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If you're considering chemical peel ...
Chemical peel is especially useful for the fine wrinkles on cheeks,
forehead, and around the eyes, and the vertical wrinkles around the
mouth.
Chemical peel uses a chemical solution to improve and smooth the
texture of the facial skin by removing its damaged outer layers. It is
helpful for those individuals with facial blemishes, wrinkles and
uneven skin pigmentation. Phenol, trichloroacetic
acid (ITCA) and alphahydroxy acids (AHAs) are
used for this purpose. The precise formula used may be adjusted to meet
each patient's needs. Although chemical peel may be performed in
conjunction with a facelift, it is not a substitute for such surgery,
nor will it prevent or slow the aging process. The following
information provides basic information about certain types of chemical
peel treatments and the results you might expect. It won't answer all
your questions, since a lot depends on your individual circumstances.
Once you and your plastic surgeon have decided on a specific peel
program, be sure to ask about any details that you do not understand.
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Chemical peel is especially useful for the fine wrinkles on cheeks,
forehead, and around the eyes, and the vertical wrinkles around the
mouth.
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Deciding if chemical peel is right for you
Chemical peel is most commonly performed for cosmetic reasons - to
enhance your appearance and your self confidence.
Chemical peel may also remove pre-cancerous skin growths, soften acne
facial scars and even control acne. In certain cases, health insurance
may cover the peel procedure. Be sure to check your policy and contact
your insurance company before the procedure is performed.
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The chemical solution can be applied to the entire face, or to a
specific area - for example, around the mouth - sometimes in
conjunction with a facelift.
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Alphahydroxy acids
(AHAs), such as glycolic, lactic, or fruit acids are the mildest of
the peel formulas and produce light peels. These types of peels can
provide smoother, brighter-looking skin for people who can't spare the
time to recover from a phenol or TCA peel. AHA peels may be used to
treat fine wrinkling, areas of dryness, uneven pigmentation and acne.
Various concentrations of an AHA may be applied weekly or at longer
intervals to obtain the best result. Your doctor will make this
decision during your consultation and as the treatment proceeds. An alphahydroxy acid, such as glycolic acid, can also
be mixed with a facial wash or cream in lesser concentrations as part
of a daily skin-care regimen to improve the skin's texture.
Trichloroacetic acid (TCA) can
be used in many concentrations, but it is most commonly used for
medium-depth peeling. Fine surface wrinkles, superficial blemishes and
pigment problems are commonly treated with TCA. The results of TCA peel
are usually less dramatic than and not as long-lasting as those of a
phenol peel. In fact, more than one TCA peel may be needed to achieve
the desired result. The recovery from a TCA peel is usually shorter
than with a phenol peel.
Phenol is the strongest of the chemical solutions and produces a
deep peel. It is used mainly to treat patients with coarse facial wrinkles,
areas of blotchy or damaged skin caused by sun exposure, or
pre-cancerous growths. Since phenol sometimes lightens the treated
areas, your skin pigmentation may be a determining factor as to whether
or not this is an appropriate treatment for you. Phenol is primarily
used on the face; scarring may result if it's applied to the neck or
other body areas.
All chemical peels carry some uncertainty and risk
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At the end of a phenol peel, a thick layer of petroleum jelly may be
applied to the treated area.
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Chemical peel is normally a safe procedure when it is
performed by a qualified, experienced plastic surgeon. However, some
unpredictability and risks such as infection and scarring, while
infrequent, are possible.
AHA peels may cause stinging, redness, irritation and crusting.
However, as the skin adjusts to the treatment regimen, these problems
will subside.
With a TCA peel, your healed skin will be able to produce pigment as
always; the peel will not bleach the skin. However, TCA-peel patients
are advised to avoid sun exposure for several months after treatment to
protect the newly formed layers of skin. Even though TCA is milder than
phenol, it may also produce some unintended color changes in the skin.
With a phenol peel, the new skin frequently loses its ability to make
pigment (that is, tan). This means that not only will the skin be
lighter in color, but you'll always have to protect it from the sun.
Phenol may pose a special risk for patients with a history of heart
disease. It's important that you make your surgeon aware of any heart
problems when your medical history is taken.
It is also possible that phenol will cause some undesired cosmetic
results, such as uneven pigment changes. Certain modified phenol peels
are gentler and may be preferred in some circumstances.
