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Posts Tagged ‘blue peel’

décolletage
Décolletage is what we call the neckline, or more specifically the area made up of the neck, chest and cleavage. If we neglect this area between our face and breasts, it is sure to age us. Although we can cover up our décolletage, we would certainly be limiting our style and where is the fun in that.

The décolletage is a special concern, because it tends to suffer more sun damage than other areas and women also tend to develop lines between the breast while sleeping on their side. Luckily, there are plenty of options to improve this area, but we have to be patient as correction for non-facial skin is much slower than it is when treating the face. When we treat the décolletage or any non-facial area, we need to treat more conservatively and thus, more often. The skin cell turn over for non-facial skin tends to be slower, so this means the recovery process will take longer, which will require more time spaced between treatments. When treating the décolletage you should treat early and often. Slow and steady wins the race.

When it comes to skin care and anti-aging, the best approach is a comprehensive one. One treatment does not necessarily replace the other. Your skincare provider should work to help you understand which treatments are best for you and the time line that treatments may be done. When budget is a concern, you will need to decide which concerns are a priority for you.

Topical Skin Care

The first step is to use effective skin care products on your neck and chest, every morning and every night, just as you would your face. Most of the skin care products that are used on the face, can also be used on the chest. Some topicals, such as hydroquinone and retinoids need to be used less frequently on non-facial skin to avoid irritation. Some products should be used daily, such as topical antioxidants and an SPF 30 or higher. There are some great products formulated specifically for the neck and chest. Revision skin care formulated Nectifirm for firming the neck and décolletage. NIA 24 Sun Damage Repair for Décolletage and Hands, is formulated with patented Pro-Niacin to repair damaged skin. Consult with your Esthetician, to determine the appropriate protocol for you.

NIA 24 Before and After

NIA 24 Before and After

PhotoFacial IPL/BBL

Treatments that use Intense Pulsed Light work to treat brown spots and redness. There is also research to suggest that ongoing treatments will positively effected gene expression in the skin to mimic that of a younger person. Generally a series of 3-5 treatments are recommended, scheduled 3-4 weeks apart. For enhanced results Levulan may be applied prior, this is known as PhotoDynamic Therapy.
FYBBL_Before_After_Gallery_1(1)

Chemical Peels

Medium depth chemical peels that reach the papillary dermis or upper reticular dermis, such as the Obagi Blue Peel or ZO controlled depth peel will improve skin discolorations, improve texture, laxity, lines and stretchable wrinkles. A medium depth peel on the chest, may take up to 14 days for peeling to be complete. On the up side, peels on the face generally do not look bad during the peeling phase and are easy to tolerate. These peels can be done as often as 4 times a year, however I find that once a year is optimal when combined with other treatments.

Ultherapy

Ultherapy is the treatment of choice for the lines that develop between the breasts. Ultherapy works at a deeper level than any other non-surgical treatment, to lift and tighten skin. Ultherapy uses focused ultrasound to target deep into the dermis and even the top of the muscle. Like many other aesthetic treatments, Ultherapy works by creating a wound healing response, but because the targeted areas are at a deeper level we see more tightening and lifting. The increased collagen production in the treated area, can be seen a year post treatment. Most people should plan on repeating this treatment once a year, although younger patients may be able to stretch it out to every two years. Those with advanced photo damage, or who desire more improvement may choose to repeat the treatment in six months. Pain medication may be prescribed, in which case you will need to arrange for someone to bring you in to your appointment and take you home.
ultherapy_018p-d_beforeandafter-180day_1tx_chest

Fractional Resurfacing

Non facial skin does not respond well to “full coverage” ablative laser resurfacing. Non-ablative or sublative fractional resurfacing treatments, such as E-Matrix or Fraxel are more appropriate for treating non-facial skin. These treatments reduce lines, wrinkles and smooth skin texture. Like many other aesthetic treatments, fractional lasers work by creating a wound healing response in the skin, that stimulates the fibroblast in the skin to up regulate the production of collagen. Because laser treatments create heat, we appreciate a different type of wound healing response than we do with other treatments such as chemical peels, micro needling, which is why we see the up regulation of collagen for longer periods of time post treatment.
Fractional lasers generally work in the deeper layers of the skins dermis, an area which is not effected by chemical peels or IPL treatments. The frequency and number of treatments will depend on the level of treatment performed, level of correction desired and condition of skin.
fraxel chest

