.
✤ Self-neutralization.

19. TCA trichloroaceticacid
✤ Depth medium to deep.
✤ Indications photo damage, dyschromia, melasma and
scarring.
✤ End point erythema and frosting.
✤ Formulation standard 35-50% can be compounded for
lower percentage.
✤ Self-neutralization.

20. Frosting
✤ Healing process
✤ Duration 1-2 weeks.
✤ Management, dryness, itching(hydrocortisone
ointment), swelling and scratching.

21. TCA
✤ Standard TCA 35-50%
✤ Very fast penetration.
✤ Easily reaches dermis layer.
✤ Penetration can be uneven depending on skin preparation.
✤ Not for novice.
✤ 15-20% TCA can achieve same result with more control.

22. Aftercare
✤ No picking, pulling or scratching.
✤ Sunblock at all times.
✤ Avoids prolonged, direct sun exposure.
✤ Sunblock and moisturizer only until healed.
✤ Aquaphor or similar for mid to deep peel.
✤ Repeat chemical peel in 2 weeks for superficial peel.
✤ Repeat chemical peel in 4 weeks for deep peel.

23. Aftercare
✤ Restart prep regiment and skin regiment after healing
skin back to normal.
✤ Call immediately for possible burns.
✤ Blistering or heavy scabbing or crusting.

24. Complications
✤ PIH
✤ Use appropriate peel or concentration.
✤ Skin preparation essential type 3 to 5 skin.
✤ Sun avoidance.
✤ Herpes , Prophylactic antiviral, acyclovir or similar 1
day prior 3 days after.

25. Complications
✤ Bacterial infection.
✤ Scarring
✤ Prolonged redness.
✤ Dry/swollen skin hydrocortisone ointment.

26. Contraindications
✤ Tendency for excessive scarring deep peel.
✤ Skin type 5-6 superficial peeling only.
✤ Excessive exposure to sun. Occupational and non
compliance patient.