This document discusses chemical peels, which remove the outer layer of skin to promote skin rejuvenation and a smoother, more even skin tone. Chemical peels can range from superficial to deep, with deeper peels having quicker effects but more potential side effects. Common agents used in chemical peels include glycolic acid, salicylic acid, TCA, and Jessner's solution. Proper skin preparation, concentration, contact time and aftercare are important for achieving desired results and avoiding complications such as PIH or scarring.

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.