Short description of the usage of chemical peelings today in the aesthetic setting.

1. ROLE OF PEELINGS TODAY
MIGUEL ÁNGEL ARISTIZÁBAL M.D.
BOARD CERTIFIED AESTHETIC PHYSICIAN
MÉDICO ESPECIALISTA EN MEDICINA ESTÉTICA, Universidad del Rosario

2. INDICACIONES

3. Pathak A1, Mohan R, Rohrich RJ. Chemical Peels: Role of Chemical Peels in Facial Rejuvenation Today. Plast Reconstr Surg. 2020 Jan;145(1):58e-66e. doi:
10.1097/PRS.0000000000006346.

4. PRETREATMENT

5. SKIN PRECONDITIONING
• The objectives of skin activation, depth control, and
shortened recovery can be routinely realized through
three active ingredients: topical tretinoin (0.05 to 0.1%),
hydroquinone (2 to 4%), and alpha hydroxyl acid (4 to
10%).
Pathak A1, Mohan R, Rohrich RJ. Chemical Peels: Role of Chemical Peels in Facial Rejuvenation Today. Plast Reconstr Surg. 2020 Jan;145(1):58e-66e. doi:
10.1097/PRS.0000000000006346.

6. TRETINOIN
• Standard for evidence-based retinoid skin care.
• Dosing requires titration to achieve the intended result while minimizing dose-
dependent side effects.
• the majority of patients using 0.05% concentrations daily and over 90 percent of
patients treated with the higher 0.1% concentration exhibit the “retinoid reaction,”
• It has been demonstrated a more intense and uniform frosting with tretinoin
application on account of the compacted stratum corneum, and a statistically
significant increase in reepithelialization after 1 week.
Pathak A1, Mohan R, Rohrich RJ. Chemical Peels: Role of Chemical Peels in Facial Rejuvenation Today. Plast Reconstr Surg. 2020 Jan;145(1):58e-66e. doi:
10.1097/PRS.0000000000006346.

7. HYDROQUINONE
• Phenolic depigmenting agent that acts on melanocytes with
active tyrosinase.
• At a 4% concentration, it has been shown to provide
significant improvement of melasma dyspigmentation and
thought to lessen postinflammatory hyperpigmentation when
included in the pretreatment process.
Pathak A1, Mohan R, Rohrich RJ. Chemical Peels: Role of Chemical Peels in Facial Rejuvenation Today. Plast Reconstr Surg. 2020 Jan;145(1):58e-66e. doi:
10.1097/PRS.0000000000006346.

8. ALPHA HYDROXY ACIDS
• Relatively weak acids used in the treatment of photoaged skin.
• Randomized controlled studies have shown they decrease
epidermal atypia, induce epidermal hyperplasia, disperse
melanosomes, and increase elastin fiber thickness.
• Concentrations up to 4 -10% are used, rendering a good
safety profile to the exfoliative process they ensue with only
local irritation and increased ultraviolet sensitivity reported.
Pathak A1, Mohan R, Rohrich RJ. Chemical Peels: Role of Chemical Peels in Facial Rejuvenation Today. Plast Reconstr Surg. 2020 Jan;145(1):58e-66e. doi:
10.1097/PRS.0000000000006346.

9. INSTRUCTIONS
• Should commence 4 to 6 weeks before and continue into the week preceding the
peel.
• Some practitioners recommend longer preconditioning programs for individuals
with darker complexions.
• Erythematous, flaky skin is something the patient must accept as a normal effect, and the
clinician should look for this as an indicator of pretreatment effectiveness.
• Other goals during pretreatment are: skin hydration with continued use of a
moisturizer and sun protection with broad-spectrum sunscreen use.
• History of herpes simplex, antiviral therapy with acyclovir should be initiated,
beginning 2 days before the procedure and continued for 7 to 10 days until
complete reepithelialization.
Pathak A1, Mohan R, Rohrich RJ. Chemical Peels: Role of Chemical Peels in Facial Rejuvenation Today. Plast Reconstr Surg. 2020 Jan;145(1):58e-66e. doi:
10.1097/PRS.0000000000006346.

