Peeling Technique

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The full description of the deep chemical peel procedure is found in Chapter 8. Before the peeling, the subcision (subcutaneous incision) technique is used to free the fibrous bands from the base of the scars. For this purpose we use an 18-gauge 1.5-inch NoKor Admix needle (Becton Dickinson and Co). This needle has a triangular tip similar to No. 11 blade (Fig. 9.5). It allows smooth separation of fibrous cords. The needle is inserted through a skin surface, and its sharp edges are maneuvered under the defect to make subcutaneous cuts or incisions. The depression is lifted by the releasing action of the procedure, as well as from connective tissue that forms in the course of normal wound healing.

The Exoderm solution is applied evenly and gradually on the skin until full frosting is achieved (Fig. 9.6). At this stage we combine mechanical skin dermabrasion by using a Ti-polisher,which is sterile surgical equipment designed originally for cleaning cauthery tips during operations (Fig. 9.7). This simple disposable tool is available in any standard operating setting. Another option is to use sterilized gentle sandpaper. At this stage pint-point bleeding is observed. Reapplication of peeling solution coagulates most of the bleeding (Fig. 9.8).

Frosting after application of the peeling solution

Frosting after application of the peeling solution

Skin dermabrasion using Tipolisher

The face is covered with impermeable tape mask for 24 h. After 24 h the tape mask is removed and the exudate is cleansed with sterile saline. Regional re-application of peeling solution and re-taping of the scarred areas is performed and the tape is left for an additional 4-6 h and then removed by the patient. The face is covered with bismuth subgalate antiseptic powder for 7 days. The third phase of the treatment is regional re-peeling, which is performed 6-8 weeks after the original treatment. This phase is optional for patients with residual scar areas.

9.6 Aftercare

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