Peel formulas at a glance
Alphahydroxy acids (AHAs)
Uses:
Smoothes rough, dry skin - Improves texture
of sun-damaged skin
Aids in control of acne
can be mixed with bleaching agent to correct pigment problems
can be used as TCA pre-treatment
Considerations:
A series of peels may be needed
As with most peel treatments, sunblock use is recommended
Trichloroacetic acid (TCA)
Uses:
Smoothes out fine surface wrinkles
Removes superficial blemishes
Corrects pigment problems
Considerations:
Can be used on neck or other body areas
May require pre-treatment with Retin-A or AHA
creams
Treatment takes only 10-15 minutes
Preferred for darker-skinned patients
Peel depth can be adjusted
Repeat treatment may be needed to maintain results
Sunblock must be used for several months
Healing is usually quick, much quicker than with a phenol peel
Phenol
Uses:
Corrects blotches caused by: sun exposure, birth-control pills, aging
Smoothes out coarse wrinkles
Removes pre-cancerous growths
Considerations:
Used on the face only
Not recommended for dark-skinned individuals
Procedure may pose risk for patients with heart problems
Full-face treatment may take one hour or more
Recovery may be slow-Complete healing may take several months
May permanently remove facial freckles
Sun protection, including sunblock, must always be used
Results are dramatic and long-lasting?
Permanent skin lightening and lines of demarcation may occur
Planning for a chemical peel
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A protective crust may be allowed to form over the new skin. When
it's removed, the skin will be bright pink.
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In some states, no medical degree is required to
perform a chemical peel - even the strongest phenol peels. Many states have
laws that permit non-physicians to administer certain peel solutions,
but regulate the strengths which they are permitted to apply. You
should be warned that phenol and TCA peels have been offered by
inadequately trained practitioners claiming "miracle
techniques" to rejuvenate the skin.
It is very important that you find a physician who has adequate
training and experience in skin resurfacing. Your plastic surgeon 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 plastic surgeon. Don't hesitate to ask any
questions or express any concerns that you may have. Expect your
plastic surgeon 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 insurance unless they are performed for medically related
problems.
Preparing for your chemical peel
Your plastic surgeon will instruct you on how to prepare for your peel
treatment.
Sometimes Retin-A - a prescription medication
derived from Vitamin A - is used to pre-treat the skin. This thins out
the skin's surface layer, allowing the TCA solution to penetrate more
deeply and evenly. If your skin won't tolerate Retin-A
pre-treatment, an AHA cream may be used instead. Hydroquinone, a
bleaching agent, is sometimes used in conjunction with Retin-A 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.
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 plastic surgeon's
office, office-based surgical facility or outpatient surgical center.
Your plastic surgeon 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
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After healing, the skin is lighter in color, tighter, smoother, and
younger looking.
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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 "after-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 plastic surgeon may add Retin-A
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 surgeon 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 plastic surgeon 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 your treatment
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.
Getting back to normal
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.
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 plastic surgeon for the ASPRS
brochure on camouflage cosmetics.)
Your new look
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.
The information on this web site is only intended as an
introduction to this procedure and should not be used to determine
whether you will have the procedure performed nor as a guarantee of the
result.
The best method of determining your personal options is to schedule a
personal consultation with Dr. Makki. He will be able to answer
specific questions related to your situation.
Please don't hesitate to call for any questions that you might have
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Fillers are used primarily to fill wrinkles, lines and
scars on the face and sometimes the neck, back and chest.
It is effective for treating:
1. Frown Lines 2. Glabellar Lines 3. Acne
Scars - Trauma Scars 4. Periorbital Lines
(Crow's Feet) 5. Perioral Lines 6. Nasolabial
Folds (Smile Lines) 7. Vermillion Border (Lip Lines) 8. Melolabial Lines (Marionette Lines)
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Injectable filler or fat can help improve the skin's texture by
filling in the laugh lines and facial creases that often occur with
aging.
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The Filler is injected using a fine needle inserted at several points
along the edge of the treatment site. If a local anesthesia has not
been used, you may feel some minor stinging or burning as the
injections are administered.
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Years of squinting and other facial muscle movements can take their
toll on the eye area, leaving crow's feet and other noticeable lines.
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Immediately following treatment, you may notice some
minor discomfort, or stinging in the injected area. Occasionally some
bruising or swelling will occur, but it is usually minor. Any redness
that appears in the injected site usually disappears within 24 hours.
However, in some individuals, particularly fair-skinned patients, this
redness may persist for a week or more.
No bandaging is needed and you are free to eat, drink, and wear makeup
with sunblock protection shortly thereafter. There may be some
temporary swelling and redness in the treated area which should
dissipate within a few days. If these symptoms persist, contact your
surgeon.
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With regular follow-up treatments, your refreshed look can be easily
maintained. As stated earlier, the duration of results from
injections is variable.
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Your doctor can help you determine how long you can go
between treatments to best maintain your results.
The information
on this web site is only intended as an introduction to this procedure
and should not be used to determine whether you will have the procedure
performed nor as a guarantee of the result.
The best method of determining your personal options is to schedule a
personal consultation with Dr. Makki. He will be able to answer
specific questions related to your situation.
Please don't hesitate to call for any questions that you might have
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