Micro-Needling Collagen Induction Therapy

Aesthetic professionals use micro-needling pens such as the Eclipse or Dermapen, to deliver tiny needles into the epidermal and dermal layers of the skin creating micro-injuries. This begins a natural wound healing or renewal process that will stimulate collagen production in the treated area. There is little to no down-time, and it is surprisingly comfortable. Although, micro needling treatments do not deliver the same level of correction to skin texture as fractional lasers, they are the treatment of choice for scars and stretch marks. Micro-needling is also a good option for early intervention or in between other aesthetic treatments.

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Read MoreApril 22, 2015 3:21 pm - Posted by Kristy

The Obagi Blue Peel improves hyper pigmentation, fine lines, wrinkles, large pores, laxity, skin texture and acne scars.

The Obagi Blue Peel is a unique procedure designed to precisely control the depth of a TCA chemical peel. The Blue Peel uses Trichloroacetic acid (TCA) as the active ingredient and a patented Blue Base with built in safeguards. The TCA and blue peel solution is prepared at a fixed concentration and applied in a “coating system”. The Blue base gives the skin professional more control over the peel by slowing the penatratation of the TCA solution and making it easier to recognize desired endpoints. The coating system helps monitor and control the depth of the peel.

The Obagi Nu Derm system and Obagi Blue Peel are designed to work together. The Obagi Nu-Derm system is used before the peel to precondition skin and as a post treatment protocol. Pre-conditioning prepares skin by correcting and stimulating normal skin function to speed healing. The amount of time for preconditioning is determined by the skin type and condition, usually a minimum of 6 weeks. Post-treatment promotes shorter recovery time, aids in resolution of erythema (redness) and post- inflammatory hyperpigmentation. I will not do a Blue Peel on anyone who has not preconditioned, post treatment care is also not optional.

The Obagi Blue Peel is not something you just schedule and show up for, it requires a little planning and preparation. A consultation is required before scheduling a Blue Peel to determine the depth of the peel needed to achieve desired results. In some cases a Blue Peel may not be your best option or additional treatments may be needed, so other treatment possibilities may be discussed. You will also need to begin a skin care regimen with the Obagi Nu-Derm system, a minimum of 6 weeks prior to your peel. During the consultation you will discuss the length and amount of peeling to expect with your peel , so that you can plan your schedule accordingly. The price of the Blue Peel varies depending on the depth of the peel, however even in the deepest Blue Peel is only a fraction of the cost of many laser treatments. ( The Blue Peel is amazing when combined with fillers and Botox. Think Chemical Facelift!)

Depth of Obagi Blue Peel

The Obagi Blue Peel can be performed at different levels or depths, depending on the desired results. The Obagi Blue peel uses a coating system as a way of preparing and controlling the depth of the peel. People often get confused by the term “coat”. When we say coats we are not referring to how many times the peel is painted on the face, a coat refers to a specific volume of a prepared solution. The blue peel uses a 30% TCA and a patented blue base that is prepared in either a 15% or 20% solution. It is important to understand that 2 coats of a 15% solution is not the equivalent of 2 coats of a 20% solution. A Blue peel solution of 20% is also not the equivalent of a plain 20% TCA. When considering a Blue Peel try not to confuse your self with the coat system and the concentration of the prepared solution, instead focus on the depth of the peel needed to achieve specific results.

