PubMed1991
Application of caustic chemicals to improve cosmesis and reverse actinic damage has been used for centuries. Although still not an exact science, it was not until the latter part of this century that peeling became more systematized. The indications, patient selection, armamentarium, histology, comprehension of the mechanisms of action, and safety parameters of peels have only recently become more extensively defined. Phenol, when used in the Baker's formula, provides the most dramatic results but also holds the most potential for systemic complications. Ideally suited for fair-skinned women, a phenol peel can provide substantial improvement in rhytidosis and actinic damage. Although the results of medium-depth peels approach those of Baker's peels, they are not quite as profound. Use of TCA and the medium-depth peels has filled an important gap between deep and superficial peels, however. Also ideal for light complexions, this category of peels lightens pigmentary problems and improves rhytides with minimal potential for systemic toxicity; however, local complications, including scarring and pigmentary anomalies, should not be underestimated. [table: see text] Superficial peels do not effectively eradicate the ravages of time and sun, but when done repetitively, they do improve pigmentary irregularities and may improve some minor surface changes and thus impart a fresher appearance to facial skin. Although pigmentary changes can occur, superficial peels are relatively safe, and maximal results can be achieved with serial applications. Peels have been categorized by patient indications and the corresponding depth of peeling required for improvement (Table 4). The depth is determined in turn by a host of factors (Table 5). Neither the classification scheme nor the peel process should be viewed dogmatically. Patients will often benefit from the concurrent use of different skin preparations and wounding agents. Localized gradations can be achieved not only with occlusion but also by employing different solutions as well as different concentrations of the same solution and skin preparation. Selection of the appropriate technique relies on critical analysis of the skin defect one wishes to treat balanced against the risks of treatment. The final protocol should be individualized for the needs of each patient. Despite heightened public awareness of the harmful effects of ultraviolet radiation, actinically damaged skin is no longer a problem restricted to an older-patient population. Fueled by the lay press and practitioners, there is a growing patient demand for chemical peels. Chemical peels alone or combined with ancillary aesthetic procedures can provide a dramatic improvement in facial appearance. The potential for improved cosmesis is not without inherent risk, however.(ABSTRACT TRUNCATED AT 400 WORDS)