| Preparing for a chemical peel In South Africa, superficial peels may be performed by non-physicians. Medium and Deep peels should be administered by doctors only. Prescription medication is also needed for these procedures and therefore can only be performed by a doctor. It is advised to ensure that the doctors has sufficient training and experience in performing the procedure and able to handle any possible complication.
Your physican may offer you a choice of peel techniques or suggest a combination of peels to obtain the best result for you.
During your initial consultation, it is important that you discuss your expectations with your physician. Don't hesitate to ask any questions or express any concerns that you may have. Expect your physician to explain the planned procedure in detail, including its risks and benefits, the recovery period and the costs. If you have a history of herpes, you should inform your physician prior to the procedure. Remember, chemical peel treatments are usually not covered by medical aids unless they are performed for medically related problems.
Preperation
Your physician will instruct you on how to prepare for your peel treatment.
Sometimes Retacnyl, Retin A or Renova - a prescription medication derived from Vitamin A - is used to pre-treat the skin. This thins out the skin's surface layer, allowing the peel solution to penetrate more deeply and evenly. If your skin won't tolerate tretinoin pre-treatment, an AHA cream may be used instead. Sometimes a bleaching agent is used in conjunction with tretinoin or AHA pre-treatment, especially if you have blotchy skin areas or pigmentation problems. You may have to spend a month or more in the pre-treatment phase before the doctor will schedule your actual peel. Pre-treatment creams may be applied to the face at night for several weeks prior to the peel. By exfoliating the skin and reducing pigmentation themselves, they improve the results seen from chemical peeling. They may also reduce the time needed for healing. Broad spectrum SPF 30+ sunscreen should be used during the day in the pre- and post peel period.
You will need to arrange for someone to drive you home and help you out for a day or two if you are having a phenol or deeper TCA peel. You probably won't need any extra assistance if you're having an AHA peel or superficial TCA peel. Where your peel will be performed
Most chemical peels may be safely performed in a doctor's office, office-based surgical facility or outpatient surgical center. Your physician may want you to stay overnight in a facility or hospital if other cosmetic procedures are performed simultaneously. Types of Anesthesia
Anesthesia isn't required for phenol or TCA peels because the chemical solution acts as an anesthetic. However, sedation may be used before and during the procedure to relax you and keep you comfortable.
No anesthesia is needed for AHA peels since they cause only a slight stinging sensation during application.
The peel
Superficial chemical peels are a minor procedure and no special arrangements are needed. But you may need painkillers, sedation, local anaesthetic or even a general anaesthetic for deeper peels.
First the face is thoroughly washed to remove surface oil. The peeling agent is then applied for several minutes. The solution will sting – the severity and period depending on the the chemical, its concentration, whether you've had pre-treatment with tretinoin, and individual factors. A fan can help with relief. The peel is then neutralized (not in the caes of deeper peels), and the burning sensation lessens.
Individual treatments may include peels with several agents on the same occasion, with the aim of improving results and reducing risks.
Antibiotics and oral antiviral agents may be recommended after deeper peels.
AHA peels/treatments: Your doctor will apply the AHA solution to your cleansed facial skin, a process that usually takes no more than 10 minutes. No post-peel ointment or covering is required. Depending on the strength of the peel, periodic treatments may be necessary until the desired effects are achieved.
For some patients, the application of an AHA-based face wash or cream once or twice a day at home will be sufficient to accomplish the desired goal. Your physician may add tretinoin or a bleaching agent to your at-home treatment schedule. After several weeks of at-home use, your doctor will examine your skin to determine if your regimen needs adjustment.
Phenol and TCA peels: Typically, the skin is first thoroughly cleansed. Then, the physician will carefully apply the phenol or TCA solution. You may feel a stinging sensation as the peel solution is applied, but this feeling will quickly pass.
A full-face TCA peel usually takes no more than 15 minutes. Two or more TCA peels may be needed to obtain the desired result, and those may be spaced out over several months. Mild TCA peels may be repeated as often as every month.
If phenol solution has been used, your physician may coat the treated area with petroleum jelly or a waterproof adhesive tape. With lighter peels, no covering is necessary.