[ Chemical Peels 101: skin anatomy, chemical peels, and peeling agents ]

Light Exfoliation: Peeling is complete in 2-3 days.
This is commonly referred to as a 1 coat peel
– Penetrates the stratum corneum layer of the skin.
– Provide light exfoliation to freshen the skin
– Unclogs pores and reduces comedones

Deep Exfoliation: Peeling is complete in 4-7 days.
This is commonly referred to as a 2 coat peel.
– Penetrates to the basal layer of the skin.
– Temporary improvement of superficial hyper-pigmentation
– Enhances results of the Nu-derm system

Standard Blue Peel: Peeling is complete in 7-9 days.
This is commonly referred to as a three coat peel.
– Penetrates the papillary dermis layer of the skin.
– Treats hyper-pigmentation Brown spots and Melasma
– Improves skin texture, reducing roughness
– Tightens large pores

Designed Blue Peel: Peeling is complete in 9-14 days.
This is commonly referred to as a 4 coat peel.
– Penetrates to the reticular dermis layer of the skin.
– Treats hyper-pigmentation Brown spots and Melasma
– Improves skin texture, reducing roughness
– Tightens large pores
– Skin laxity, fine lines, “stretchable” wrinkles and scars.
*Immediate reticular dermis (IRD) is the area where the papillary dermis meets the upper reticular dermis.

Pre-conditioning before the Obagi Blue Peel

Skin should be conditioned before a Blue Peel, this is done by using the full Obagi Nu Derm system along with a topical tretinoin (Retin-A). Conditioning the skin prior to the peel will enhance results and reduce complications. Pre-conditioning prepares skin by correcting and stimulating normal skin function to speed healing. The Obagi Nu Derm is a complete system and should be used as such. It is not recommended to eliminate or substitute the skin products in the Obagi System. Your skin health professional will give you a specific protocol that is appropriate for your skin. You will be instructed when and how to use each product as well as how to measure the recommended amount of each product. You will also be shown how manage reactions and how to modify your protocol to fit your lifestyle.

Obagi Medical skin care products are prescription strength, and available only through a physician’s office.The products in this system should be used with the same respect and diligence as any prescribed drug. You should only use Obagi products that you have received directly from your skin care professional, under a doctors supervision. Products sold by unauthorized distributers or online may be counterfeit, expired or degraded in quality. This can lead to reduced results and complications. When you purchase Nu-derm products from anyone other than your personal skin care professional, they are unable to calculate if you are using your creams correctly or guarantee efficacy of the products, consequently the results of your treatment can not be assured.

[ Obagi Nu-Derm: Restore Skin Health ]

Post- treatment after the Obagi Blue Peel

The Peel Stage
The peeling stage is 3-14 days depending on depth of peel.
The amount of peeling will depend on the level of peel. Skin will generally begin to darken on the 3rd day and peeling will begin on day 3 or 4, depending on depth of peel. Peeling begins around eyes, nose and mouth. With a standard or designed blue peel, days 4-6 will appear the worst. The peeling stage is not painful, but the skin will feel tight and dry. Follow all post treatment instructions. NO PICKING! It is extremely important that you do not assist the peel, treat the skin like you are trying to keep it on. Do not pick, pull or remove skin. Complications can occur if skin is peeled off prematurely.

During the peeling stage you will be instructed to follow specific post treatment instructions. This will include using a gentle cleanser and mild topical creams designed by Dr Obagi to be used after a Blue peel. If you have had a deeper peel you may be instructed to use an astringent solution compress. Sun exposure should be avoided after the peel. Chemical sunblocks and makeup can not be used, however you may be able to use an “approved” mineral makeup which will provide a little sun protection. I usually recommend Jane Iredale mineral makeup.

[ Chemical Peels: Post Treatment Care and Instructions ]

Recovery Stage
The recovery stage begins when peeling is complete and lasts 1-6 weeks, depending on depth of peel. When the peeling is complete, skin will look good and will continue to improve as it heels. Skin may look a little pink or red and it is not un usual to see an acne flare-up. After peeling is complete it is important to resume Obagi Nu-derm system as instructed to enhance results and reduce the probability of post inflammatory pigmentation.

Return to Normal
Skin will return to normal when the recovery stage is complete. Results of the procedure can be evaluated at this point and you will resume Obagi Nu-Derm system under the normal protocol. It is important to not discontinue Nu-Derm system prematurely. You will continue on a normal Obagi Nu Derm protocol until advised to begin a maintenance protocol, usually 6-12 weeks. This will depend on how aggressive your nu-derm protocol is, the condition of your skin and desired results.

