Chemical Peels Procedures in Cosmetic Dermatology Series

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	PROCEDURES IN COSMETIC DERMATOLOGY SERIES
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	Copyright
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	CONTRIBUTORS
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	SERIES PREFACE, FIRST EDITION
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	SERIES PREFACE, THIRD EDITION
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	CHEMICAL PEELS, THIRD EDITION
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	LIST OF VIDEOS
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	1 - The Chemistry of Peels: A Hypothesis of Mechanism of Action and Classification of Peels
		INTRODUCTION
		USEFUL ELEMENTS OF BASIC CHEMISTRY
			Acids
				Arrhenius Acids
				Brønsted Acids
				Lewis Acids
				Dissociation and Equilibrium
				Acid Strength
			Polarity and the Inductive Effect
			Atomic Radius and Bond Strength
			Chemical Characteristics
				Monoprotic Acids
				Polyprotic Acids
				Weak Acid–Weak Base Equilibria
			Buffer Solution
				Le Chatelier’s Principle
				Henderson–Hasselbach Equation
				Buffer Capacity
			Current Applications of Buffer Solutions
				Useful Buffer Mixtures
				Neutralization
		ANATOMY OF THE SKIN
			Skin Basic Chemistry
			Acids and Cell Membranes
		BASIC CHEMISTRY OF THE MOST USED MOLECULES IN SOLUTIONS FOR CHEMICAL PEELINGS
			How the Most Commonly Used Substances in Chemical Peel Solutions Work—A Hypothesis
		SUBSTANCES WITH MAINLY METABOLIC ACTIVITY
			Alpha Hydroxy Acids
				Comparison of the pH to the pKa: The Interesting Cosmetic Actions of the Alpha-Hydroxy Acids
			Aliphatic Alpha Hydroxy Acids (Glycolic, Lactic, Malic, Tartaric, Citric) With pKa >3
				Glycolic Acid (pKa = 3.83) and Its Different Concentrations
				Lactic Acid (pKa = 3.86)
				Malic Acid (pKa1 = 3.4, pKa2 = 5.13)
				Tartaric Acid (pKa1 = 3.04, pKa2 = 4.37)
				Citric Acid (pKa1 = 3.15, pKa2 = 4.77, pKa3 = 6.40)
			Aromatic Alpha Hydroxy Acid with pKa >3
				Mandelic Acid: An Aromatic Alpha Hydroxy Acid (pKa = 3.37)
			Alpha Keto Acids With pKa <3
				Pyruvic Acid: An Alpha Keto Acid (pKa = 2.49)
			Bi Carboxylic Acid With pKa >3
				Azelaic Acid (pKa1 = 4.550, pKa2 = 5.598)
			Beta Hydroxy Acid Peels With pKa Around 3
				Salicylic Acid (pKa = 2.97)
				Jessner’s Peel
				Retinoic Acid Peels
		SUBSTANCE WITH MAINLY CAUSTIC ACTIVITY
			Trichloroacetic Acid Peels
				Trichloroacetic Acid (TCA) (pKa = 0.54)
		SUBSTANCES WITH MAINLY TOXIC ACTIVITY
			Phenol ((pKaphoh2+/phoh) – 6.4 (pKaphoh/pho−) 9.95)
				Resorcinol (pKa = 11.27)
			Classification of Substances Used for Chemical Peels (L. Dewandre)
			Tranexamic Acid (pKa = 4.3) and Aromatic Carboxylic Acid
				Dermis
					Epidermis
				Delivery of Tranexamic Acid to the Skin
					Oral route: 500 mg daily (250 mg twice daily). Three recent clinical studies used this dose with reports that patients exhibited...
