facial peels are most advanced cosmetic procedures.

2. :
• The outer layers of your facial skin will go
through a lot during the course of your
life: acne, sun damage, aging. Even though
this happens to everyone, some people are
more emotionally affected by it than
others. When everyday creams and
lotions aren't corrective enough for your
desired appearance, a chemical facial peel
could be your next best choice…………………

3. • A facial peel is a cosmetic, chemical
treatment that can be performed to
help lessen the appearance of blemishes,
freckles, age spots, light scarring, and
any number of other skin irregularities
on the face. Also called chemical peels,
facial peels can improve the appearance
of fine lines and wrinkles, and give new
life to sun-damaged skin.
• Also known as “chemoexfoliation”

4. • The modern era of chemical peeling began at
the turn of the century when George Miller
MacKee, a dermatologist, began using phenol
to treat facial scars.

5. • The skin is made up of two layers, the
epidermis and the dermis. Chemicals used
in facial peels work by removing the top
layers of damaged skin revealing the
undamaged layers of skin underneath. Mild
chemical peels will remove layers of the
epidermis while some of the stronger
chemicals will reach the dermis

6. • Mild chemicals used in facial peels are known as alpha
hydroxy acids and include glycolic, lactic and fruit
acids.
• Trichloroacetic acid or TCA is slightly stronger and
will remove more of the epidermis than the milder
chemicals.
• . The phenol chemical peel is the strongest peel and is
used to remove deep wrinkles, scarring, intense
discoloration and pre-cancerous growths on the skin

7. Types of facial peels
O 1.superficial peels
O 2.medium depth peels
O 3.deep peels

8. • According to the American Society of
Plastic Surgeons, the mildest peel
formulas are composed of
alphahydroxy acids (AHAs) such as
glycolic, lactic or fruit acids , tartaric
acid and malic acid
• concentrations of 50% glycolic acid
or higher arwe used. After application
subsequent exfoliation occurs over
several days.

10. • Application with a sponge from one
side of face to the other , face is
divided into 6-8 regions
Initial erythema
accompanied by oedema
White patches
develop
subsequently

11. • re-epithelialization is complete within 7-
10 days.
• Multiple treatments may be required.
• Glycolic acid peels produce the least
profound results but also are associated
with the lowest frequency of
complications.

12. • Another agent used for superficial
peeling is Jessner’s solution.
• This solution is comprised of 14 g of
resorcinol, 14 g of salicylic acid, and
14 mL of 85% lactic acid mixed in
enough 95% ethanol to bring the
quantity to 100 mL.
• applied with either cotton-tip
applicators or sponge gauze
• frosting achieved with Jessner’s
solution typically results in the

13. • This peel uses trichloroacetic acid
(TCA) in concentrations ranging from
20-35%.,
• Trichloroacetic acid works as a
keratocoagulant that produces a
frost or whitening of the skin, which
is dependent on the concentration
used.
• Associated with an intense burning
that usually resolves within 30

14. • The entire process can take one hour
or more and will require a sedative
must bbe administered to minimise
the discomfort that patient will
experience.
• Indications : coarse facial wrinkles,
blotchy, damaged skin, precancerous
growths and freckles.
• It uses phenol.

15. Deep peels

16. • pure phenol (which is really 88%) or
phenol mixed with soap, water, croton
oil, and sometimes olive oil.
• Phenol causes keratolysis and
keratocoagulation.
• In contrast to other agents,
increasing the concentration of
phenol actually decreases the
penetration up to a point
• Phenol causes an intense burning upon
application that may last 4-6 hours

17. Acne treatment
Signs of aging
Wrinkles
Asymmetrical skin pigmentation
Scars
Decrease fine lines that are produced
around the mouth
Care for wrinkles caused by sun harm
and family history
Improve the appearance of genital
scarring

18. • include patients with active bacterial,
viral or fungal infection,
• tendency to keloid formation.
• facial dermatitis
• taking photosensitizing medications and
• unrealistic expectations.

19. Superficial peels are considered safe in
Indian patients. Medium depth peels
should be performed with great caution,
especially in dark skinned patients. Deep
peels are not recommended for Indian
skin. It is essential to do prepeel priming
of the patient's skin with sunscreens,
hydroquinone and tretinoin for 2-4 weeks

20. • Not appropriate for treating deep scars
• Chemical facial peels also will not
remove or even reduce the appearance
of veins.

21. .
• Comedones (blocked pores) or acne may
result from the peel itself or from thick
moisturisers used afterwards; ask your
dermatologist for treatment.
• Infection due to bacteria (Staphylococcus
aueus, yeast (Candida albicans), or virus
(Herpes simplex); you may need antibiotics.
• Scarring may result from infection or picking
the scabs, and can be permanent.
• Blotchy pigmentation is most likely in those

22. • Adequate evaluation and photographic
documentation of the patient prior to
peeling is absolutely essential.
• A cornerstone of the evaluation of the
patient for chemical peeling is
Fitzpatrick's scale of sun-reactive skin
types

23. Type I patients: always burn and
never tan.
Type II patients: tan only with
difficulty and usually burn.
Type III patients: tan but
sometimes burn.
Type IV patients: rarely burn and
tan with ease.

24. • A thorough medical history and review
of systems should be completed in
concert with the physical examination.
• use of exogenous estrogens, oral
contraceptives, and other
photosensitizing medication
• history of herpes simplex infection
• informed consent, including a thorough
discussion of possible complications, is
obtained.

25. • Preconditioning the skin is done with
Trans-retinoic acid (Retin-A,
Renova), an exfoliative agent
• To facilitate uniform penetration of
the peeling agent and promote more
rapid re-epithelialization.
• This may be applied nightly or every
other night for several weeks prior
to peeling,
• This promotes a thinning of the

26. • more likely with darker skin types and
certain peeling agents
• related to the depth of wounding.
• hyperpigmentation. Treatment : topical
hydrocortisone, trans-retinoic acid,
glycolic acid, or hydroquinone.
• pruritus :treatment:antihistaminics
• Hypo pigmentation:usually occurs with
phenol.

27. • Hypertrophic scarring :
treatment : Topical or
intralesional steroids, silicone
sheeting, pressure
application, and scar massage
may improve outcomes. Scar
excision or dermabrasion may
be necessary in some cases
• Pseudomonas infections
:treatment by washing the
face with equal parts water
and distilled vinegar.

28. :
• a generous amount of bland
ointment (eg, white petrolatum,
A&D ointment) is applied to the
entire treated area.
• some practitioners use topical
agents that contain platelet
products or growth factors.
• Recall after 48 hrs and thereafter
periodically
• Instruct patients to refrain from
trans-retinoic acid, sunscreen, or

29. References:
• Text book of pharmacology- K.D.TRIPATHI
• Text book of oral and maxillofacial surgery-
FONSECA VI
• Indian J Dermatol Venereol Leprol. 2008
Jan;74 Suppl:S5-12.
• Dermatol Clin..1995 Apr;13(2):285-307.

30. THANK YOU