Maintenance
When skin has been corrected and has returned to a normal healthy state a maintenance protocol will be designed to help you maintain your results. Your skin health professional will instruct you when to begin a maintenance protocol, this is usually.

The content provide in this post is intended to be informative and does not replace medical or professional treatment.

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®© All Rights Reserved.

Read MoreOctober 18, 2011 1:18 pm - Posted by Kristy


Chemical Peel’s can very in depth from very superficial to very deep. Post treatment care for chemical peels is dependent on the type of peel, and condition of the skin. Your skin health professional should give you post treatment instructions that are specific for the type of peel you have had. Some peels are so superficial that they cause little to no peeling, and may not require a big change in your skin care regimen. Having a deeper level chemical peel provides a greater level of correction, however it also can create a greater risk for complications. Most complications can be avoided by strict patient compliance, meaning you should follow your post treatment care instructions exactly as instructed. Deeper peels may also require preconditioning, this especially important for darker skin types. The Obagi Nu-Derm system is ideal for preconditioning skin for resurfacing procedures and chemical peels. Be sure that you have all of the appropriate products needed and do not use any skin care products that have not been approved by your skin health professional.

Keep Your Skin on

One of the most important things to remember after a chemical peel is to avoid picking, scrubbing or assisting the peel in any way. Treat the skin like you are trying to keep it on. The old dead skin that is about to peel off acts as a protective barrier. If you have caused the skin to peel off prematurely you are at increased risk for complications, including hyper-pigmentation. If you have assisted or accidentally removed the peeling skin prematurely, contact your skin health professional immediately. You may be instructed to apply an occlusive such as Aquaphore to the area’s that have peeled off. You may also need to use hydroquinone and/or tretinoin after the peeling process is complete to prevent or correct complications.

[ Chemical Peel: Do’s and Don’ts ]

Gentle Cleanser

Beginning the day of the peel until peeling is complete you will need to use a gentle cleanser. Avoid scrubs, exfoliants and any acne cleansers unless otherwise instructed. This is also not the time to use cleansing brushes such as the Clarisonic, you should cleanse the skin gently.


I prefer Obagi Gentle Cleanser after most chemical and laser peels.


Cetaphil gentle cleanser is another option, and you can buy this product at most drug stores.

Moisturizer and Topical Hydrocortisone Cream

Use a gentle moisturizer 2 – 4 times a day.
Be careful that you do not use a moisturizer that contains exfoliants or irritating ingreadiants after your peel. If you have had a medium to deep peel, you may also be instructed to use a topical Hydrocortisone cream. It is important that you do not over use Hydrocortisone creams, as extended use can inhibit healing. Check with your Esthetician or Doctor before using any products after a peel.

post peel instructions
Obagi’s Tolereen has a 0.5% Hydrocortisone cream, and can be applied before moisturizer or mixed with in with the moisturiser.


Obagi Action is appropriate after most peels and is generaly my first choice.


Skin Medica’s Ceratopic Replenishing cream is ultra hydrating and can be used after most peels.

Sun Protection


After a chemical peel your skin is more vulnerable to Ultra Violet Rays. You should avoid sun exposure as much as you can, hats and sunglasses are helpful. Depending on the depth of the peel, you may be instructed to avoid sunscreen until the skin has completed the peeling phase. You will find that your skin is sensitive to chemical sunscreens, so look for a physical sunblock that contains zinc oxide. A pure mineral makeup such as Jane Iredale, contains a Titanium Dioxide 14% and Zinc Oxide 3% and can be used immediately after chemical peels, when other sunscreens may not be appropriate. Keep in mind that the depth of your peel will determine when you can start to use sunblock.

Anti viral

post peel
Herpes simplex infection can occur on the face after skin resurfacing procedures, including chemical peels. A viral outbreak is more common with deeper procedures. You may be prescribed an antiviral medication such as Zovirax to help prevent breakouts. If you do have a history of cold sores or any herpes breakout be sure to mention this to your Esthetician or Doctor before your peel. Many skin professionals prefer to treat all patients with antiviral agents regardless of a positive history. Don’t be insulted or embarrassed if you are prescribed an antiviral medication, it is often standard protocol. It is important to understand that some people may carry the virus, even if they have never had an outbreak.