					Topical route. Topical serum 5% TXA in a suitable base for use BID
				Tranexamic Acid and Its Usefulness With Chemical Peeling
		CONCLUSION
		REFERENCES
		FURTHER READING
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	2 - Choosing the Correct Peel for the Appropriate Patient
		INTRODUCTION
		EVALUATION OF THE PATIENT
			Color
			Oiliness
			Skin Thickness
			Skin Laxity
			Fragile Skin
			Other Considerations
		VERY SUPERFICIAL CHEMICAL PEELS
		SUPERFICIAL CHEMICAL PEELS
		MEDIUM-DEPTH CHEMICAL PEELS
		DEEP CHEMICAL PEELS
		SUMMARY
		FURTHER READING
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	3 - The Role of Priming the Skin for Peels
		INTRODUCTION
		PRETREATMENT
		PREPARATION
		CONCLUSION
		FURTHER READING
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	4 - Light Chemical Peels
		INTRODUCTION
		PEELING AGENTS: CHEMISTRY AND CHEMICAL FORMULATIONS
			Alpha-Hydroxy Acids
			Beta-Hydroxy Acid
			Retinoic Acid
			Salicylic-Mandelic Combination Acid Peels
			Pyruvic Acid
		INDICATIONS
		PATIENT PREPARATION
		PEELING TECHNIQUE
			Salicylic Acid Peel and General Instructions
			Glycolic Acid Peels
			Jessner’s Solution Peels
			Trichloroacetic Acid Peels
		POSTPEEL CARE
		CONTRAINDICATIONS AND COMPLICATIONS
			Contraindications
			Complications
		PRACTICAL TIPS AND CONCLUSION
		REFERENCES
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	5 - Medium-Depth Peels and Trichloroacetic Acid Blue Peel
		INTRODUCTION
		INDICATIONS FOR MEDIUM-DEPTH CHEMICAL PEELS
		AGING SKIN (INTRINSIC AND EXTRINSIC)
		PATIENT EVALUATION
		CONSIDERATIONS IN MEDIUM-DEPTH SKIN RESURFACING
		MEDIUM-DEPTH SKIN RESURFACING
			Mechanisms of Action
			Keratolytics
			Protein Denaturants
		TRICHLOROACETIC ACID PEELS
			Phenol Peels
			Techniques
				Trichloroacetic Acid Peels
				Glycolic Acid–Trichloroacetic Acid Peel
				Jessner’s Solution–Trichloroacetic Acid Peel
				Trichloroacetic Acid–Blue Peel
			Phenol Peels
				Hetter VL Peel
				Combination Procedures
			Postoperative Care
				Medium Depth Peels
		CONCLUSION
		FURTHER READING
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	6 - Trichloroacetic Acid Peels of the Neck, Chest, and Arms and Hands
		INTRODUCTION
		INDICATIONS AND EVALUATION FOR CHEMICAL PEELS OF THE HANDS, NECK, AND CHEST
		PREPROCEDURE SKIN PREPARATION
		TRICHLOROACETIC ACID PEEL COMPLICATIONS
		TRICHLOROACETIC ACID PEEL PROTOCOL
		POSTPEEL WOUND AND SKIN CARE
		COMBINATION AND ADJUNCT PROCEDURES
		MAINTENANCE OF RESULTS
		REFERENCES
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	7 - Phenol-Croton Oil Peels
		INTRODUCTION
		PATIENT SELECTION
		PREOPERATIVE PLANNING
			Preparation of the Solution
		ANESTHETIC TECHNIQUE
		MEDICATION
		SURGICAL ROUTINE
		JUDGING PEEL DEPTH
		APPLICATION AND PRACTICAL RECOMMENDATIONS
		SEGMENTAL PEELS
		POSTPEEL CARE
		RESULTS
		COMPLICATIONS
		CONCLUSION
		FURTHER READING
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	8 - Deep Chemical Peels
		HISTORY
		CHEMICAL BACKGROUND
			Formulations
			Histology
		INDICATIONS AND PATIENT SELECTION
			Contraindications
			Prepeeling Preparation
			Preparation of the Skin
			Monitoring and Pain Control
		PREPARATION OF THE PEELING SOLUTION
		PEELING TECHNIQUE
		AFTERCARE
		COMPLICATIONS
			Cardiac Arrhythmias
			Pigmentary Changes
			Scarring
			Infection
			Milia
			Acneiform Dermatitis
		SUMMARY
		REFERENCES
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	9 - Peels in Men: Special Considerations
		INTRODUCTION
		INTRINSIC GENDER-LINKED SKIN DIFFERENCES RELEVANT TO CHEMICAL PEELING
		EXTRINSIC GENDER-LINKED SKIN DIFFERENCES RELEVANT TO CHEMICAL PEELING
		PEEL CONSIDERATIONS IN SEXUAL-MINORITY MEN
		OVERVIEW OF TREATMENT STRATEGY
			Indications
			Prepeel Consultation
			Prepeel Skin Conditioning
			Postpeel Skin Care
		TREATMENT TECHNIQUES
			Salicylic Acid Peel
			Glycolic Acid Peel
			Trichloroacetic Acid, Combination Medium-Depth Peels, and Chemical Reconstruction of Skin Scars Technique
			Phenol–Croton Oil Peel
			Combination of Chemical Peeling With Other Minimally Invasive Procedures
		COMPLICATIONS
		CONCLUSION
		FURTHER READING
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	10 - Combination Therapy in Acne: Peels as Adjuvant Therapy
		INTRODUCTION
		ACNE: WHY CHEMICAL PEELS?
