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MEDICAL CHEMICAL PEELINGS
CAPE TOWN / SIMON’S TOWN, SWELLENDAM
What are chemical peelings?
Chemical peeling (chemexfoliation) is a term used for a skin regeneration procedure where a chemical solution is applied in order to remove the top layers of the skin. Once the skin is healed it becomes smoother, less wrinkled with decreased dyschromia (discoloration) and it has more youthful appearance. There are many chemical agents used for this purpose, the most popular are: alfa and beta hydroxyacids (AHA and BHA), trichloroacetic acid (TCA) and phenol. The depth of the peeling depends on a few factors: the time of application, the number of layers applied as well as the type and concentration of the chemical agent used.
How does chemical peeling work?
The role of chemical peeling is to create a wound of a specific depth in the skin in order to stimulate a new growth, leading to an improvement of the texture and the appearance. Applied chemical solution causes controlled damage of the skin which leads to a response of the skin with thickening of the epidermis, increased production of collagen, increased dermal volume as well as reorganization of important skin elements. In simple words one can say that chemical peels speed up the natural cell turnover and stimulate production of new collagen. Depending of the depth of the injury, chemical peelings are divided into : very superficial, which remove stratum corneum, superficial ( epidermal) which cause necrosis of the full thickness of the epidermis, medium which lead to necrosis of the epidermis as well as upper layers of the dermis (papillary dermis) deep which reach deeper layers of the dermis (reticular).
What results can I expect after the treatment with chemical peeling?
The results depend on the type of the peeling, but generally one can expect: Improvement in skin discolouration,
hyperpigmentation, and other pigmentary skin disorders Improvement in skin texture and minor changes of the skin surface Disappearance if fine lines, wrinkles Rejuvenation of the skin: skin looks refreshed Improvement in acne, especially comedonal acne Improvement in scars, especially post acne scars Decrease in pores size
The benefits of chemical peelings are: Cost effectiveness comparing to other skin resurfacing treatments Short healing time: usually 5-7 days (no downtime for very superficial peels) Superficial peelings can be used for most skin types
How long the effects after chemical peelings last?
This depends on the type and depth of the peeling used. After superficial peels the effects generally last up to a month, after the medium depth usually 6- 12 months, while the deep peels may give results lasting a few years. The deeper the peel the more dramatic and longer results, but they involve a longer recovery times.
Are there any special preparations needed before the treatment?
It is recommended to stop priming agents like tretinoin (RetinA) at least 1week prior peeling. It is also advisable to avoid facial scrubs, depilating creams, waxing, bleaching, dermabrasion as well as laser hair removal for at least 1 week before peelings in order to prevent post inflammatory hyperpigmentation. Even superficial peels can trigger herpes simplex infection therefore patients with positive history of recurrent herpes simplex (fever blisters) should take prophylactic treatment with antivirals.
How long is the treatment?
The full treatment with skin preparation usually takes 45 to 60 minutes.
Is there any anaesthesia needed?
For superficial peelings no anaesthesia is needed, but for medium and deep peelings local anaesthesia with injectable local anaesthetics usually is recommended. For patients with low pain threshold and needle phobia a procedural sedation might be performed.
What are the potential side effects and complications?
Possible risks and complications resulting from peels are usually minor and can be minimalized by proper timing, neutralization on time or decreasing the number of coats applied. The most common complications include: erythema, stinging and burning sensations, blistering, allergic reactions as well as transient PIH (Post Inflammatory Hyperpigmentation). Milia are often seen during first few weeks after a peel. They are inclusive cysts which appear as a part of healing. They mostly resolve spontaneously, but in some cases extraction might be indicated. In rare cases peels can lead to hypopigmentation, persistent erythema and flare up of acne. Scarring is rare but might occur after medium depth peels.
What are the contraindications for the treatment with chemical peelings?
Contraindications are: pregnancy and breast feeding, allergy or hypersensitivity to any of the ingredients of the peel, treatment with oral isotretinoin ( Roaccutane) until 6 months after the last dose, active dermatological disease, autoimmune disease, recent dermatological surgery, history of keloids or hypertrophic scars, radiotherapy treatment, facial herpes, wounds, active acne with infection, patients with unstable psychological profile or unreasonable expectations.
What are the aftercare instructions?
Following a very superficial peel. In most cases there is no visible peeling, although some patients might experience mild flaking 3-4 days after the treatment. One must not pick or pull the skin. The skin must heal at its own pace. The skin might be slightly redder for 1-2 hours after the procedure; if neck and décolletage were also treated the redness here might be longer. In most cases the next day the treated skin looks normal. When washing/cleansing the skin one must not rub, not scrub and not use a wash cloth. Only a very gentle, soap-free cleanser should be used. A moisturizer should be applied as often as needed to relieve any dryness for at least 4-5 days after the procedure. It is imperative to use a sunscreen with SPF 50 plus as well as to avoid a direct sunlight for a minimum of one week. One can start using creams containing treatinoin (IlotycinA, RetinA), alfa hydroxyl acids as well as bleaching creams only one week after the procedure. Any other facial procedures like: facials, lasers (including laser hair removal), microdermabrasion might only be performed when all flaking or mild peeling completely subside. After a superficial peel. The skin might be redder up to 5 days post procedure. Usually after 48h one can notice the peeling effect which can last up to 5 days. The skin must not be picked or pulled; it has to heal at its own pace. When washing/cleansing the skin one must not rub, not scrub and not use a wash cloth. Only a very gentle, soap-free cleanser. A moisturizer should be applied as often as needed to relieve any dryness for at least 7 days after the procedure. It is imperative to use a sunscreen with SPF 50 plus as well as to avoid a direct sunlight for at least one month. One can start using creams containing treatinoin (IlotycinA, RetinA), alfa hydroxy acids as well as bleaching creams only once the peeling process is completed. Any other facial procedures like: facials, lasers (including laser hair removal), microdermabrasion might be performed once the peeling is completely subsided. After a medium depth peel. Minor post peel effects are: oedema (especially eyelids), darker appearance of the skin with a crust. The peeling usually begins around the 3rd day and lasts a week. Once the peeling is completed the skin becomes erythematous usually for few days. During the first 24h one should soak the face with mild acetic acid compresses (15 ml of white vinegar added to 470 ml of cool, previously boiled water) at least 4 times a day. A good sealing product to keep the skin moist must be used. One could recommend dexpanthenol, petroleum or paraffin based products (e.g.Sudocream or Bepanthen). One of these products should be applied until the skin is peeled off, which is usually in 5-7 days. Once the peeling process is completed a good, hydrating skin cream is important to protect the lipid barrier and to speed up the healing time. The skin should be cleansed with mild cleansers. Make up is allowed to be applied only after re-epithelialization process is completed (6-7 days). One must not apply make up on oozing or crusted areas and avoid agents which are abrasive, exfoliant or acidic. Strong medical treatment with tretinoin and AHA should be withhold for at least 6 months. Sun needs to be avoided. Sun filters of SPF 50+ should be applied after the procedure for several months (minimum 6). One must not scratch, pick or pull the peeled skin. The healing is completed in most cases within 1 week but in some cases might last up to 21 days.