Procedures

Skin Care 

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Introduction.  Your skin is a reflection of the person inside. At least that�s how most of us feel. When your skin looks good you feel good. That is why more and more men and women are taking better care of their skin these days. With a variety of options available, you can take control of your skin!

A facial peel is a non-surgical option available to improve skin appearance and texture. A chemical peel is most commonly performed for cosmetic reasons-to enhance your appearance and your self confidence. A chemical peel uses a chemical solution to improve and smooth the texture of the facial skin by removing it�s damaged outer layers. It is helpful for those individuals with wrinkles, facial blemishes, and uneven skin pigmentation. A chemical peel may also remove pre-cancerous skin growths, soften acne facial scars and even control acne.  Alphahydroxy acids (AHAs), trichloroacetic acid (TCA), and phenol are used for this purpose. The precise formula used may be adjusted to meet each patient�s individual needs.

Alphahydroxy acids (AHAs), such as glycolic, lactic, or fruit acids are the mildest of the peel formulas and produce light peels. Many skin problems are caused by or associated with excessive build-up of dead skin cells that make the skin thick and dull. AHA�s help to loosen and remove the layers of dead cells that accumulate on the surface of the skin. This release of surface dead skin cells initiates the response of deeper skin cell rebuilding and restructuring. This produces an initial thinning of the thickened skin while causing the surface skin to appear healthier, plumper and tighter. Essentially, the glycolic acid peel process is a controlled removal of surface skin cells that acts as a stimulus for renewal of the skin and an improved skin appearance. They are sometimes referred to as lunch-time peels, because makeup can be worn the following day. AHA peels may be used to treat fine wrinkling, uneven pigmentation, areas of dryness, superficial acne scarring, periorbital solar comedones, and mild to moderate acne.

The chemical solution is applied to the entire face, avoiding the upper eyelids and lips. Treatment time is approximately three to eight minutes, varying with each individual. Because the solutions come in different concentrations (20%, 35%, 50% and 70%) the physician can safely design a treatment program around a particular patient�s skin care needs and tolerances. AHA peels may cause stinging, itching, burning, tightness, redness, irritation and flaking of the superficial layer of the skin.  However, as the skin adjusts to the treatment regimen, these problems will subside. After an AHA peel, it is common to experience some temporary flaking or scaling, redness and dryness of the skin. However, these conditions will disappear as the skin adjusts to treatment. A �post peel� cream is applied afterwards and is used twice a day, followed by sunscreen, until skin is healed. You can expect an increase in the smoothness of the skin and an overall newfound glow and radiance. 

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. Various concentrations of an AHA may be applied weekly or at longer intervals to obtain the best results. Dr. Shienbaum typically recommends a series of 5 to 7 peels, depending on your special needs, spaced one to two weeks apart. After the initial series of peels, we recommend a �maintenance� peel as needed.  Usually once every month or two. Dr. Shienbaum will make this decision during your consultation and as the treatment proceeds.

Trichloroacetic acid (TCA) can be used in many concentrations, but it is most commonly used for medium-depth peeling. TCA may be used to smooth out fine surface wrinkles, remove superficial blemishes, and correct pigment problems.

The chemical solution can be applied to the entire face, or to a specific area�for example, around the eyes or mouth�sometimes in conjunction with other surgical procedures such as a facelift or a blepharoplasty. Treatment time is approximately five to fifteen minutes. The patient may feel a stinging sensation as the peel solution is applied, but this feeling will quickly pass. You can choose to have IV sedation before and during the procedure to relax you and keep you comfortable. Petroleum jelly, or an antibiotic ointment, is then applied. With a TCA peel, moderate discomfort and mild swelling may be experienced, depending on the strength of the peel used. However, this will subside within the first week. In about a week to ten days, your new skin will be apparent and you should be healed sufficiently to return to your normal activities. It is best to avoid sun exposure unless you are adequately protected. Two or more TCA peels may be needed to obtain the desired result, and those may be spaced out over several months. Mild TCA peels may be repeated as often as every month. 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.

Phenol is the strongest of the chemical solutions and produces a deep peel. 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. It is mainly used to treat patients with coarse facial wrinkles, pre-cancerous growths, or areas of blotchy or damaged skin caused by sun exposure.

Phenol is primarily used on the face; scarring may result if it�s applied to the neck or other body areas. A full face phenol peel generally takes one or two hours to perform, while a phenol peel to a smaller facial region (like the skin above the upper lip) may only take ten or fifteen minutes. A single treatment usually suffices. 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 that you will always have to protect it from the sun. Phenol may pose a special risk for patients with a history of heart disease. It is important that you make your surgeon aware of any health problems when your medical history is taken. It is also possible that phenol will cause uneven pigment changes.

Certain modified phenol peels are gentler and may be preferred in some cases. As with a TCA peel, a phenol peel may cause a stinging sensation. IV sedation may be used before and during the procedure to relax and keep you comfortable. Following the application of phenol, the treated area will be covered with petroleum jelly or a waterproof adhesive tape.

After the procedure, your face may become quiet swollen. Your eyes may even be swollen shut temporarily. You will need to arrange for someone to drive you home and help you out for a day or two. You may also be advised not to talk very much and may be limited to a liquid diet during the first few days of recovery. You will be prescribed a pain medication to relieve any tingling or throbbing you may feel. If tape was used to cover your face, it will be removed after a day or two. A crust or scab will form on the treated area. New skin will begin to form in about seven to ten days. Your face will be very red at first, gradually fading to a pinkish color over the following weeks to months. It is especially important during this time, that you use a sun block or irregular skin coloring may result. About two weeks after treatment, you may return to normal activities. Your skin will be healed enough for you to wear makeup.

Improvements from AHA peels may be subtle at first. With continued treatments, you will notice a general improvement in the texture of your skin. Fine lines will lessen and overall pigmentation will appear more even.

The results of a TCA peel are noticeably smoother and fresher-looking skin after one treatment. However, the results are usually not as long lasting as those of a phenol peel but it can be repeated after several months.

A phenol peel will provide dramatic improvement in the surface of your skin. Your results will be long lasting, fewer fine wrinkles, fewer blemishes and more even-toned skin.

All the peels available will help improve the appearance of most skin, however, results are not immune to the effects of aging and sun exposure.

Contact our office and schedule a free consultation to discuss your specific skin care needs.

American Society of Plastic and Reconstructive Surgeons. (1997). Chemical Peel [Brochure]. Arlington Heights, IL

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