Peel Selection

Facelift Without Surgery

An alternative approach to perioral rhytides

Get Instant Access

Chemical peeling agents are classified as superficial, medium-depth, or deep peels [11]. Superficial peels target the stratum corneum to the papillary dermis (Fig. 13.1). They include glycol-ic acid, salicylic acid, Jessner's solution, tretinoin, and TCA in concentrations of 10-30%. Medium-depth peels penetrate to the upper reticular dermis and include TCA (35-50%) combination glycolic acid 70%/TCA 35%, Jessner's/ TCA 35% and phenol 88%. Deep chemical peels utilize the Baker-Gordon formula and penetrate to the midreticular dermis. Analysis of morphologic,physiologic, and clinical data (see Introduction) suggests that the benefits of chemical peeling in dark skin can be maximally achieved utilizing superficial peels while simultaneously minimizing risks.

Grimes [12] compared the histologic alterations induced by a variety of chemical peels in 17 patients with skin types IV-VI, including glycolic acid 70%, salicylic acid 30%, Jessner's solution, and 25 and 30% trichloroacetic acid (TCA). Peels were applied to 4 x 4 cm areas of the back and 2 x 2 cm post auricular sites. Biopsies were performed at 24 h (Fig. 13.2a-d). Gly-colic acid induced the most significant stratum corneum necrosis. Compared with the other tested peels, salicylic acid and Jessner's peels caused mild lymphohistiocytic dermal infil

Epidermis

Papillary Dermis

Reticular Dermis

Subcutaneous Fat

Epidermis

Papillary Dermis

Reticular Dermis

Subcutaneous Fat

Superficial Peels

TCA 10-30% Tretinoin Salicylic Acid Glycolic Acid Jessner's Solution

Medium Depth Peels

TCA 35-40%, Jessne/s-TCA 35% 70% Glycolic - 35% TCA, Solid CO2 - 35% TCA, 88% Phenol

Deep Peels

Unoccluded or occluded Baker's phenol peel, TCA >50%

Fig. 13.1. Illustration of the depth of wounding caused by peeling agents

Superficial Peels

TCA 10-30% Tretinoin Salicylic Acid Glycolic Acid Jessner's Solution

Medium Depth Peels

TCA 35-40%, Jessne/s-TCA 35% 70% Glycolic - 35% TCA, Solid CO2 - 35% TCA, 88% Phenol

Deep Peels

Unoccluded or occluded Baker's phenol peel, TCA >50%

Fig. 13.1. Illustration of the depth of wounding caused by peeling agents trates. The most severe damage was induced by 25 and 30% TCA, which caused deep epidermal necrosis and dense papillary dermal lympho-histiocytic infiltrates. TCA test sites developed post-inflammatory hyperpigmentation. These findings corroborate our clinical experience using these agents. In general, glycolic, salicylic acid, and Jessner's peels induce a lower frequency of post-peeling complications compared with 25 and 30% superficial TCA peels.

Was this article helpful?

0 0
Wrinkle Reverse

Wrinkle Reverse

It's true, & deep down we all know it, there is no way to stop the natural aging process, not really. But you can take action to slow this process right down. And when done right you can even start to roll back the years as far as facial appearance goes that is! You know, Anyone can look younger when they know how. Skin rejuvenation is very real & It doesn't have to cost the earth!

Get My Free Ebook


Post a comment