Archive for September 20th, 2010
Do go to an experienced skin professional with a successful reputation.
Be sure that the Aesthetician or Physician is experienced with the type of peel you are having, and with your specific skin type.
Don’t attempt to do a chemical peel yourself.
If done incorrectly Chemical Peels can cause hyperpigmentation, hypopigmentation and scars. You can find just about anything on the internet these days, however just because you can do something, doesn’t mean you should. I can go to Home Depot and buy a bag of cement, that doesn’t make me qualified to pave your driveway.
Do precondition your skin.
If you are having a deeper peel, such as an Obagi Blue Peel or Zo controlled depth peel, you will likely be instructed to precondition in advance. Preconditioning often involves using Tretinoin (Retin-A) and hydroquinone along with a comprehensive skin care regimen, to restore skin health, enhance the results of the peel and reduce risk of complications. You may also be instructed to start antiviral medications a few days before deeper peels, skin trauma can cause herpe blisters (cold sores) on face and lips.
Don’t have a chemical peel if..
Don’t have a chemical peel if you are pregnant or on Accutane. Avoid deeper peels if you have active acne, superficial peels are generally recommended when treating skin with acne.
Don’t exfoliate.
Don’t have exfoliating treatments or use exfoliating products until the recommended time, based on the depth of your peel. With deeper peels you may be instructed to wait up to 6 weeks before exfoliating.
Do follow post treatment instructions.
Use a gentle facial cleanser, and a mild moisturizer. A hydrocortisone cream and antiseptic compresses may also be recommended. An occlusive ointment, such as Aquaphor may be used around areas such as the mouth, to prevent cracking from deeper peels. With deeper peels a 4% hydroquinone may be recommended, after peeling has been completed to reduce the chance of post inflammatory hyper pigmentation. You may also be instructed to use tretinoin (Retin-A). Post treatment care varies depending on level of peel, skin condition and skin type. Always discuss appropriate post treatment care with your provider.
Don’t assist peeling.
Don’t pick, pull or prematurely remove peeling skin. Removing skin prematurely can cause complications including hyper and hypo pigmentation. Removing skin prematurely will also put you at increased risk for infection.
Do wait for skin to peel off on it’s own.
Treat the skin almost as if you are trying to keep the peeling skin on.
Don’t hesitate to call if you have questions or concerns.
If you are unclear about your post treatment instructions, or are concerned about your reactions contact your Aesthetician, Physician or skin care provider.
Do avoid cracking and trauma.
Minimize making facial expressions, sleep on your back and avoid letting the shower hit you in the face.
Don’t expose your skin to heat or UV rays.
Avoid sun exposure and heat, your skin will be photosensitive post peel and heat will increase skin inflammation and increase the risk of post inflammatory hyper pigmentation.
Do use a pure mineral SPF and a pure mineral powder with SPF.
It is generally recommended to avoid chemical sunscreens immediately post peel, as the can be irritating. A pure Physical (mineral sunscreen) will have Titanium Dioxide and Zinc Oxide as the only active ingredients. Epionce Daily Shield Lotion Tinted SPF 50 is a great option.
Most cosmetics are contraindicated to cosmetic procedures, however a pure mineral makeup can be used immediately after most cosmetic procedure. Mineral makeup such Jane Iredale or Color Science have an SPF protection and are not irritating. They also do not contain talc, that can increase skin dryness while peeling. Cosmetic marketing and labeling can be misleading, be careful that you do not use a mineral based make-up, it needs to be a pure mineral.
Don’ Sweat
Avoid strenuous exercise until peeling is complete.
The old skin that is preparing to peel off acts kind of like an occlusive barrier, trapping sweat underneath. The sweat can bead up underneath and may even look similar to a blister, this can cause the dead skin to separate prematurely and may lead to complications.
