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Facelift Without Surgery

An alternative approach to perioral rhytides

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Part I

Types of Chemical Peels: Advantages/Disadvantages -an Illustrated Algorithm

1 Types of Chemical Peels 3 Antonella Tosti, Maria Pia De Padova, Matilde Iorizzo

1.1 Advantages/Disadvantages ... 4

1.1.1 Glycolic Acid 4

1.1.1.1 Advantages 4

1.1.1.2 Disadvantages 4

1.1.2 Jessner's Solution 4

1.1.2.1 Advantages 4

1.1.2.2 Disadvantages 4

1.1.3 Pyruvic Acid 5

1.1.3.1 Advantages 5

1.1.3.2 Disadvantages 5

1.1.4 Resorcinol 5

1.1.4.1 Advantages 5

1.1.4.2 Disadvantages 5

1.1.5 Salicylic Acid 5

1.1.5.1 Advantages 5

1.1.5.2 Disadvantages 5

1.1.6 Trichloracetic Acid 5

1.1.6.1 Advantages 5

1.1.6.2 Disadvantages 6

1.1.7 Deep Chemical Peels 6

1.1.7.1 Advantages 6

1.1.7.2 Disadvantages 6

1.1.8 Combination Peels:

Salicylic Acid + TCA 6

1.1.8.1 Advantages 6

1.1.8.2 Disadvantages 6

1.2 How to Choose the Best Peeling for the Patient 6

1.2.2 Actinic Keratosis 7

1.2.3 Dark Skin 8

1.2.5 Photoaging 9

1.2.6 Post-inflammatory Hyperpigmentation 9

1.2.7 Rosacea 9

1.2.8 Solar Lentigo 10

Part II

Modalities of Application

2 Glycolic Acid 13

Gabriella Fabbrocini, Maria Pia De Padova, Antonella Tosti

2.1 History 13

2.2 Chemical Background 13

2.3 Properties 13

2.4 Formulations 13

2.5 Indications 14

2.6 Contraindications 14

2.7 Peeling Preparation 14

2.8 Peeling Technique 16

2.9 Post-peeling Care and Complications 19

2.10 Disadvantages 19

2.11 Side Effects 19

2.12 Results 20

2.13 Informed Consent 20

References 21

3 Jessner's Solution 23

Pearl E. Grimes

3.1 History 23

3.2 Chemical Background 23

3.3 Formulations 24

3.4 Indications 25

3.5 Contraindications 25

3.6 Skin Preparation 26

3.7 Peeling Technique 27

3.8 Post-peel Care 27

3.9 Advantages of Jessner's Peeling 27

3.10 Disadvantages of Jessner's Peeling 27

3.11 Side Effects 28

3.12 Patient's Informed Consent . . 28 References 29

4 Pyruvic Acid 31

Ilaria Ghersetich, Benedetta Brazzini, Torello Lotti, Maria Pia De Padova, Antonella Tosti

