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The application of a wounding agent to induce epidermal and/or dermal sloughing.


  • Epidermal defects—ephelides, melasma

  • Epidermal and dermal defects—melasma, lentigines, post-inflammatory hyperpigmentation, actinic keratoses, superficial rhytides, acne vulgaris

  • Dermal defects—deep rhytides, acne scarring, scars


Peeling agents are selected based on the patient’s lifestyle, defect depth, skin characteristics, and defect location (Tables 5.15.3).

TABLE 5.1Clinical Indications and Peel Types
TABLE 5.2Wounding Depth of Superficial, Medium-Depth, and Deep-Depth Strength Peels
TABLE 5.3Peeling Agent Characteristics

  • Past medical history

    • – Past radiation history—decreased adnexal structures likely

    • – History of oral herpes simplex virus—reactivation may occur

    • – Pregnancy—peels contraindicated with the exception of glycolic acid

    • – History of keloid formation—moderate and deep-depth peels should be avoided

  • Past surgical history

    • – Prior cosmetic procedures—prior face lift, blepharoplasty, carbon dioxide resurfacing, or dermabrasion may affect peel outcome. Increased ...

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