The earliest recorded attempts to improve the skin date back to antiquity. Recipes for smoothing the skin and removing blemishes through the use of alabaster and pumice were recorded in the writings of the ancient Egyptians who used them for centuries. Today, as a result of modern technology, safe and effective procedures have been developed to improve facial wrinkles and mild scarring.
One technique used to treat facial irregularities is chemical peel. Chemical peel is a procedure in which chemical agents are applied to skin that is wrinkled, scarred or otherwise damaged. After treatment, scabs form which, upon falling off, leave smoother, younger looking skin. This procedure, although initially prescribed mainly for cosmetic purposes, is used therapeutically as well. Cosmetic indications for the use of chemical peel include wrinkles caused by aging, sun damage, or heredity factors; superficial acne scarring, irregular pigmentation of the skin, freckles and age spots. Melasma, a dark pigmentation of the face found primarily in women who are pregnant or are taking birth control pills, can also be improved. Pre-cancerous conditions such as keratoses (thick, rough, reddish growths) also respond well to treatment. Chemical peel is sometimes done in conjunction with other surgical procedures such as rhytidectomy (facelift).
Prior to the procedure, a medical history of the patient is taken in order to evaluate the general health of the patient. A careful examination is also conducted. The physician describes the procedure, what results might realistically be expected, as well as possible risks and complications. Photographs are often taken before and after the procedure in order to evaluate the amount of improvement. Instructions may include the elimination of certain drugs. The patient may be advised to cleanse the face and hair with an antiseptic soap the day before the procedure.
A chemical peel can be performed in a physician’s office, an outpatient surgical facility or a hospital, depending upon the patient’s and physician’s preference. There are several types of chemical peel techniques; the light peel and medium peel are used to remove superficial wrinkles and discolorations; the deep chemical peel is used for more severe conditions. In all procedures, medications to relax the patient and relieve discomfort are usually administered a short time before surgery. The skin is thoroughly cleansed with an agent that removes excess oils, and eyes and hair are protected.
A small applicator is used to apply the chemical to one small area of the face. Excess solution is then wiped off and the procedure is repeated on other areas of the face with the exception of the lips and eyes. (Fig. A)
A light burning sensation may occur when the solution is applied, but it quickly diminishes. Bandaging may be required for a deep peel but is not used with the other peels. (Fig. B) The procedure can last from 20 minutes to one hour or more depending on the extent of the surgery.
Following the Procedure
Patients may be discharged soon after the light peels and three to six hours after the deep peels. If bandages are used, they are removed within a day or two. At this time, the face may be cleansed and ointments may be applied to speed up the healing process. For a few days, the skin feels as though it has been severely sunburned. This discomfort can be alleviated with medications. Swelling of the affected area is to be expected. Moving around rather than lying in bed is recommended to keep swelling to a minimum. Keeping the head slightly elevated when reclining is also advised.
As the skin heals, crusts begin to form and some tingling and itching may occur. Cool compresses can reduce those sensations. After the crusts fall off, the skin appears quite pink, but this coloration fades in a few weeks. During this period, special ointments, soaps and cosmetics may be recommended. The skin must not be exposed to direct or reflected sunlight for several months and sunscreen should be worn at all times when out of doors.
Thousands of patients who undergo chemical peels each year are delighted with the results. The amount of improvement is individual and depends upon the initial condition of the patient’s skin. Maximum improvement of damaged skin ranges from 75% to 85%, and, although 100% improvement is not possible, most patients view the results as dramatic. Some patients may require additional treatments to achieve the desired results.
Although complications are rare, there are certain inherent risks connected with every surgical procedure which should be thoroughly discussed with the physician before the surgery. Patients can minimize complications by carefully following directions given by the physician.
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