Do make sure you understand what to expect
Some peels are very superficial with little to no peeling, while others may have more significant peeling and down time. The terms used to describe the depth of chemical peels are not generally agreed upon, which can cause some confusion, in terms of a peel being considered light, medium depth or deep. It helps if your provider can give you an idea how much peeling can be expected and for how many days. They may be able to tell you, which layer of the skin the peel generally reaches and what is achieved by a peel at that level. Deeper peels offer more correction, but also inherently come with more risk.
Don’t forget to follow up with skin care professional
Your Aesthetician or skin care provider can recommend products and follow up treatments to help enhance and maintain results. If you suspect any complications, contact your aesthetician or skin care provider immediately.
Do have realistic expectations.
If you are having a superficial peel, you would not expect the same results as you would with a deep peel. Even a deep peel can not replace a surgical procedure, botox or fillers. All aesthetic treatments have their place and limitations, a comprehensive approach will always provide the best results. It is the patients responsibility to follow post treatment instructions, non compliant patients can expect complications. Unless you are having a very light peel, you should obviously expect to peel.
Kim Cattrall’s character Samantha, has a chemical peel in a memorable episode of Sex in The City. Unfortunate timing left her with a dark and peeling face the day of Carries Launch Party. It looks as if she had a medium – deep peel. If she were better informed she could have timed her peel so that she looked as gorgeous as usual for her event or just opted for a more superficial peel. Now in her mid-fifty’s, Kim Cattrall looks amazing, I would not be surprised if she has chemical peels to maintain her skin.
Action and Benefits of Chemical Peels
Chemical peeling is used to improve the skin’s appearance by applying a chemical solution to the skin, causing the top layers of skin to separate and peel off. The new skin is smoother, less wrinkled, more even in color, peels can also be used to improve acne. Chemical peels can be performed at different depths, depending on the layer of correction desired. Deeper peels will cause the skin to peel for a longer period of time and provide more improvements in the skin. There are also a variety of acids and peeling agents that can be used alone or together, depending on skin conditions to be treated.
Chemical exfoliation and peels involve using destructive chemical agents to create a controlled wound.
All peels (whether they are chemical or laser) create a mild burn. They improve skin by the wound healing process, new tissue is created and damaged tissue is quickly replaced. Chemical peels stimulate the fibroblasts wound healing activity, the proliferation of fibroblast activity increases collagen and elastin. The depth of the wound determines the amount and intensity of healing. The body’s response to the burn is what yields the results, a deeper peel will result in more correction.
The terms exfoliation and chemical peel are often used interchangeably, however superficial peels are technically exfoliation not a true peel. True chemical peels are generally performed under medical supervision, and penetrate into the papillary dermis.
Chemical exfoliation and peels are a way to speed up the natural migration process of skin cells. When the bonds between cells are dissolved and epidermal cells begin to shed more rapidly. The shedding skin cells send signals for more cell division, which in turn forces keratinocytes to the top of the stratum corneum. This process helps treat acne, fade skin discoloration and leave the skin with a fresh new layer of skin on the surface.
*Dark skin types are more prone to complications such as hyperpigmentation and should go to a professional that is experienced in treating dark skin.
[ Read: Chemical Peel Do’s and Don’ts ]
Skin Layers
Epidermis (Epidermal layers)
Stratum corneum horny layer
Stratum lucidum horny layer – only present on palms of hands, soles of feet
Stratum granulosum horny layer
Stratum spinosum basal layer
Stratum mucosum basal layer
Stratum germinativum / basal layer
Dermis ( Dermal layers)
Papillary dermis
Immediate reticular dermis
upper reticular dermis
mid dermis
lower reticular dermis
Hypodermis/Subcutaneous Tissue
Adipose Tissue ( fatty tissue)
Epidermis
The epidermis is completely cellular, meaning it is in a constant cycle of producing new cells while older dead skin cells are pushed to the surface to exfoliate or slough off. The epidermis is made up of keratinocytes, lymphocytes, melanocytes, Langerhans cells and Merkel cells. Approximately 80% -90% of the cells in the epidermis are keratinocytes, with all others interspersed among them.
