Textbook of Chemical Peels: Superficial, Medium and Deep Peels in Cosmetic Practice (Cosmetic and Laser Therapy)

402 Pages·2007·20.24 MB·English

by  Philippe Deprez

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Textbook of Chemical Peels
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SERIES IN COSMETIC AND LASER THERAPY
Published in association with the Journal of Cosmetic and Laser Therapy
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Prelims 7/11/06 8:34 am Page iii
Textbook of
Chemical Peels
Superficial, Medium and Deep Peels
in Cosmetic Practice
Philippe Deprez
MD
Medical Director
Policlinica Estetica & Anti-Aging
Empuriabrava
Spain
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© 2007 Informa UK Ltd
First published in the United Kingdom in 2007 by Informa Healthcare,
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held responsible for errors or for any consequences arising from the use of
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ISBN-10: 1 84184 495 0
ISBN-13: 978 1 84184 495 4
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Contents
Acknowledgment vii 15 Easy TCA®: basic protocol and skin
aging 109
1 Chemical peels: definition and
classification 1 16 Treating melasma, chloasma and
post-inflammatory
2 Pre-peel care 5
hyperpigmentation 121
3 Post-peel care 13
17 Treating acne 125
4 Factors influencing chemical peels 27
18 Treating multiple keratoses on
5 Choosing the right peel 31 the scalp 131
6 Alpha-hydroxy acids: chemistry, pH 19 Treating aging of the hands and
and pK , and mechanism of action 47 forearms 135
a
7 Alpha-hydroxy acids: histology and 20 Treating the neck and décolletage 141
factors influencing penetration 53
21 Stretch marks and scars:
8 Alpha-hydroxy acids: indications dermabrasion and peeling 145
and results 55
22 Actinic keratoses and lentigines 167
9 Alpha-hydroxy acids: application as
23 Trichloroacetic acid to the papillary
cosmetics and as peels 59
dermis: Unideep® 177
10 Alpha-hydroxy acids: side-effects
24 Resorcinol: Unna’s paste/Jessner’s
of AHAs 67
solution 183
11 Alpha-hydroxy acids: a new slow-
25 Phenol: chemistry, formulations and
release AHA complex with no
adjuvants 193
neutralization required 69
26 Phenol: properties and histology 203
12 Trichloroacetic acid: general
information, toxicity, formulations 27 Phenol: skin penetration and
and histology 79 detoxification 209
13 Trichloroacetic acid: indications and 28 Toxicity of phenol: causes,
contraindications 95 prevention and treatment 213
14 Trichloroacetic acid: classic semiology 105 29 Phenol: choice of peel and
combination treatments 225
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vi Contents
30 Phenol: indications 233 35 Phenol: post-peel care 283
31 Phenol: contraindications, 36 Phenol: chemical blepharoplasty
precautions and safety 249 and cheiloplasty 295
32 Phenol: pre-peel preparation 253 37 Complications of chemical peels 313
33 Full-face phenol: nerve block 38 Combination of techniques 371
anesthesia and/or sedation 261
Index 377
34 Full-face phenol: application 273
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Acknowledgment
The publication of this work has been assisted by an educa- ancillary products (such as sunscreens) manufactured in
tional grant from Skin Tech (www.skintech.info; comparable formulations about which it cannot be
www.peeling.com). expected to be comprehensive; the author is most familiar
It should be noted that this textbook is comprehensive with and recommends those from Skin Tech, but does not
about all available peel products, but that there are many imply by this that other products may not be comparable.
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1
Chemical peels: definition and classification
Definition of a chemical peel It is clear that it does not take much to turn a very light
glycolic acid peel into a medium-depth peel that can even
A chemical peel is a skin treatment intended to visibly reach the deeper layers of the dermis and risk discoloration
improve the structure of treated tissue by the external or even scarring. All it takes is for the peel not to be neu-
application of a caustic solution. It can simply accelerate tralized properly. The same goes for all of these caustic
the natural processes of exfoliation, but can also com- molecules, which is why, until recently, it was usually nec-
pletely destroy the epidermis and a more or less large pro- essary to have a thorough knowledge of chemical peels and
portion of the dermis, essentially by protein coagulation or skin anatomy before undertaking this kind of treatment.
lysis. The effect of any peel reaches the dermis, directly or Every practitioner, through personal experience and prac-
indirectly and to varying depths, where the processes of tice, should aim to standardize their treatments in order to
regeneration are induced to a greater or lesser degree, eliminate the maximum number of variables. Fortunately,
depending on the molecule or molecules used and the new chemical peel formulas are now available that are eas-
application procedure. ier, safer and quicker to use, allowing young physicians to
Chemical peels are among the oldest forms of skin rejuve- get on with the job of peeling without losing sleep and hav-
nation and form a group of treatments in their own right. ing post-peel nightmares. Sound knowledge and experi-
They are both flexible and effective, with a histological, chem- ence are still essential for peels to the papillary dermis.
ical, toxicological and clinical basis. They have an ancient his-
tory, have evolved rapidly and can be adapted to almost any
circumstances within the limits of their indications. Criteria for classification
Most peels, to varying degrees, cause the same types of
histological changes, whose clinical results lead to a more
Molecular dependence
or less rejuvenating effect on all or part of the skin.
Classification is always restrictive, as it forces highly vari-
able events into a rigid framework. We will see in this book It is very simple to understand that phenol is more aggres-
that so many different factors come into play that it sive than lactic acid.
becomes difficult to fit all chemical peels into a simplified
and rigid classification of ‘superficial’, ‘medium’ and ‘deep’. Doctor dependence
Let us take the well-known glycolic acid peel as an exam-
ple: its depth of action depends on the patient’s skin type, the Classification may be personal; it may be related to the
presence of associated disorders (e.g. seborrheic dermatitis), practice of one particular doctor who has standardized his
skin preparation in the long, medium and short term, the methods of treatment with a view to limiting uncontrol-
galenical form (gel, liquid, mask or self-neutralizing pseudo- lable variables. But such a classification would not allow for
gel), the concentration of the product, the m/m, m/v or m+v any scientific exchange.
calculation, whether or not it is combined with other acid What would produce a superficial peel with one practi-
molecules (e.g. lactic or kojic), the pH of the solution (e.g. tioner could in fact result in a medium peel with another
0.5 or 3.5) and therefore the fraction of free glycolic acid, who uses the same product with a different application
what it is applied with (brush, cotton pad, etc.), the number technique. This is why peels are often considered to be
of coats, how forcefully it is applied, whether it is applied on ‘doctor-dependent’.
the face or body, the exact location on the face (e.g. nostrils How can we give a valid classification for a treatment
or eyelids1), the contact time, how or whether it is neutral- that is doctor-dependent? We should also compare prod-
ized or diluted at the end of the peel, the immediate post- ucts of the same type only, and yet the quality of the prepa-
peel care, the quality of care between peels, the number and rations and excipients is highly variable and impossible to
frequency of repeat sessions,... And the list goes on! control.