Antibiotics

antibiotics, post peel procedures
It is not unusual to see milia or small acne breakouts after deep resurfacing procedures, including deep chemical peels. There are chemical peels, such as Skin Medica’s Vitalize peel that are appropriate for treating skin with active acne. Deep chemical peels should be put off until acne is under control, without any active breakouts. Topical antibiotics can not be used immediately after a chemical peel, so if you have a recent history, you may be prescribed an oral antibiotic.

Domeboro Astringent Soaks

post peel, domeboro
Domeboro Astringent solution is an over the counter product that can be found at most drug store. Domeboro Astringent Solution, when applied as a wet dressing or compress, cools and cleanses irritated skin and soothes inflammation. Domeboro contains Aluminum acetate which helps to reduce itching, stinging, and inflammation. Domeboro powder can be mixed with water, the solution is then applied topically as cold compresses to the treated area. I usually recommend using sterile gauze dipped in the solution and gently press onto the treated area for about 5-10 minuets, twice a day. The skin should first be cleansed with a gentle cleanser, after treating skin with the compress solution you can apply an appropriate moisturizer and Hydrocortisone.

Cosmetics

Generally, cosmetics such as foundation, concealer and powder are not recommended after resurfacing procedures and chemical peels. There are some mineral cosmetics that can be used immediately post procedure. It is important to know that not all mineral makeup is created equal, many are simply mineral based. Jane Iredale is an excellent mineral makeup, that is safe to use after cosmetic procedures and provides SPF protection. Jane Iredale is also antimicrobial and anti inflammatory, offering several benefits after a chemical peel.

[ Chemical Peels 101: A lesson in skin anatomy, chemical peel levels, and peeling agents ]

Deep Chemical Peels

If you have a deep chemical peel, such as a 30% – 35% TCA peel, Standard or Designed Obagi Blue Peel, you will be instructed to follow additional instructions. Avoid “cracking” by keeping the skin moist and minimizing facial expressions. You can use Aquaphor in the corners of the mouth. Aquaphor can be used if the skin becomes tight or over areas that cracking may have occurred. When you shower, do not let the water strike you in the face. You will also need to sleep on your back with your head slightly elevated. If you have a deep chemical peel, it is important to make follow up appointments with your skin care professional and address any concerns immediately.

After the peeling phase

The first stage of a peel is the peeling stage, this is complete when the skin is no longer peeling and reepithelialization has occurred. After the skin has completed peeling, you may begin a skin care regimen. Again, if you have had a superficial peel you will most likely continue with your normal skin care regimen. If you have had a deeper peel, the next stage is when dermal changes begin. You may be instructed to use products like Hydroquinone, tretinoin and a good sunblock. You should avoid exfoiliating treatments and products for about 6 weeks, depending on the depth of the peel.

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Read MoreMarch 28, 2011 8:49 pm - Posted by Kristy

pregnancy mask

Melasma (chloasma) is hyperpigmentation or dark, irregular patches commonly found on the upper cheeks, nose, upper lip, and forehead. The patches can develop gradually over time or during pregnancy. Melasma can also develop when taking oral contraceptives or hormone replacement therapy medications. Melasma is thought to be stimulated by hormones, however exactly which hormones are involved has yet to be determined. The most important factor in the development of melasma is sun exposure,and without the strict avoidance of sun exposure, treatments for melasma are likely to be unsuccessful. Melasma can be permanent or disappear and reappear with each pregnancy.