Dermis
The dermis is a layer of connective tissue, composed mainly of collagen fibers as well as about 5% elastin. The Dermis is subdivided into the superficial papillary dermis and the reticular dermis. The papillary dermis is a thin layer of connective tissue fibers, the reticular dermis is thicker and contains collagen and elastin fibers.
Collagen constitutes 75% of dry skin weight, giving the skin volume. Fibroblast cells lie among collagen fibers and are known to synthesize (produce) collagen. Fully mature collagen fibers have a low turnover rate. Elastin fibers maintain tension in the skin and provide elasticity ( snap back after being stretched). Metabolic turnover for elastin fibers are very slow and only make up about 2% – 4% of dermal volume. Damage or alterations to the elastin fibers network cause skin to become loose, saggy and wrinkled. Fibroblasts are responsible for producing collagen, elastic fibers, and the ground substance of the dermis. Fibroblasts also control the turnover of connective tissue, unfortunately with age they become smaller and less active.
Understanding the depth of a chemical peel
With chemical peels, the depth is determined by the agent used, concentration of agent, and time applied. {click to view photo’s of peeling}
Very Superficial
Penetrates to Stratum Corneum, Peeling is complete in 0-3 days. Very superficial peels can usually be done as often as once a week. This type of “peel”, generally produces little to no peeling and is ideal for anyone that can’t afford any downtime.
[ Chemical Peels: Superficial Peels Create Little To No Peeling ]
Superficial
Penetrates between the stratum granulsome and stratum germinativum basal layer of epidermis. Peeling is complete in 3-7 days, superficial peels can usually be repeated in 4 weeks. Ideal for most skin types including acne prone skin. This is the most common form of chemical peel performed by estheticians. There isn’t any true “down time” with superficial peels, only what is referred to as “social down time”. You can generally continue normal activities including work, however superficial peels should be done a week before any special events. You can expect to be slightly red or bronzed and have a few days of superficial peeling. On day 1 and 2 skin is slightly red or bronzed, skin starts to peel around day 3 and continues to peel for 2-3 days, may have minimal areas of superficial peeling on day 7. You may be red or pink first few days after peel.
Medium
Penetrates papillary dermis, performed under medical supervision. Peeling is completed in 7-8 days, medium depth peels can be repeated as soon as 6-8 weeks, however it isn’t usually necessary. Peeling skin will be darker and thicker with medium peels vs. superficial peels. Skin will start to darken on day 2 or 3, slight peeling around mouth on day 3, skin will continue to peel until day 7 or 8, starting around mucus membrane ( eyes, nose , mouth) and the forehead usually peels last. Toward end of peel you may just have slight peeling in the hairline. Often times you look okay the first 2 days and last 2 days, it is day 3- 6 that look bad. Exfoliating products and treatment need to be avoided for at least six weeks after a medium depth peel. You can start to see complications at this level, skin should be precondition before peel, especially for darker skin types. Should not be performed on skin with active acne. Follow post treatment instructions to avoid complications. Treats: skin discolorations, epidermal melasma, skin roughness, large pores, fine lines. If peel is medium – deep you may see improvement in stretchable scars and wrinkles. The “Standard Obgai Blue Peel” is a medium depth peel.
Deep
Penatrates to Intermediate Reticular Dermis (IRD). Peeling is completed in 8-10 days. Must be performed under medical supervision. Skin should be preconditioned in advance, and skin should not have any active acne. Following proper post treatment care is important, to prevent complications. This level of peel can be done with phenol, however TCA and lasers have largely replaced phenol peels. This treats: lines, wrinkles, deep melasma, and some scars, The” Designed Blue Peel” is a deep peel. With deep peels the skin will start to darken very quickly and may not start peeling until day 4 or 5, peeling skin will look very dark and thick almost like a thin scab. It is important that you do not assist the peel by picking or pulling skin off, loose peeling skin should be cut of with small sterile scissors to prevent inadvertently removing skin prematurely.
