Chemical Peels: Role of Chemical Peels in Facial Rejuvenation Today

Abstract

Summary: The practice of chemical peeling remains an important aspect of the nonsurgical techniques available to the aesthetic surgeon when approaching skin rejuvenation. Despite past predictions of their disappearance in favor of lasers, the overall use of chemical peels by plastic surgeons continues to grow. In the past two decades, the techniques available to the clinician have evolved in safety and efficacy based on the dermatologic investigations of various individuals, including Obagi, Hetter, and Stone. The versatility, clinical endpoint–directed predictability, and favorable risk profile of chemical peels proffered by these latest advancements affirm that this modality is essential to the practice of the plastic surgeon treating patients with rhytides and dyschromias. This review presents the current role of chemical peels in skin rejuvenation, emphasizing the significant clinical advancements and their modern day applications and practice.

Medium-depth Trichloroacetic Acid and Deep Phenol–Croton Oil Chemical Peeling for Facial Rejuvenation: An Update

“…6,31,39 Another important progress witnessed in the practice of chemical peels similar to other nonenergy rejuvenation modalities, was the appreciation of prepeel skin preparation, peel application, and post-peel skin care as critical components of the rejuvenation process for the prevention and/or treatment of postprocedural adverse events such as inflammation, infection, and scarring. 26,62 The objectives of skin activation, depth control, and shortened recovery can be routinely realized mainly through 3 active ingredients: topical tretinoin (0.05%-0.1%), hydroquinone (2%-4%), and alpha hydroxyl acid (4%-10%). 25,26 Tretinoin (Retin-A) pretreatment improves epidermal regeneration, 4% hydroquinone lessens postinflammatory hyperpigmentation, and alpha hydroxyl acid decreases epidermal atypia, induces epidermal hyperplasia, disperses melanosomes, and increases elastin fiber thickness.…”

“…Ironically, this increased knowledge arrived at a time when the demise of chemical peeling was expected with the advent of laser technology that offered an increased ability of depth control by varying flux energy for different skin thicknesses 15,26 . Moreover, contrary to the large number of heterogeneous nonstandardized publications over the last 30 years about combined medium and deep peels with surgical or other nonsurgical rejuvenation options as well as reports about unproven combinations of peeling formulations and protocols, valuable published chemical peeling literature with high level of evidence to override deeply anchored dogmas and to dramatically alleviate surgeons’ apprehensions unfortunately is relatively sparse as evidenced by this review.…”

“…2 They are classified by the depth of injury into superficial, medium, and deep depending on the concentration, pH, and type of peeling agent used; depth of the peel is also influenced by anatomical location, epidermal integrity, adnexal structure density, and skin thickness as well as cutaneous priming, application technique, occlusion, and contact time. 2,4,8,23,25,26 Using the correct depth chemical peel, based on the disorder to be treated and the histological level or severity of the skin pathology, is critical for treatment success. 2 A peel too superficial will not be effective to efface rhytides; if too deep, scarring or hypopigmentation would result.…”

“…With TCA peels, visual determination of frosting and epidermal sliding as described and histologically elucidated by Obagi et al are reliable indicators for determination of peel depth penetrance. 6,26 Epidermal sliding indicates a medium peel penetrance to the level of the papillary dermis. It is observed when the coagulated epidermis becomes separated from the underlying reticular dermis and slides as a thin independent sheet.…”

Male Face-Lift Finesse

“…The modality and depth of treatment is determined by the extent and location of rhytides, dyschromia, and/ or actinic damage. 18,19 [See Video 6 (online), which demonstrates a perioral augmented 35% trichloroacetic acid peel.]…”