CHEMICAL PEEL Chemical peel is a technique to treat superficial acne scars and small wrinkles of the facial area. It has begun to replace dermabrasion (sanding of the skin), particularly with respect to fine wrinkling. The superficial burn sustained from the chemical peel gives uniform tightening of the skin and therefore, some eradication of these small fine wrinkles. Also, there is the added advantage of removing layers of skin, which lend to further furrowing or wrinkling of the skin. The technique is indicated particularly for fair skinned individuals. The patient must refrain from sunlight exposure for at least six months with total sun block and subsequently with sun exposure limited to only those times when level 15 sunscreen is utilized. It is not indicated for those patients who are olive or dark complected. The burn sustained from the chemical peel can become more hyperpigmented in such individuals and thus cause a significant coloration deformity. In rare cases a chemical peel can cause a significant enough burn to scar the skin. This is particularly seen in patients who smoke. Therefore, patients are requested to refrain from chewing Nicoret gum or smoking two weeks prior and one week after their peel. The chemical peel is also contraindicated for patients who have renal disease due to the topical Phenol which is absorbed through the skin and may compromise kidney function. Chemical peel is performed with a dilute Phenol acid solution. This solution is applied with a Q-tip marking an evenly distributed superficial burn. It is feathered into the areas of the hairline and chin line if a total face is done. The upper and lower eyelids are usually avoided for the technique. A heavier application is made in areas, which are more wrinkled and have thicker skin. The technique is not advised for patients who have previously undergone a chemical peel or dermabrasion. The same is true for patients who have had facial burns or x-ray treatments. The application of Phenol is usually done without anesthesia. Infrequently, we use minimum sedation for the procedure. The major discomfort is noted in the first hour or two after application. Patients are advised to control their discomfort with Tylenol, Tylenol with Codeine or other mild pain relieving derivatives. Patients are asked to refrain from washing the areas treated until the following day at which time they can shower and shampoo in their normal fashion. They can and should wash the areas treated three to four times a day. This is done with a mild soap and water solution. After washing, patients are requested to apply Bacitracin ointment or Crisco. The latter, we have found to be quite handy. Not only does it keep the subsequent scabbing from breaking off, but it also moisturizes the skin. The scabs from the treatment are usually gone by the seventh to tenth day when patients are usually capable of wearing cover-up make-up. We advise from this point forward that they also wear total sun block sunscreen and avoid sunlight at all cost. Moisturizers or Crisco alone is sufficient to sustain adequate lubrication of the skin along with their topical cover-up make-up. Cover-up make-up is necessitated by the redness left in the skin after the treatment. This redness may take weeks or even months to resolve and rarely is permanent. The application of moisturizers will continue to help with dryness and may be necessitated for several weeks after the procedure. The technique is certainly amenable for patients who have heart trouble and cannot tolerate a facelift procedure. However, chemical peel, particularly around the upper and lower lip and chin area, is a usual adjunctice procedure included with a facelift. Please feel free to ask questions on any of these points raised in this letter of Dr. Kennedy, or any member of the staff.
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