In dermo-cosmetics, this technique produces an accelerated cell renovation of the skin layers with diverse objectives like cleansing, nourishing, moisturizing, astringency, de-pigmentation remodelling effects, etc.
- Fewer filaments in the cytoplasm of basal cells.
- More uniform dispersion of melanin, regulates the melanocyte population and eliminates the extra cellular pigmentation.
- Skin is more consistent to the touch, smoother, and pinker.
- Increase of glycosaminoglycans (hyaluronic and basic intracellular sustenance)
- Increased production of collagen, with more fibers which are better organized.
- Improved quality of elastin fibers; longer and less fragmented.
- Evident reduction of wrinkles and non fibrous scars.
b) Surface (to the basal layer).
c) Medium and its variants (papillary dermis).
d) Deep and its variants (reticular dermis).
• glycolic acid - 1 to 2 layers, less than 5 minutes.
• Melaspeel - 1 to 2 layers
• Resorcinol - 1 to 2 layers
• Trichloroacetic acid (TCA or ATA) 10% to 25% - One layer
• Thioglycolic acid - more than 2 layers.
. Mandelic acid - 2-4 layers, for 2 to 20 minutes
• Melaspeel, improved Jessner's solution - 2-4 layers
• Resorcinol - 2-4 layers
• Trichloroacetic acid (TCA) 10% to 30%.
Medium (papillary dermis)
• Glycolic acid - for more than 10 minutes
• Mandelic acid 50% - from 5 to 30 minutes
• Melaspeel (Jessner) - more than 4 layers
• Glycolic Acid + TCA 35%
• Melaspeel + glycolic acid 40% to 70%
Deep (reticular dermis)
Based on the depth needed and according to the histological events of each pathology, making clear that epidermal skin lesions, only need focal treatment, while lesions that need the dermis modified, especially photo-aging should work in the first as well as the second skin layer.
Superficial Melasma – Superficial
Mixed Melasma – Medium / deep
Post inflammatory hyperpigmentations – superficial / medium / deep
Scars – Medium
Active – Superficial
Regressive – Medium
Marks – Superficial / medium
Rosacea – Superficial / medium
Seborrheic Dermatitis – Superficial
The depth achieved depends on many variables, including:
- Concentration of the active ingredient used.
- In gel peels, depth depends on contact time.
- In solution peels, depth depends on how many layers are applied
- The application technique; massaging will increase the depth.
- The frequency of application.
- Integrity of the epidermis.
- Proper cleaning and degreasing of the skin before treatment
- Skin preparation in the weeks leading up to the peeling
- Thickness of the skin
- The type of skin (thin or thick, tenderness, presence of a skin disease ...)
- The anatomical location of the area to exfoliate (face or non-facial area)
• Destruction of specific layers of damaged skin, depending on the depth of the lesion.
• Activation of inflammatory mediators, which induces the production of new collagen and fundamental dermal substance.
CONSIDERATIONS BEFORE THE PEELING
Based on the indications for chemical peels, all patients should be examined to determine which of the peeling agents produce the desired result with the least amount of aggressiveness, according to the patient's lifestyle, the depth of the lesions to be corrected and general characteristics of the skin to be treated.
An important consideration to prevent damage is to evaluate the skin photo type of the patient. To do this we will use the Fitzpatrick classification.
This information is very useful in determining which patients will respond well to a chemical peeling and which will be more easily irritated by the chemical peel, or run a high risk of pigmentation (dyschromia) after the procedure. Skin types I to III are ideal for all peeling types where types IV to VI have a greater risk of developing dyschromia.
In case of recurrent herpes, Acyclovir is recommended 1 week before the peeling, do not peel active herpes.
IMPORTANT ASPECTS OF CHEMICAL PEELING
Important to assess the concentration of free acid and have criteria to select a suitable peeling.
3. Texture of the peeling
- Depth of the peeling related to the contact time.
- Contact time: 5-10 minutes. (Depending of the active ingredient and the precautions described above.)
- Clean in order to neutralize.
- Slow penetration: less irritation.
- Wait 3 minutes between each layer
Massaging (gel) or pressure applied (solution) can enhance the penetration of the peeling.
Avoid using corticosteroids because they interfere in the inflammatory process, which is important for reepithelialization, if possible also avoid the use of estrogens and oral contraceptives, which increase the risk of post-inflammatory pigmentation, or otherwise initiate the use of previous depigmenting agents.
Signing an informed consent is recommended.
Control photos (front and sides). Patients usually forget their appearance before the procedure and habitually point a pre-existing “defect” from before the peeling.
List of important stages that should be checked during the course of the peeling.
Instructions, in writing, to be followed in the post-peel (avoid sun and direct heat sources during the first week, constant use of sunscreen and antioxidants during the day.)
• Appropriate Cleansing (makeup remover) & tonic
• Degreasing solution
• Silkses (silicone) to protect mucous membranes or sensitive areas (lips, nostrils).
• Sensyses solution (calming solution)
• non-sterile gloves.
• Container with water.
• Skin Cleaning solution.
• Post-peel cream (Hidraloe facial cream or Silkses)
• Soothing masks.
- Be careful with the patient's eyes to avoid contact with product.
- Keep the head slightly elevated by an average of 45 °.
- Have on hand a bottle on hand with clean water or saline to wash the eyes, in case of accident.
- Before you apply the exfoliating agent, ask if:
There was recent surgery on the face or neck.
There is the use of systematic tretinoin or topical isotretinoin in recent months.
A rejuvenating treatment was performed recently .. (Microdermabrasion, IPL, fractional laser...).
- The stinging or burning sensation associated with chemical peels is short, not constant and increases during the procedure. It is important to warn patients in advance what they will be feeling and reassure them that will be for a short time and is normal during the treatment.
- Post-inflammatory hyper pigmentation is a condition in which an inflammatory response of the skin leads to the development of hyper pigmentation. Usually it is associated with dark-skinned patients and sun exposure after the peel. The treatment of this condition can be simply waiting a time because it tends to disappear gradually over time. Another alternative is to start a therapy with bleaching and photo protective agents. The pigmentation may occur in the post peeling stage (four to five days) or as late as two months after the peeling.
- Never do chemical peels if pregnant or nursing.
- During the first week after the peel, avoid saunas, Turkish baths and vigorous exercise.
- With men, do not shave the day of peeling.
- Wait 30 days after surgery in the treatment area before performing a peeling.
- Scrapes, facial injuries, wait 1 week before applying the peel.
- Abrasive agents, wait 1 week.
Afterwards, depending on the treatment and the condition to be resolved, recommend an appropriate home treatment.
The repetition of 6-12 continuous sessions, depending to pathology and maintenance sessions guarantees the effectiveness of treatment.
More information about our chemical peels is available at www.mediderm.com, or by calling 800796-0996.