Hyperpigmentation is the term used to describe any type of abnormal dark area of the skin, this includes melasma, freckles and sun spots. When we treat hyperpigmentation in the skin, it is important to understand that the melanocyte is not functioning properly, so it overproduces melanosomes and the excess melanin can not be evenly distributed among the keratinocytys. As the cells rise to the surface of the skin they cause over pigmented or dark spots. When the skin is exfoliated with AHA’s, chemical peels or microdermabrasion, the hyperpigmentation will appear lighter because some of the top layers of skin have been removed and the pigment is less dense (temporarily). The pigment is still there, it is just appears lighter and the melanocyte is still not functioning properlly, so in a few weeks as the top skin layers are replaced the pigment will appear dark again. Tanning will also further stimulate the melanocyte causing darker pigmentation to develop and Melasma will become worse. Hydroquinone works to suppress the melanocyte and is an excellent way to treat the pregnancy mask. For best results Hydroquinone can be used in conjunction with exfoliating treatments. I understand this description may be a little difficult to understand, so if I have lost you, you can come in for a consultation and I will use visual aids to better explain the cause and treatment for hyperpigmentation.

melasma, pregnancy mask

Melasma: My Personal Story

I have Melasma myself, on my upper cheeks and forehead. I first developed Melasma patches on my upper cheeks in my late twenties and later after giving birth to my second child I developed another large patch in the center of my forehead. I have successfully treated my Melasma, but I need to continue to maintain my skin so that it doesn’t come back. As a Medical Esthetician, I obviously have access to the best skin care products and treatments available. I can share both my professional and personal experience with treating Melasma. Using hydroquinone, and broad spectrum sunblock is absolutely necessary for treating and controlling Melasma. Even after successful correction of Melasma, the hyperpigmentation can reappear especially after sun exposure.

My Personal Skin Regimen

Topical Products
My personal skin regimen includes using the Obagi Nu-Derm system, with a 1/2 gram of Clear (4% hydroquinone) AM and PM. Initially I used a 1/2 gram of a .1% tretinoin ( Retin-A) every night, however I am now on a maintenance protocol and only use tretinoin occasionally. I also use a topical vitamin C and a broad spectrum sunblock containing Zinc oxide. I top it off with Jane Iredale mineral makeup SPF 20.

Professional Skin Treatments
I have had an Obagi Blue Peel, and Fraxel treatments. I personally felt I had better results with the Blue Peel. Fractional laser resurfacing and Blue Peels are ideal when treating deep or resistant Melasma.

Although I have corrected my Melasma, I still need to continue to maintain my skin to keep the Melasma under control. In addition to the topical products I previously mentioned, I try to have a light chemical peel every 4-6 weeks. The chemical peel I have found that gives me the best results treating pigmentation, is a custom chemical peel.

Obagi Nu-Derm System

This is correction after using the Obagi Nu-Derm System. This is a prescription strength skin system and is only available at medical skin clinics. Treatment protocols vary depending on skin type and condition.

Obagi Blue Peel

This is an example of deeply pigmented Melasma.
After treatment with Obagi Nu- Derm & Obagi Blue Peel

It is important to precondition with the Obagi Nu-Derm System and Retin-A before having a Blue Peel. I recommend preconditioning for a minimum of 6 weeks or longer depending on how aggressively Tretinoin is used. Patients that are better preconditioned get a better result. It is also necessary to continue to use the creams after peel to prevent Hyperpigmentation & to maintain healthy skin.

Custom Chemical Peel for Melasma
The Custom Chemical Peel I use is a light peel that can be repeated as often as every 4-6 weeks, compared to the Obagi Blue Peel which is a deeper peel necessary for treating deeper pigmentation. I have decided to not include details of my protocol for this custom peel. It is proprietary information that I don’t wish to share with others in the industry. If you would like to learn more, you can schedule a private consultation. I can tell you that with this peel, I will usually get light peeling for 2-3 days. The peeling is minimal and I would not consider there to be any “down-time”, you can still go about your regular routine. You just don’t want to schedule a peel less than a week before any major event like a wedding. I make it a point to work with my clients and their social calendar, so that they look their best for any events.

Get Professional Treatment For Melasma

If you have Melasma call to schedule a free consultation at
Paradise Valley Skin Klinic.
480 421-1701

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Read MoreMarch 9, 2011 1:36 pm - Posted by Kristy

Chemical Peel, Sex in the City
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

layers of the skin

Layers of skin, chemical peel

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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Read MoreSeptember 20, 2010 2:15 am - Posted by Kristy