4.1 History 31

4.2 Properties 31

4.3 Indications 31

4.4 Formulations 32

4.5 Contraindications 32

4.6 Peeling Preparation

(Home Treatment) 32

4.7 Peeling Technique 32

4.8 Post-peeling Care 35

4.9 Side Effects 35

4.10 Advantages 35

4.11 Disadvantages 35

4.12 Results 35

4.13 Patient's Informed Consent . . 38 References 39

5 Resorcinol 41

Ilaria Ghersetich,

Benedetta Brazzini, Torello Lotti,

Maria Pia De Padova, Antonella Tosti

5.1 History 41

5.2 Chemical Background and Properties 41

5.3 Formulations 41

5.4 Indications 42

5.5 Contraindications 42

5.6 Peeling Preparation 44

5.7 Peeling Technique 44

5.8 After Peel Care 45

5.9 Side Effects 45

5.10 Advantages 46

5.11 Disadvantages 46

5.12 Patient's Informed Consent . . 46 References 47

6 Salicylic Acid

Pearl E. Grimes

6.1 History 49

6.2 Chemical Background/Properties 49

6.3 Formulations 50

6.4 Indications 50

6.5 Contraindications 50

6.6 Patient Preparation 51

6.7 Peeling Technique 51

6.8 Post-peeling Care and Complications 55

6.9 Advantages 55

6.10 Disadvantages 56

6.11 Side Effects 56

6.12 Patient's Informed Consent . . 56 References 57

7 Trichloroacetic Acid 59

Christopher B. Harmon, Michael Hadley, Payam Tristani

7.1 History 59

7.2 Chemical Background 59

7.3 Chemical Formulations 59

7.4 Classification of Peel Depths . . 60

7.5 Indications 61

7.6 Facial Versus Non-facial Skin . 63

7.7 Peeling Preparation 63

7.8 Peeling Technique 64

7.9 Post-peeling Care 65

7.10 Complications 66

7.11 Advantages/Disadvantages of TCA Peels 66

7.12 Conclusion 66

References 67

8 Deep Chemical Peels for Photoaging 69

Marina Landau

8.1 History 69

8.2 Chemical Background 70

8.3 Formulations 70

8.4 Histology 71

8.5 Indications and Patient Selection 72

8.6 Contraindications 72

8.7 Pre-peeling Preparation 73

8.8 Preparation of the Skin 73

8.9 Peeling Preparation 74

8.10 Peeling Technique 75

8.11 Aftercare 79

8.12 Complications 85

8.12.1 Cardiac Arrhythmias 85

8.12.2 Pigmentary Changes 85

Scarring 86

Infection 86

Milia 86

Acneiform Dermatitis 86

Skin atrophy 87

Advantages 87

Disadvantages 87

Patient's Informed Consent . . 87

References 88

Deep Chemical Peels for Post-acne Scarring 91

Marina Landau

History and Classification ... 91

Indications 93

Contraindications 93

Pre-peeling Preparation 93

Peeling Technique 94

Aftercare 96

Advantages 96

Disadvantages 96

References 100

Combination Salicylic Acid/

TCA Chemical Peeling 103

Pearl E. Grimes

History 103

Chemical Background/Properties 103

Formulations 104

Indications 104

Contraindications 105

Peeling Preparations 107

Peeling Technique 108

Post-peeling Care and Complications 109

Advantages 109

Disadvantages 109

Side Effects 109

Patient's Informed Consent . . 109

References 110

Part III

How to Choose the Best Peeling for the Patient

Vincenzo Bettoli, Alessandro Borghi, Maria Pia De Padova, Antonella Tosti

11.1 Definition 113

11.2 Epidemiology 113

11.3 Pathophysiology 113

11.4 Clinical Patterns 114

11.5 Clinical Types 119

11.6 Differential Diagnosis 121

11.7 Therapy 122

References 131

12 Actinic Keratosis 133

Ilaria Ghersetich, Benedetta Brazzini, Maria Pia De Padova, Antonella Tosti

12.1 Definition 133

12.2 Etiology 135

12.3 Clinical Types 135

12.4 Histopathology 136

12.5 Diagnostic Criteria 136

12.6 Differential Diagnosis 136

12.7 Therapy 136

12.8 Management of the Patient ... 138 References 138

13 Chemical Peels in Dark Skin . . 139

Pearl E. Grimes

13.1 Definition 139

13.2 Epidemiology 139

13.3 Morphologic and Physiologic

Skin Differences in Dark Skin . 139

13.4 Peeling Indications in Dark Skin 140

13.5 Peel Selection 140

13.6 Peeling Preparation 141

13.7 Peeling Techniques 143

13.8 Superficial Peeling Agents ... 143

13.8.1 Glycolic Acid 143

13.8.2 Salicylic Acid 144

13.8.3 Jessner's Solution 144

13.8.4 Tretinoin Peeling 144

13.8.5 Trichloroacetic Acid 146

13.8.6 Medium and Deep Peels 147

13.9 Summary 147

References 148

14 Melasma 149

Matilde Iorizzo, Antonella Tosti, Maria Pia De Padova

14.1 Definition 149

14.2 Epidemiology 149

14.3 Etiology 150

14.4 Clinical Features 150

14.5 Diagnostic Criteria 151

14.6 Therapy 152

14.6.1 Sunscreens 152

14.6.2 Hydroquinone 152

14.6.3 Azelaic Acid 153

14.6.4 Kojic Acid 153

14.6.6 Chemical Peels 153

14.7 Why Is a Combined Chemical Peel Useful for Treating Melasma? 158

14.7.1 Laser 158

14.7.2 Cryotherapy 158

References 159

15 Photoaging 161

Pearl E. Grimes

15.1 Definition 161

15.2 Etiology 161

15.3 Epidemiology 162

15.4 Clinical Types 164

15.5 Therapeutic Intervention . . . 164

15.5.1 Photoprotection 164

15.5.2 Retinoids 165

15.5.3 Tretinoin 166

15.5.4 Tazarotene 167

15.5.5 Retinol 167

15.5.6 Vitamin C 167

15.5.7 Alpha Hydroxy Acids 168

15.5.8 Polyhydroxy Acids 168

15.6 Bleaching Agents 168

15.6.1 Hydroquinone 168

15.6.2 Azelaic Acid 169

15.6.3 Kojic Acid 169

15.6.4 Miscellaneous 169

15.7 Chemical Peels for Photoaging . 169

15.8 Superficial Peeling Agents . . . 169

15.9 Medium-Depth Peeling 170

15.10 Summary 173

References 173

16 Post-inflammatory

Hyperpigmentation 177

Teresa Soriano, Pearl E. Grimes

16.1 Definition 177

16.2 Epidemiology 177

16.3 Etiology 177

16.4 Clinical Types 178

16.5 Diagnostic Criteria 178

16.6 Differential Diagnosis 178

16.7 Therapy 178

16.8 Topical Agents 178

16.9 Chemical Peels 180

16.10 Summary 182

References 182

17 Rosacea 185

Maria Pia De Padova, Matilde Iorizzo, Antonella Tosti

17.1 Definition 185

17.2 Epidemiology 185

17.3 Pathology 185

17.4 Clinical Types (Clinical Stages) 185

17.5 Diagnostic Criteria 191

17.6 Differential Diagnosis 191

17.7 Therapy 191

17.8 Erythrosis 191

17.9 Papulo-Pustular Rosacea 192

17.10 Rhinophyma 192

17.11 How to Perform the Best Peeling for the Treatment of Rosacea . . 193

17.12 Peeling Technique 196

References 198

18 Solar Lentigo 199

Ilaria Ghersetich, Benedetta Brazzini, Maria Pia De Padova, Antonella Tosti

18.1 Definition 199

18.2 Epidemiology 199

18.3 Etiology 199

18.4 Clinical Features 199

18.5 Pathology 200

18.6 Diagnostic Criteria 200

18.7 Therapy 200

References 205

Part IV

Management of the Patient

19 Management of the Patient . . 209

Maria Pia De Padova, Antonella Tosti

19.1 Patient Selection 209

19.2 Patient Evaluation 209

19.3 Instructions 209

19.3.1 Pre-operative Phase 209

19.3.2 Post-operative Phase 210

19.4 Photographs 210

Subject Index 213

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