Post-application, specific agents (primarily TCA) can induce a reaction called frosting. Ĭertain areas requiring special attention include:Įyelid skin: delicate and careful application is paramount so that excess peel solution does not come into the eyes or come into contact with tears a semi-dry applicator should be gently rolled onto the lids and periorbital skin, with care to remain at least 3 mm from the lid margin The edge of the treatment site can be feathered to blur demarcation lines. Overlaps in brushstroke coverage should be avoided as it may cause overconcentration of the agent and an uneven outcome. As an example, gauze sponges can be more abrasive and more suitable for liquid formulations. Peel-specific application nuances exist for each type and require experience until achieving mastery. A brush, gauze, or a wooden spatula can be used to apply the chemical in evenly distributed strokes, the choice of which application method will depend on the desired effect and chemical peel used. The peeling agent can be applied on the thicker skin regions first (i.e., chin, nose, cheeks, and forehead) followed by the thinner skin regions (i.e., around the eyes and mouth). Oral analgesics can be administered, such as acetaminophen. General anesthesia is not routinely required but may be a consideration for deep peels. The eyes should be covered with an appropriate shield. The clinician can apply petroleum jelly to areas of potential pooling of the chemical such as the nasolabial folds and lateral canthi. A hair cap should be worn to keep the hair away from the treatment field. They should be in a supine position with the head of the bed elevated to 45 degrees. īefore starting the chemical peeling procedure, the patient's skin requires cleaning with a degreasing agent such as isopropyl alcohol or acetone for the removal of any residue or makeup. On the day of the procedure, they should be instructed to cleanse their skin and not to apply any skincare or makeup products. Patients are advised to avoid procedures that could traumatize the skin such as dermabrasion and waxing. The clinician must stress the importance of protection against UV rays (pre and post-treatment) to the patient. In patients with a history of herpes simplex viral infection, a course of acyclovir merits consideration, though some authors routinely prescribe prophylactic antivirals as well. For patients susceptible to hyperpigmentation, hydroquinone (2 to 4%) cream can be utilized pre- and post- peel to decrease post-inflammatory pigmentary reactions by targeting and inhibiting tyrosinase in melanocytes. Other options include salicylic and glycolic acids at 5 to 10% concentration. A commonly prescribed priming agent is all-trans retinoic acid or tretinoin (0.025 to 0.05%) cream. Adequate priming should be started 2 to 4 weeks before the procedure and involves the application of a topical agent on the skin to thin the stratum corneum layer, which increases the depth of penetration. The clinician should perform priming should to facilitate effective peeling. One way to reliably predict the result is with pre-peel spot testing, though this is not a routine process nevertheless, some clinicians elect to perform pre-peel testing to help select the proper peel for the patient. Special considerations in male patients are often needed as they tend to have thicker skins with less predictable peeling outcomes. The factors affecting the depth of peeling, and thus the degree of its therapeutic effects, include the properties of the chemical agent used (e.g., concentration and pH), the physician's application technique, and the patient's skin condition and sensitivity. Chemical peels are commonly classified based on their depth of skin penetration into superficial, medium, and deep peels. Also, dermatologists and facial plastic surgeons commonly employ a chemical peel as a therapeutic or cosmetic intervention to enhance appearance either alone or in combination with other techniques, such as laser or dermabrasion. Chemical peels can be used to treat various skin conditions, such as acne vulgaris, photodamage, pigmentary disorders, and scars. Chemical peeling, also known as chemexfoliation or chemical exfoliation, is a procedure where a chemical substance applied to the skin causes controlled destruction of the epidermis with or without part of the dermis, leading to skin regeneration and remodeling.
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