Very Deep
Penetrates upper to mid reticular dermis. Peeling takes up to 3 weeks.
Special training is required, done by a physician. Lasers have largely replaced very deep peels.
Acids and Chemical Peeling Agents
Chemical peels use several types of acid solutions to improve and smooth the texture of skin. Acids come in different strengths and can be used individually, combined or layered. A variety of acid compounds can be used. There are many branded peels, however an experienced esthetician can also create custom peels.
CO2 (cryogen therapy)
Cryotherapy, also called Co2 slush or acne slush, has been used in dermatology for over a quarter of a century. Co2 slush is created at the time of treatment, liquid Co2 is made into a “snow” ball and wrapped in gauze or cheese cloth and then dipped into acetone. The “slush” is the lightly swiped over the treated areas. Cryogenic “slush” can cause mild exfoliation and has antibacterial and anti-inflammatory abilities. Cryogen therapy is added to some superficial peels at the end of treatment
Also known as: Dry ice treatment, acetone slush and slush peel
Glycolic acid
AHA (alpha hydroxy acid), AHA’s are water soluable. Glycolic acid is formulated from sugar cane, and has the smallest AHA molecule, giving it great penetration ability and softening ability. Glycolic acid works by loosening up the horny layer and exfoliating the superficial top layer, also stimulates collagen growth. Needs to be neutralized to stop action, and can cause irritation.
Lactic Acid
AHA, derived from sour milk and bilberries, mild action, often used in conjunction with other acids.
Malic Acid
AHA, derived from apples, mildly invasive peel It can open up the pores, allow the pores to expel their sebum and reduce acne.
Tartaric Acid
AHA, derived from grapes, mildly invasive, similar benefits to other AHA’s
Salicylic acid
BHA (beta hydroxy acid), derived from wintergreen and birch bark. Differs from AHA’s, because it is oil soluble and penetrates the lipid plug in a congested follicle. Salicylic acid is also less irritating than glycolic acid and doesn’t alter skin barrier properties. Has antimicrobial properties.
Retinoic Acid
derived from retinoids; which is denatured vitamin A. It is chemically similar to Retin-A. It is a deeper peel than the Beta Acid peel and is used to remove scars as well as wrinkles and pigmentation problems. It is usually performed in conjunction with other acids to a cause peeling at a deeper level.
Resorcinol
A dihydroxy phenol produced from resins. Used externally resorcinol is an antiseptic and disinfectant, and is used in ointments in the treatment of chronic skin diseases such as psoriasis, and eczema. Resorcinol has been used as a peeling agent as far back as 1800 in strengths up to 30%, the problem with high concentrations of resorcinol is it’s corrosive ability and tenancy to depigment. Currently it is used at low concentrations in chemical peel compounds such as Jessner’s Peels.
TCA (Trichloroacetic acid)
TCA is a chemical cauterant, an agent that coagulates skin proteins. TCA can be used in different strengths and has the ability to penetrate past the papillary dermis and should be used with caution. TCA in concentrations less than 25% can be used in superficial peels. Medium depth peels are achieved with 30-40% TCA, and 50% TCA should only be used by a physician to achieve a deep peel and has greater chance for complication. TCA is used in the Obagi Blu Peels.
Phenol
Phenol is a very strong and toxic chemical, phenol peels require general anesthetic and heart monitoring. Lasers and TCA have largely replaced deep phenol peels, however low concentrations are often added to superficial and medium depth peels.
The Medical Estheticians at Shapiro Plastic Surgery, Paradise Valley Skin Klinic are experienced with chemical peels at all levels.
Call to schedule a treatment or consultation.
480 421-1701
www.shapiroplasticsurgery.com
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