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Getting a New Face...with Chemical Peels Ragini Chaturvedi Ragini Chaturvedi has been living in New Jersey, USA for the last 3 years. Before that she was in New Delhi and Bombay. Ragini has a 12 years of experience in Print Media in the capacity of transcriber, translator, copy-editor and editor with various reputed publishing houses.

Photodamaged or sun burnt skin occurs from several factors including overexposure to the sun, the wind, the aging process and genetics. Individuals, who have fair skin, light eyes, and a history of long-term sun exposure, are more susceptible to photodamage, represented by blotchy pigmentation, wrinkling and scaling.

To prevent photodamage, overexposure to the sun should be avoided and an individual must be diligent about wearing a sunscreen with an SPF of 15 or higher everyday.

In this era of concern about reversing the signs of sun-damaged and over exposed skin, dermatologists have taken lasers and chemical peels to the next level to provide their patients with a myriad of options. First popularized for the face, laser resurfacing and chemical peels are now available to treat non-facial skin, such as the chest, neck and upper extremities, where sun exposure frequently occurs.

Dermatologist Edward Victor Ross, MD, of the dermatology department of the Naval Medical Center, San Diego, California spoke at the American Academy of Dermatology's 2002 Annual Meeting in New Orleans, about laser resurfacing and chemical peeling of non-facial skin.

"Laser resurfacing and chemical peeling are two procedures that are valuable for improving the appearance of the skin," said Dr. Ross. "Patients with both mild and severe sun-damaged skin can now benefit from the latest techniques that can be performed on non-facial, photodamaged skin."

Today, however, there are innovative techniques that can improve the appearance of photodamaged skin and rejuvenate the skin's feel and texture.

Laser Resurfacing

Laser resurfacing was first used on facial skin to remove photodamage, hyperpigmentation, and wrinkles. However, with the versatility of lasers and the advancements in scientific technology, dermatologists have expanded the use of lasers to improve the appearance and texture of non-facial skin.

Dermatologists have developed two basic approaches for non-facial laser resurfacing. The Erbium YAG laser selectively removes the outer layer of the skin with little heat. It can be used as a superficial or medium depth resurfacing procedure, which targets the upper two layers of the skin.

Carbon dioxide laser resurfacing, which uses heat energy to selectively destroy the outer and middle layers of the skin, has become beneficial to treat moderate to advanced photodamaged skin, from fine lines and weathered skin to deeper lines and wrinkles. While this short pulse laser can treat more severe photoaging, this type of laser resurfacing must be applied very lightly to non-facial skin and requires anesthesia as well as a recuperation period.

Dermatologists also use the Q-switched alexandrite laser to treat non-facial skin. This procedure utilizes Q-switch lasers which have been successful in removing pigmented lesions and tattoos. With the Q-switch alexandrite laser, pigmented photodamaged areas are selectively treated while preserving the undamaged skin. Repeated treatments can produce a noticeable effect on moderate photodamaged skin.

"Laser resurfacing, when properly utilized for non-facial skin, is a conservative treatment which provides modest enhancements in fine wrinkling and photodamage," said Dr. Ross. "The best candidate for laser treatment is a patient between the ages of 35 and 70, who is interested in rejuvenation and has realistic expectations about moderate improvements in hyperpigmentation and skin texture."

Treatment in the neck and chest region will take approximately 20 to 30 minutes and about 30 minutes for both arms and hands. The application of the topical anesthetic prior to the procedure requires an additional hour of time. The major limitation of non-facial laser resurfacing is the depth of treatment - because of the slow healing of non-facial skin, any resurfacing procedure must be performed very conservatively.

Chemical Peels

Chemical peel, an alternative to lasers, uses a chemical solution to improve and smooth the texture of the facial skin by removing its damaged outer layers. It is helpful for those individuals with facial blemishes, wrinkles and uneven skin pigmentation. Phenol, trichloroacetic acid (TCA) and alphahydroxy acids (AHAs) are used for this purpose. The precise formula used may be adjusted to meet each patient's needs. Although chemical peel may be performed in conjunction with a facelift, it is not a substitute for such surgery, nor will it prevent or slow the aging process. This brochure provides basic information about certain types of chemical peel treatments and the results you might expect. It won't answer all your questions, since a lot depends on your individual circumstances.

Chemical peels, are also being used today to treat non-facial photodamaged skin. Three different levels of peels, from very superficial to deep peels, can be applied to rejuvenate photodamaged skin. The depth of the peel and concentration is based upon the level of photodamage as well as the expectations of the patient.

Very superficial chemical peels remove the top layer of cells and stimulate a more rapid regeneration of the epidermis. These peels include the 20 to 40 percent glycolic acid peels, often referred to as the "lunchtime peel;" alpha-hydroxy peels, including the salicylic acid peel, which is a simple, very light peel with little or no down time; and the 10 to 20 percent Trichloroacetic Acid (TCA) peels, which can be increased in intensity to produce more dramatic benefits.

