![]() ![]() Usually performed with phenol in combination with croton oil, deep peels cause rapid denaturization of surface keratin and other proteins in the dermis and outer dermis. Because of the risk of prolonged hyperpigmentation, medium-depth peels should be conducted with caution in patients with dark skin.ĭeep peels may be used for severe photoaging, deep or coarse wrinkles, scars, and sometimes precancerous skin lesions. Sun protection after a medium-depth peel is recommended for several weeks. The healing process is longer, with full epithelialization occurring in about one week. Medium-depth peels may be used in the treatment of dyschromias, such as solar lentigines, multiple keratoses, superficial scars, pigmentary disorders, and textural changes. 1 These peels are a good method for rejuvenating the epidermis and upper dermal layers of skin. ![]() Superficial peels exert their actions by decreasing corneocyte adhesion and increasing dermal collagen. After a superficial peel, epidermal regeneration can be expected within 3 to 5 days, and desquamation is usually well accepted. Because of their superficial action, superficial peels can be used in nearly all skin types. They are useful in the treatment of mild dyschromias, acne, post-inflammatory pigmentation, and AKs and help in achieving skin radiance and luminosity. Superficial peels affect the epidermis and dermal-epidermal interface. Using the correct depth chemical peel is a critical component for success. 2 Although peels have recently had an upsurge in research interest, 3 they are best performed and/or supervised by dermatologists and plastic surgeons who have far more experience and knowledge with cosmetic procedures than other physicians. The American Society of Plastic Surgery reported that more than one million peel procedures were performed by its members in 2008. ![]() However, other considerations, such as skin characteristics, area of skin to be treated, safety issues, healing time, and patient adherence, should also be taken into account for best overall results.Ĭhemical peels are very common in clinical practice. 1 Specific peeling agents should be selected based on the disorder to be treated and used with an appropriate peel depth, determined by the histological level or severity of skin pathology to maximize success. Chemical peels are classified by the depth of action into superficial, medium, and deep peels. The exfoliative effect of chemical peels stimulates new epidermal growth and collagen with more evenly distributed melanin. Used properly, the chemical peel has the potential to fill an important therapeutic need in the dermatologist's and plastic surgeon's armamentarium.Ĭhemical peels are used to create an injury of a specific skin depth with the goal of stimulating new skin growth and improving surface texture and appearance. Successful outcomes are based on a careful patient selection as well as appropriate use of specific peeling agents. Peels can be combined with other in-office facial resurfacing techniques to optimize outcomes and enhance patient satisfaction and allow clinicians to tailor the treatment to individual patient needs. Deep peels, affecting reticular dermis, may be used for severe photoaging, deep wrinkles, or scars. Medium-depth peels, penetrating to the papillary dermis, may be used for dyschromia, multiple solar keratoses, superficial scars, and pigmentary disorders. Superficial peels, penetrating only the epidermis, can be used to enhance treatment for a variety of conditions, including acne, melasma, dyschromias, photodamage, and actinic keratoses. A wide variety of peels are available, utilizing various topical agents and concentrations, including a recent salicylic acid derivative, β-lipohydroxy acid, which has properties that may expand the clinical use of peels. However, the depth is also associated with longer healing times and the potential for complications. The depth of the peel is correlated with clinical changes, with the greatest change achieved by deep peels. This article focuses on chemical peels and their use in routine clinical practice. Chemical peeling is a popular, relatively inexpensive, and generally safe method for treatment of some skin disorders and to refresh and rejuvenate skin. ![]()
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