Current Chemical Peels and Other Resurfacing Techniques

Abstract

The currently available methods for resurfacing will be addressed in this article, which has been divided into three areas of focus: chemical peels, lasers, and dermabrasion. Emphasis will be placed on chemical peels, a technique with a long history that provides a very reliable method of resurfacing and that every facial plastic surgeon should be familiar with.

Chemical peels: A review of current practice

“…Any history of cardiac, hepatic or renal disease, diabetes mellitus, immunosuppression or nutritional deficiency should be elicited, as patients with these comorbidities are at increased risk of toxicity, delayed wound healing and infection. 5,7,51,52 Previous resurfacing procedures, Herpes simplex infection, postinflammatory hyperpigmentation, photosensitivity and abnormal (hypertrophic and keloid) scarring should be noted, as these factors increase the risk of post-peeling complications. 53 Having undergone prior radiation and X-ray therapy also requires evaluation as these treatments may reduce the density of adnexal structures, delaying re-epithelisation and increasing the risk of scarring with dermal peels.…”

“…3,4,30 Similarly, the use of photosensitising drugs, hormonal agents and oral contraceptives increases the risk of post-peel hyperpigmentation. 5,52,55 The occupation, lifestyle and hobbies of the patient require exploration. The amount of UV light exposure should be quantified and photoprotection maximised.…”

“…4,52 Lastly, women of childbearing potential should be asked about possible pregnancy and where relevant, their breastfeeding status clarified.…”

Is chemical peeling becoming outdated?

“…Deep peeling is indicated for patients with prominent photo-aging (Table 1) [4][5][6][7][8][9][10] . The chemical peeling procedure commonly used today is a quite simple method.…”

“…The expected side effects (occurring as part of the process after the procedure and healing spontaneously) include temporary erythema, milia, and acne-like rashes. The complications can be cutaneous (hypopigmentation, hyperpigmentation, irregular pigmentation, occurrence of a demarcation line, emergence of nevi, erythema, persistent flushing, scaring and keloid), structural (ectropion, eclabium), infectious (bacterial [Staphylococcic, Streptococcic, Pseudomonas, Toxic shock syndrome) or viral (Herpes simplex, verrucas]) and systemic (cardiac, renal, hepatic, hematologic, laryngeal edema) [8][9][10] . First started being used in 1990s in Turkey in the field of dermatocosmetics employing glycolic acid, chemical peeling has become increasingly popular since then and in combination with other agents such as AHA, beta hydroxy acid and trichloroacetic acid (TCA) it proved to be one of the most widely used noninvasive methods.…”