A full-face phenol peel generally takes one or two hours to perform, while a phenol peel to a smaller facial region (perhaps the skin above the upper lip) may take only 10 or 15 minutes. A single treatment usually suffices. After the peel
After an AHA peel, it is common to experience some temporary flaking or scaling, redness and dryness of the skin. However, these conditions will disappear as the skin adjusts to treatment.
After a phenol or TCA peel, your doctor may prescribe a mild pain medication to relieve any tingling or throbbing you may feel. If tape was used to cover your face, it will be removed after a day or two. A crust or scab will form on the treated area. To help your face heal properly, it is essential that you follow your doctor's specific post-operative instructions.
A TCA peel may also cause significant swelling, depending on the strength of the peel used.
If you've had a phenol peel, your face may become quite swollen. Your eyes may even be swollen shut temporarily. You will need someone to help care for you for a day or two. You may also be limited to a liquid diet and advised not to talk very much during the first few days of recovery. Recovery post peel
Superficial peels result in mild facial redness and occasional swelling which usually resolve within 48 hours. The peeling is similar to sunburn. Most people can continue their normal activities. Make-up can be applied a few hours after the procedure. With an AHA peel, the temporary redness, flaking and dryness that you experience will not prevent you from working or engaging in your normal activities. A fresher and improved skin texture will result with continued AHA treatments. Remember, protecting your skin from the sun is also important following these mild acid peels. Ask your doctor to recommend a sunblock with adequate UVA and UVB protection and use it every day.
Medium depth peels result in dry crust, inflammation and swelling, which resolve within a week. The peeling is more marked. Mild redness can persist for several weeks. Most people take a week off from work after a moderate depth peel. With a TCA peel, the moderate discomfort and mild swelling you may experience will subside within the first week. In about a week to ten days, your new skin will be apparent and you should be healed sufficiently to return to your normal activities. It is best to avoid sun exposure unless you are adequately protected.
With a phenol peel, new skin will begin to form in about seven to ten days. Your face will be very red at first, gradually fading to a pinkish color over the following weeks to months. During this time, it is especially important that you use a sunblock or blotchy, irregular skin coloring may result.
About two weeks after treatment, you may return to work and resume some of your normal activities. Your skin will be healed enough for you to wear makeup. (For makeup tips, ask your physician for a brochure on camouflage cosmetics.)
Post treatment Instructions
• Keep treated areas cool (use a water spray).
• Do not pick! Picking delays healing and causes scarring
• Moisturize - use light preparations after a superficial peel, thicker moisturisers after a deeper peel. The skin should stay moist all the time during the healing period.
• Protect from the sun - especially for the first 6 months
• If advised to do so, continue to use tretinoin, glycolic acid, depigmenting agents and/or hydroquinone at night long term
RESULTS
Improvements from AHA peels may be very subtle at first. You may detect a healthier glow to your skin. With continued treatments, you will notice a general improvement in the texture of your skin.
The results of a TCA peel are usually not as long-lasting as those of phenol peel. However, your skin will be noticeably smoother and fresher-looking.
If you're planning a phenol peel, you can expect dramatic improvement in the surface of your skin - fewer fine wrinkles, fewer blemishes and more even-toned skin. Your results will be long-lasting, although not immune to the effects of aging and sun exposure.
Peels can be repeated as necessary; some people have superficial peels every few weeks. It is wise to wait 3 to 6 months before repeating a moderate depth peel.
Complications
Complications are uncommon if the health professional performing the peel is properly trained.
• Comedones (blocked pores) or acne may result from the peel itself or from thick moisturisers used afterwards; ask your doctor for treatment.
• Infection due to bacteria (Staphylococcus aureus), yeast (Candida albicans), or virus (Herpes simplex); you may need antibiotics or antivirals.
• Scarring may result from infection or picking the scabs, and can be permanent.
• Blotchy pigmentation is most likely in those with darker skin or who had a pigmentation problem before the peel; keep out of the sun and use hydroquinone.
• Persistent solar keratoses may require treatment. Your dermatologist may choose cryotherapy, 5-fluorouracil cream or biopsy a lesion in case it is skin cancer.
Avoiding complications
• Ensure your doctor's instructions are carefully followed
• If you don't understand, ask!
• Let your doctor know promptly if there are any problems - complications are easier to deal with early than late
|