Dermatologic & Cosmetic Surgery

Dermatologic Treatments

Chemical Peels

Thousands of chemical peels are performed each year. Dermatologic surgeons have used various peeling agents for the last 100 years and are experts in performing multiple types of chemical peels. Today, with the public's increasing interest in rejuvenating skin and slowing the effects of the aging process, chemical peeling has emerged as an exciting supplement to a total skin care program. Dr. Lawrence will conduct a thorough evaluation before embarking upon a chemical peel.

INDICATIONS
Melasma, acne, skin aging, sun damage, wrinkles (depends on peel solution)

Melasma is a brown discoloration of the face most often seen in women. This change in pigmentation tends to get worse in the summer when exposed to the sun’s harmful rays and often fades in the winter months. Pregnancy is the most common cause of melasma. Women who are taking oral contraceptives are also at risk.

The Center for Dermatologic Surgery treats melasma with a prescription bleaching cream combined with other topicals in addition to a series of chemical peels. Since sunlight is a major factor in the development of melasma, it is imperative to continue to avoid the sun, wear protective clothing and apply liberal amounts of sunscreen.

BENEFITS

• SUPERFICIAL: Freshens skin, makeup goes on nicer, may decrease some fine lines
• MEDIUM DEPTH: Chemical peeling is often used to treat fine lines under the eyes and around the mouth. Wrinkles caused by damage, aging, and hereditary factors can often be reduced or even eliminated with this procedure. However, sags, bulges and more severe wrinkles do not respond well to peeling and may require other kinds of cosmetic surgical procedures. Dr. Lawrence will help you determine the most appropriate treatment for your needs.

Mild scarring and certain types of acne can be treated with chemical peels. In addition, pigmentation of the skin in the form of sun spots, age spots, liver spots, freckles, blotchiness due to taking birth control pills, and skin that is dull in texture and color may be improved with chemical peeling. Areas of sun-damaged skin, spots of precancerous keratoses and scaling patches may improve after chemical peeling. Following treatment, new lesions or patches are less likely to appear.

Age spots, also known as sun spots, are flat, brown discolorations of the skin which usually occur on the face, neck, hands, and other areas of the skin exposed to the sun over many years. These harmless spots are a sign of cumulative years of sun damage rather than age alone, but the names “age spots” or “liver spots” have been associated with them. The Center for Dermatologic Surgery treats these undesirable spots with a combination of topicals in addition to a series of chemical peels. It is imperative to continue to avoid the sun, wear protective clothing and apply liberal amounts of sunscreen.

WHAT IS A CHEMICAL PEEL?
Chemical peeling is a technique used to improve the appearance of the skin. In this treatment, a chemical solution is applied to the skin which causes it to separate and eventually peel off. The new, regenerated skin is usually smoother and less wrinkled than the old skin. The new skin is also more even in color.

HOW IS A CHEMICAL PEEL PERFORMED?
The procedure can be performed on the face, neck, chest, hands, arms and legs. Superficial, medium, or deep chemical peels may be used to improve damaged skin. As a rule, the deeper the peel, the longer the recovery time. Dr. Lawrence will recommend the best peel for your skin problems.

Prior to treatment, instructions may include stopping certain medications and preparing the skin with pre-conditioning creams.

A chemical peel will be performed in Dr. Lawrence's office as an out-patient procedure. The skin is thoroughly cleansed with an agent that removes excess oils, and the eyes and hair are protected. One or more chemical solutions such as glycolic acid, trichloroacetic acid, salicylic acid, lactic acid, or carbolic acid (phenol)- are used. Dr. Lawrence will select the proper peeling agent based upon the type of skin damage present.

During a chemical peel, Dr. Lawrence applies the solution to various areas of the skin. These applications produce separation and eventual peeling of layers of skin, enabling new, regenerated skin to appear.

During the procedure, most patients experience a warm to somewhat hot sensation which lasts about five to 10 minutes, followed by a stinging sensation. A deeper peel may require pain medication during or after the procedure.

WHAT SHOULD BE EXPECTED AFTER TREATMENT?
Depending upon the type of peel, a reaction similar to a mild to severe sunburn occurs following a chemical peel. Superficial peeling usually involves redness, followed by scaling that ends within three to five days. Medium-depth and deep peeling can sometimes result in swelling and blisters that may break, crust, turn brown, and peel off over a period of seven to fourteen days.

Some peels may require surgical tape to be placed on part or all of the skin that is treated. It is important to avoid overexposure to the sun immediately after a chemical peel since the new skin is fragile and more susceptible to injury. Your dermatologic surgeon will prescribe proper follow-up care to help the skin through the healing stages.

WHAT ARE THE POSSIBLE COMPLICATIONS?
In certain skin types, there is a risk of developing a temporary or permanent color change in the skin. Taking birth control pills, pregnancy, or a family history of brownish discoloration on the face may increase the possibility of developing abnormal pigmentation.

