Transcript Introduction to Chemical Peels

chemical peel overview
Presented by
Lindsey Miller
Licensed Aesthetician
Advanced Educator, PCA SKIN®
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did you know…
 According to the American Society of Aesthetic Plastic Surgery
1,048,577 chemical peels were performed in the United States in
2008.
 In 2008, among the 10.4 million minimally invasive or non-surgical
cosmetic procedures, the top five were:
 Botox® (5 million)
 Hyaluronic acid fillers (1.1 million)
 Chemical peel (1 million)
 Laser hair removal (892,000)
 Microdermabrasion (842,000)
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topics of discussion
 Function of chemical peels within the skin
 Types of peeling agents
 Classification of chemical peels
 Variables determining depth of peel
 Chemical peel fundamentals
 Peel technique and contraindications
 Frequency of treatment
 Patient expectations
 Peels with medical modalities
 Pre- and post-procedure skin care
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function of chemical peels within the skin
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types of peeling agents
 AHAs
 Salicylic acid (BHA)
 Jessner’s solution
 TCA
 Phenol
 Baker-Gordon
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classification of chemical peels
 Superficial – very light to light (epidermal exfoliation)
 AHAs
 Retinoids
 Salicylic Acid
 Jessner’s solution
 Up to 30% TCA
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classification of chemical peels
 Medium Depth (papillary dermal)
 35-40% TCA
 Jessner’s solution combined with 35% TCA
 Deep (reticular dermal)
 Phenol peel
 Baker-Gordon
 TCA in concentration > 50%
 Erb:YAG/CO2 laser resurfacing
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classification of chemical peels
Depth of Peel Penetration
• AHAs
• Retinoids
• Salicylic acid
• Jessner’s solution
• Up to 30% TCA
• 35-40% TCA
• Jessner’s solution
combined with
35% TCA
• Phenol peel
• Baker-Gordon
• TCA > 50%
• Erb:YAG/CO2
laser resurfacing
Superficial
Cornified Layer
Granular Layer
Squamous Layer
Basal Layer
Medium Depth
Papillary Dermis
Deep Depth
Reticular Dermis
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variables determining depth of a peel
 Peeling agent
 Concentration of the peeling agent
 Layers of the agent applied
 Application technique
 Prepping of the skin
 Patient skin type
 Location of the peel
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Fitzpatrick’s classification of skin types and correlating sensitivity
Fitzpatrick
Skin Type
Skin Color
Common Hereditary
Backgrounds
Visual
Reaction to
Sun
Typical
Sensitivity
to
Chemical
Peels
Common
Response to UV
Rays
I
Pale White
Nordic, Scandinavian
(Swedish, Danish)
Always Burns,
Never Tans
Very
Resilient
Skin Cancer &
Hypopigmentation
II
White
Irish, English, Welsh
Usually Burns
Resilient
Skin Cancer &
Telangiectasia
III
Light Brown,
(Naturally
Tan) Skin
Asian, Mediterranean (Italian,
Greek)
Mildly Burns,
Tans Relatively
Well
Moderately
Responsive
Telangiectasia
IV
Moderate
Brown
Hispanic, Middle Eastern,
African American, Native
American
Rarely Burns,
Tans Well
Sensitive
Hyperpigmentation
V
Dark Brown
Hispanic, Middle Eastern,
African American, Native
American, South Asian
Very Rarely
Burns, Tans
Easily
Moderately
Sensitive
Hyperpigmentation
VI
Black
African American, South
Asian
Least Likely to
Burn, Tans Very
Darkly
Very
Sensitive
Hyperpigmentation
chemical peel fundamentals

Do not peel a red/traumatized face

Have antidote for heat on hand

Use the sensitivity scale of one to ten

Other visual factors
 Excessive erythema
 Frosting
 Blanching
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chemical peel fundamentals

Frosting
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chemical peel fundamentals

Blanching
© 1995, J.B.Lippincott
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peel technique

Cleanse the skin and remove excess sebum and cell debris

Degrease the skin with an alcohol-free toner (do not use acetone);
patch test for sensitivity

Apply appropriate number of layers of peel

Customize the treatment with advanced serums and moisturizers

Occlude the treatment and protect from UV exposure with a
combination of anti-inflammatory and broad-spectrum SPF
moisturizers
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contraindications to peels

Pregnancy

Lactation

Active herpetic lesions

Allergies to ingredients found in peels

Trentinoin/Retin-A®/Renova®/Differin®/Tazorac®/Avage®/
EpiDuo™/Ziana®: Discontinue use 5 days before and after treatment
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frequency of treatment
Day of
treatment
Week 1
Week 2
Week 3
Week 4
Normal/Maintenance
(once a month)
X
X
Pigment/Melasma
(every three weeks to
begin, then once a month)
X
X
Acne/Blemishes
(every two weeks to begin,
then once a month)
X
X
X
Rosacea
(once a month)
X
X
Aging Skin
(every three weeks, then
once a month)
X
X
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what to expect immediately following a peel

Mild to moderate erythema (redness)

Periorbital edema (puffy eyes)

Tightness/dryness
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immediately following treatment
day of treatment
following
morning
day 2
day 3 - 5
day 5+
skin
appearance
and feeling
▪ tight
▪ moist and dewy
appearance
▪ mild to moderate
edema and
erythema
▪ tight
▪ dry
▪ mild to moderate
edema and
erythema
▪ skin may
begin to peel
▪ heaviest
peeling
▪ typically
peeling is
complete
precautions
▪ apply products in
an appropriate
post- procedure
solution
▪ keep cool
▪ reapply products
in an
appropriate
postprocedure
solution
▪ keep cool
▪ do not pick at
loose skin
▪ reapply
products in an
appropriate
postprocedure
solution
▪ reapply
products in an
appropriate
postprocedure
solution
▪ avoid direct sun
exposure
▪ restart
recommended
daily care
regimen
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peels with medical modalities

Enhance results by combining chemical peels with:
 Microdermabrasion
 Ultrasound
 IPL
 LED
 Non-ablative and fractionated laser
 Erb:YAG and CO2 laser resurfacing
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the importance of daily care
 Pre-treatment
 Minimize complications
 Accelerate results
 Pre-condition the skin
 Customized systems
 Hyperpigmentation
 Acne
 Rosacea
 Age control
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the importance of daily care

Post-treatment
 Minimize complications
 Heal and soothe the skin
 Post-procedure recommendations
 Post-procedure products
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