A chemical peel is a method of skin resurfacing in which an acid is applied to the skin for the purpose of initiating a reaction that will alter the skin surface and perhaps its deeper layers. Peels can reduce pigment irregularities and some wrinkling (deeper peels), but not all skin conditions can be improved with chemical peels. Chemical peels are categorized as light (or superficial), medium, or deep. The depth of effect is controlled by the choice of acid, the method of application, and the length of time the chemical is left on the skin.
The acids most commonly used for peels are (in approximate order of intensity) alpha hydroxy acids (AHA) such as glycolic acid, lactic acid, and fruit acids; beta hydroxyl acids; vitamin A (tretinoin); trichloroacetic acid (TCA); and phenol. All acids can be used diluted or full strength, depending on the patient’s skin type and the goals of treatment.
Before undergoing certain types of chemical peeling, patients may be required to pretreat their skin at home with a topical medication like Retin-A. Lighter chemical peels (AHA peels) are performed in an office setting without anesthesia. The chemical solution is painted on the skin, and the patient may experience a mild burning sensation and slight, temporary redness. Patients can resume normal activities immediately, as long as they use sun protection. TCA peels may cause a more intense reaction, especially in higher concentrations, and the patient will have some activity restrictions for a few days.
Phenol is an especially powerful and potentially dangerous chemical and is toxic to the heart if excessively absorbed. Phenol peels should only be performed by an experienced, qualified physician in a controlled environment in which the patient has cardiac monitoring by appropriate personnel. Phenol creates a significant burn. After a phenol peel the patient may experience severe swelling and may have to avoid talking and solid foods for several days. The crust that forms after a phenol peel must be kept soft with ointments and may take several days or weeks to come off entirely. Complete healing may take as long as a month, and patients may have their activities significantly curtailed during that time. Phenol peels are rarely performed these days. Incredibly, some states allow nonphysicians to administer any type of peel, including full-strength phenol peels. Common side effects of chemical peeling are visual skin pore enlargement and blotchy pigmentation after sun exposure.
Patients are strongly encouraged to use high SPF sunscreen after any type of peeling. After a phenol peel some degree of permanent skin bleaching is virtually guaranteed, and blotchy pigment irregularities may persist, especially if isolated sections of the face were treated. Infection and scarring are potential complications after chemical peels, especially medium and deep peels. The bottom line: Chemical peels can help improve the appearance of the skin of properly selected patients. The milder peels are safer, even though multiple sessions may be necessary for a good result. Deep wrinkling requires a deeper peel, but the risks are significant. Because the results of chemical peeling are so operator dependent, the stronger chemicals are highly likely to lead to complications when improperly used. Because peels may be offered in salons and medical spas, a patient should be very careful when selecting a provider for a chemical peel.
Dermabrasion has been used by cosmetic surgeons for decades to help smooth irregular skin surfaces, especially those affected by burns and acne. These mechanical methods of skin resurfacing can be alternatives for patients who are not candidates for chemical peels. The tool used for traditional dermabrasion resembles a small drill with a sanding bit or wire brush. Dermaplaning is a similar procedure in which the skin is shaved rather than sanded. Many physicians feel that traditional dermabrasion is overrated. It can yield some improvement of surface irregularities but almost never to the degree that the patient wants. Dermabrasion has been largely replaced by laser resurfacing, although it still has a role in treating acne scars.
Modern technology has provided a method of “dermabrasion lite” called microdermabrasion. This technology, widely available in salons, uses tiny crystals to sandblast the surface of the skin, knocking off the dead cells and leaving the skin with an appearance very much like that of a good facial. Microdermabrasion of your face is like buffing your car: You look great afterward, but the effect is short-lived.
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