Although low, there is a risk of scarring after chemical peels. If scarring does occur, it can usually be treated with good results. There is a small incidence of the reactivation of cold sores or Herpes simplex infection in patients with a history of fever blisters. Prior to a chemical peel, it is important for a patient to inform the physician of any past history of keloids, unusual scarring tendencies, extensive X-rays or radiation to the face, or recurring cold sores.

WHAT IS THE DOWN TIME REQUIRED?

• SUPERFICIAL PEEL: Like a sunburn pink and peels in 3 to 5 days.
• MEDIUM DEPTH PEEL: Deeper resurfacing technique requires pain medication and sedation during procedure. Will need someone to drive. Healing time 7 - 14 days.

WHAT ARE THE LIMITATIONS OF CHEMICAL PEELS?
Chemical peels cannot remove loose or sagging skin and do not serve the same function as a face lift, brow lift, or eyelid lift. They do not eliminate the gravitational forces that produce loose skin. Chemical peeling will not remove deep scars. Dermabrasion, punch grafting, punch elevation, scar, or soft tissue fillers may be much more effective for scars and should be discussed with Dr. Lawrence. Chemical peels cannot change pore size, nor can they predictably remove broken blood vessels on the face. However, chemical peels may improve the appearance of these conditions.

ABOUT ALPHA HYDROXY ACIDS (AHA)
Alpha Hydroxy Acids that were originally used by the Egyptians, like Cleopatra, were believed to have a rejuvenating effect on the skin. In ancient Egypt they used tartaric acid from the bottom of wine bottles and lactic acid from sour milk.

Alpha Hydroxy Acids are now produced synthetically for cosmetic use. AHA's have an ingredient that comes from a by-product of either milk (lactic acid), citrus fruit (fruit acid) or glycolic. They are available in gels, creams and lotions. Creams are recommended for very dry skin and gels for oily skin. Lotions are used for normal skin types.

It may be recommended that you start with a moderate 7-8 % concentration. This can be found in over the counter products. We recommend Neutrogena Healthy Skin which has an AHA of 8% and a sunscreen with SPF 15. The skin regime we design is tailored to your needs and some people will be started on higher concentration AHA. AHA's can be used twice a day. Some people experience a slight tingle when applying AHAÕs. This is a normal sensation, but use of the AHA should be discontinued if it persists or is worse than a slight tingle. Prescription AHA 10%, 15% and 20% are available from our office. We combine AHA with Retin A for skin rejuvenation, pre-peel regimens and post peel maintenance.

We have a skin care program available to you, here at our office. Products can be recommended to help improve your skin texture and quality. We have products available for purchase and some can be found over the counter at the drug store. It takes a month, or longer, for your skin to adapt to a product before we can make adjustments or additions. Tolerance is built up gradually with some products, enabling us to increase the strength. It is common for us to have to adjust products with weather or seasonal changes. This depends on the dryness of your skin.

Occasionally when someone is having trouble tolerating a product, they will be instructed to use it every other night until the irritation resolves. If the irritation continues, we can add a mild steroid called Hytone. It can help with the adjustment period. We will work closely with you to achieve the best skin care program for your skin type.

When AHA's are applied daily they help to loosen the "glue" that holds dead skin cells on the surface of your skin. This exfoliation results in smoother, more radiant skin.

It is important to remember that a basic skin care regimen should include applying a sunscreen daily and cleaning properly. When you add this routine to good eating, sleeping and exercise habits, it will help your skin stay at its optimum. This also includes a smoke free environment.

MEDIUM DEPTH CHEMICAL PEEL
Medium depth chemical peel is a surgical procedure performed in the office with Jessner solution and trichloracetic acid of strengths from 20% to 50%. This acid is not absorbed into the body and will not cause any systemic side effects like chemicals used in some other chemical peels. The upper layer of skin is "burned" and is shed or peels off when it is replaced by new skin. The depth of the peel is controlled by the concentration and the amount of acid applied. This procedure is especially good for sun-damaged skin, small wrinkle lines, irregular pigmentation, dilated pores and very small scars. A deep chemical peel takes about one week to heal and will remove most of the abnormalities listed above. A superficial peel may be done which does not require staying home during a healing time. The skin peels like a sunburn in 4 to 5 days. You may develop water blisters that break, crust, turn brown, and peel off over a period of a week.

You may be given a sedative to take just prior to surgery. An injection may be given to decrease discomfort. You may feel some burning while the chemical is applied, but it is gone in 15 to 30 minutes after the procedure.

To make an appointment with a Cooper University Hospital physician at an office near you, call 1-800-8-COOPER (800-826-6737) to speak with a member of our physician referral and information service.