		PEELING AGENTS AND PATIENT CONSIDERATIONS
			Salicylic Acid
			Glycolic Acid
			Trichloroacetic Acid
			Jessner’s Solution
			Lactic Acid
			Mandelic Acid
			Pyruvic Acid
			Commercially Available Peeling Blends
		ACNE SCARRING
		The Authors’ Approach
		ADVERSE EVENTS AND SPECIAL CONSIDERATIONS
		CONCLUSION
		FURTHER READING
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	11 - Treatment of Acne Scars With a Combination of Chemical Peels and Microneedling
		INTRODUCTION
		MICRONEEDLING
			The Instrument
			Mechanism of Action
			Histopathology After Microneedling
		CHEMICAL PEELS
			Indications (Fig. 11.4)
			Contraindications
			Protocol
			Preprocedure Preparation13
		THE MICRONEEDLING PROCEDURE14
		POSTPROCEDURE CARE
		COMPLICATIONS
		DISCUSSION
		CONCLUSION
		REFERENCES
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	12 - The Rullan Two-Day Croton Oil–Phenol Chemabrasion Peel
		INTRODUCTION
		BENEFITS OF THE RULLAN METHOD
		SAFETY RECOMMENDATIONS
		PATIENT SELECTION AND PREOPERATIVE PROTOCOL
			Skin Preparation
		PROCEDURE PROTOCOL
			Anesthesia, Medications, and Monitoring
			Croton Oil–Phenol Peel Formulas
		DR. RULLAN’S TWO-DAY CROTON OIL–PHENOL CHEMABRASION TECHNIQUE
			Day 1
			Day 2
			Days 3 to 8
			Days 8 to 30 and Beyond
			Touchups
			Postoperative Skin Care
		SEGMENTAL CROTON OIL–PHENOL PEELS
		COMPLICATIONS
		SUMMARY
		REFERENCES
		FURTHER READING
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	13 - New Advances Combining the Chemical Reconstruction of Skin Scars (CROSS) and Subcision
		INTRODUCTION
		REVIEW OF THE LITERATURE
		TRIPLE COMBINATION OF CARBOLIC CROSS, CANNULA SUBCISION, AND MICRONEEDLING
		REFERENCES
		FURTHER READING
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	14 - Chemical Peeling as an Adjunct to Facelift and Eyelid Surgery
		PEELING AGENTS
		DEPTH OF PEELING
		SKIN TYPES
		PREPEEL SKIN CONDITIONING
		ANESTHESIA
		CHEMICAL PEEL INDICATIONS
			Chemical Peel as an Adjunct to Cosmetic Blepharoplasty
		LOWER EYELID CHEMICAL PEEL TECHNIQUE
		HYBRID LASER/PEEL TECHNIQUES
		FACELIFT WITH SIMULTANEOUS TRICHLOROACETIC ACID CHEMICAL PEEL
		CASE PRESENTATIONS
		COMPLICATIONS
		CONCLUSION
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	15 - Segmental Phenol Croton Oil Peels for Brow Lifting, Eyelid Tightening, and Lip Eversion
		INTRODUCTION
		MECHANISM OF ACTION
		STRENGTH AND EFFECTS
		SEGMENTAL (PARTIAL) PEELS
		SAFETY IS THE NUMBER ONE PRIORITY
			Technique Limitations
		THE BLEPHAROPEEL
		THE BROWLIFT PEEL
		THE LIP PEEL
		STANDARD TOPICAL POSTOPERATIVE CARE
		FINAL WORD
		REFERENCES
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	16 - Skin Resurfacing Complications
		INTRODUCTION
		COMPLICATIONS
			Swelling
			Contact Dermatitis
			Infection
			Bacterial Infection
			Viral Infection
			Yeast Infection
			Other Infections
			Milia
			Acne and Rosacea Flare
			Prolonged Erythema
			Scarring
			Delayed Wound Healing
			Pigmentary Alteration
				Hyperpigmentation
				Hypopigmentation
				Ocular Injury
				Uneven Peel Penetration
			Complications From Deep Phenol Peels
				Cardiac Arrhythmias
				Laryngeal Edema
		CONCLUSION
		FURTHER READING
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