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What’s Important?

  1. Superficial peels induce epidermal injury and are indicated for mild acne, melasma, pores, texture, and mild photodamage.

  2. Superficial peels include the water-soluble alpha-hydroxy acids (AHA) (which include lactic acid, mandelic acid, glycolic acid (GA) and pyruvic acid (PA)), the lipid-soluble acids, beta-hydroxy acid (which includes salicylic acid), retinoic acid, Jessner’s solution (JS), and trichloroacetic acid (TCA) 10% to 35%.

  3. GA and PA require neutralization by removal with water or 10% sodium bicarbonate.

  4. Medium depth peels penetrate into or through the papillary dermis when a level II frost (confluent white frost with background erythema) or a level III frost (confluent white frost without background erythema).

  5. The classic combination medium depth peels for the face and scalp include solid CO2 plus TCA 35%, JS plus TCA 35%, and GA 70% plus TCA 35%.

  6. Baker-Gordon’s formula (2.1% croton oil) was the standard phenol-croton oil peel from 1962 to 2000, but since 2000 Hetter’s formulas (less than or equal to 1.6% croton oil) have been the standard.

  7. Segmental phenol/croton oil peels limited to one or two cosmetic units, over 10–15 minutes per unit, do not require cardiac monitoring.

What’s New?

  1. Medium and deep chemical peels: updated safety and patient selection information, histology, techniques, healing stages and endpoints.

  2. Chemical peels for acne scars.

What’s Coming?

  1. More publications on deep chemical peels (segmental and full face) showing safety protocols, procedures, and technique.

Chemical peels are safe and inexpensive methods of resurfacing the skin. Peels have been utilized since ancient Egyptian times but the science behind chemical peeling has evolved significantly over the last 30 years. Recent scientific studies investigating the histologic and long-term effects of peels support their effective controlled wounding for medical and aesthetic improvement.1 Chemical peeling is an art, and successful outcomes depend on tailoring the peel to the patient’s skin needs, with the correct technique, patient education, and safety standards. When the appropriate peel is selected and the desired end point is achieved, the risks of complications are minimized. Supervised hands-on training is of utmost importance and provides the highest quality of education.

Chemical peels are categorized based on the depth of the procedure: superficial, medium or deep (Table 24-1).2 Superficial peels induce necrosis of all or parts of the epidermis, from the stratum granulosum to the basal cell layer (Figs. 24-1) and can be used in all skin types. These peels can treat melasma, acne, acne scars, thin seborrheic keratoses, and post-inflammatory hyperpigmentation, with subtle improvement in texture and pores.2 Medium-depth peels, safest in skin types I–III, create necrosis of the epidermis and the papillary dermis. These peels can be used to treat actinic keratoses, fine lines, laxity, melasma, seborrheic keratoses, solar lentigines, acne scars, and skin texture. Deep peels, safest in skin types I–II, can dramatically improve deep facial rhytids, acne scarring, and photoaging. The depth of injury for deep peels is the mid-reticular ...

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