Alphahydroxy acids (AHAs), such as glycolic, lactic, or fruit acids are the mildest of the peel formulas and produce light peels. These types of peels can provide smoother, brighter-looking skin for people who can't spare the time to recover from a phenol or TCA peel. AHA peels may be used to treat fine wrinkling, areas of dryness, uneven pigmentation and acne. Various concentrations of an AHA may be applied weekly or at longer intervals to obtain the best result. Your doctor will make this decision during your consultation and as the treatment proceeds. An alphahydroxy acid, such as glycolic acid, can also be mixed with a facial wash or cream in lesser concentrations as part of a daily skin-care regimen to improve the skin's texture.

Since superficial peels remove a part or all of the epidermis, patients experience a 48 to 72 hour recovery period as their skin heals from the peeling and redness. "It is important that during the healing process, the patient keep their skin hydrated by drinking water and protect it from the sun by wearing a sunscreen with an SPF of 15 or higher."

For more advanced photodamaged skin, medium depth peels are recommended to penetrate to the middle layer of the skin. These peels can cause mild discomfort, due to the large treatment area and healing usually takes from five to seven days. Trichloroacetic acid (TCA) is most commonly used for medium-depth peeling though it can be used in many concentrations. Fine surface wrinkles, superficial blemishes and pigment problems are commonly treated with TCA. The results of TCA peel are usually less dramatic than and not as long-lasting as those of a phenol peel. In fact, more than one TCA peel may be needed to achieve the desired result. The recovery from a TCA peel is usually shorter than with a phenol peel.

Phenol is the strongest of the chemical solutions and produces a deep peel. It is used mainly to treat patients with coarse facial wrinkles, areas of blotchy or damaged skin caused by sun exposure, or pre-cancerous growths. Since phenol sometimes lightens the treated areas, your skin pigmentation may be a determining factor as to whether or not this is an appropriate treatment for you. Phenol is primarily used on the face; scarring may result if it's applied to the neck or other body areas.

While a medium depth peel provides a more desirable result for patients with moderate photodamage, they are typically too aggressive and one should generally stick to superficial peels for non-facial skin. Deep peels traditionally have been used to remove wrinkles and mild scarring, as well as some acne scars and actinic keratoses. Because deep peels may cause hypopigmentation, or lightening of the skin, and a change in skin texture, a combination of a medium and deep chemical peel may be used.

"Patients today have more options available to them than ever before to treat photodamaged skin," said Dr. Ross. "Anyone considering a cosmetic procedure should always consult with their dermatologist to determine which individual treatment is right for them."

Some Side Effects of all the Peels

AHA peels may cause stinging, redness, irritation and crusting. However, as the skin adjusts to the treatment regimen, these problems will subside.

With a TCA peel, your healed skin will be able to produce pigment as always; the peel will not bleach the skin. However, TCA-peel patients are advised to avoid sun exposure for several months after treatment to protect the newly formed layers of skin. Even though TCA is milder than phenol, it may also produce some unintended color changes in the skin.

With a phenol peel, the new skin frequently loses its ability to make pigment (that is, tan). This means that not only will the skin be lighter in color, but you'll always have to protect it from the sun. Phenol may pose a special risk for patients with a history of heart disease. It's important that you make your surgeon aware of any heart problems when your medical history is taken.

It is also possible that phenol will cause some undesired cosmetic results, such as uneven pigment changes. Certain modified phenol peels are gentler and may be preferred in some circumstances.

Making the Decision

Deciding if chemical peel is right for you Chemical peel is most commonly performed for cosmetic reasons -- to enhance your appearance and your self-confidence. Chemical peel may also remove pre-cancerous skin growths, soften acne facial scars and even control acne. In certain cases, health insurance may cover the peel procedure. Be sure to check your policy and contact your insurance company before the procedure is performed.

In some states, no medical degree is required to perform a chemical peel - even the strongest phenol peels. Many states have laws that permit non-physicians to administer certain peel solutions, but regulate the strengths that they are permitted to apply. You should be warned that phenol and TCA peels have been offered by inadequately trained practitioners claiming "miracle techniques" to rejuvenate the skin.

It is very important that you find a physician who has adequate training and experience in skin resurfacing. Your plastic surgeon may offer you a choice of peel techniques or suggest a combination of peels to obtain the best result for you.

Your new look

Improvements from AHA peels may be very subtle at first. You may detect a healthier glow to your skin. With continued treatments, you will notice a general improvement in the texture of your skin.

The results of a TCA peel are usually not as long-lasting as those of phenol peel. However, your skin will be noticeably smoother and fresher-looking.

If you're planning a phenol peel, you can expect dramatic improvement in the surface of your skin - fewer fine wrinkles, fewer blemishes and more even-toned skin. Your results will be long-lasting, although not immune to the effects of aging and sun exposure.

Peel formulas at a glance

Alphahydroxy acids (AHAs)

Uses:
· Smooths rough, dry skin
· Improves texture of sun-damaged skin Aids in control of acne
· Can be mixed with bleaching agent to correct pigment problems
· Can be used as TCA pre-treatment

Considerations:

Trichloroacetic acid (TCA)

Uses:
· Smooths out fine surface wrinkles
· Removes superficial blemishes
· Corrects pigment problems

Considerations:

Phenol

Uses:
· Corrects blotches caused by: sun exposure, birth-control pills, aging
· Smooths out coarse wrinkles
· Removes pre-cancerous growths

Considerations:

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