10. Pathak A1, Mohan R, Rohrich RJ. Chemical Peels: Role of Chemical Peels in Facial Rejuvenation Today. Plast Reconstr Surg. 2020 Jan;145(1):58e-66e. doi:
10.1097/PRS.0000000000006346.

11. CLINICAL ASSESSMENT OF DEPTH OF PEEL
• This is visually determined, dependent on a practitioner’s assessment of
frosting and/or erythema.
• A thin, transparent frost with a pinkish background indicates a peel depth down
through the epidermal layer to the papillary dermis.
• A solid, organized frost with minimal erythema strikethrough denotes a depth
down to the upper to mid reticular dermis.
• A thick, solid gray-white sheet of frost, with eventual darker red-brown hues,
means a depth down to the mid dermis and the recommended maximal depth
to minimize the incidence of scarring and hypopigmentation
Pathak A1, Mohan R, Rohrich RJ. Chemical Peels: Role of Chemical Peels in Facial Rejuvenation Today. Plast Reconstr Surg. 2020 Jan;145(1):58e-66e. doi:
10.1097/PRS.0000000000006346.

12. EPIDERMAL SLIDING
• Tangible means of assessment seen when the peel reaches
the level of the papillary dermis and the epidermis is separated
from the underlying reticular dermis and slides as a thin,
independent sheet.
• Sliding is evident to a practitioner performing a medium peel
and subsides once peeling advances to the immediate
reticular dermis.
Pathak A1, Mohan R, Rohrich RJ. Chemical Peels: Role of Chemical Peels in Facial Rejuvenation Today. Plast Reconstr Surg. 2020 Jan;145(1):58e-66e. doi:
10.1097/PRS.0000000000006346.

13. Pathak A1, Mohan R, Rohrich RJ. Chemical Peels: Role of Chemical Peels in Facial Rejuvenation Today. Plast Reconstr Surg. 2020 Jan;145(1):58e-66e. doi:
10.1097/PRS.0000000000006346.

14. POSTPEEL CARE

15. POSTPEEL CARE
• Begins before the peel itself is performed!
• Superficial peeling therapies require only simple hydration.
• Medium depth peels, a short downtime period of 1 week is required, even
with pretreatment.
• Strategy: moisturizers.
• Petroleum-based cream can be applied to treated areas for comfort and to
moisturize.
• Patients may resume facial cleansing without scrubbing and allow contact
with direct shower water at approximately 3 days after peel.
• Petroleum-based cream can then be applied after washing and gently
patting dry the treated areas.Pathak A1, Mohan R, Rohrich RJ. Chemical Peels: Role of Chemical Peels in Facial Rejuvenation Today. Plast Reconstr Surg. 2020 Jan;145(1):58e-66e. doi:
10.1097/PRS.0000000000006346.

16. POSTPEEL CARE
• For deep peels, postoperative care is more intense,
• A10-day period of unsightliness that may impose social isolation. Care during this
time is largely based on moisturizers or bandages with recommended daily
surveillance.
• During the initial 12 weeks, the patient is particularly susceptible to
ultraviolet light exposure and resultant hyperpigmentation.
• Sunscreens, however, should be avoided for the first 2 weeks until the patient is
less sensitive and reepithelialization is ensured, as the paraaminobenzoic acid
found in many sunscreen products can cause irritation, increased erythema, and
induration.
Pathak A1, Mohan R, Rohrich RJ. Chemical Peels: Role of Chemical Peels in Facial Rejuvenation Today. Plast Reconstr Surg. 2020 Jan;145(1):58e-66e. doi:
10.1097/PRS.0000000000006346.

17. HYPERPIGMENTATION
• It is important to note that reactive hyperpigmentation can occur after any peel
depth.
• Lighter complexions have a lower risk for hyperpigmentation, but as genotype
does not always correspond to phenotype, some light skin patients of mixed
lineage will unexpectedly hyperpigment.
• The use of hydroquinone alone or in combination with a glycolic cream or retinol
should be commenced twice a day or at bedtime, depending on irritation.
• Sun avoidance and the liberal use of sunscreen with higher sun protection factor is
recommended.
• Postinflammatory hyperpigmentation generally develops when the pink stage
begins to fade.
Pathak A1, Mohan R, Rohrich RJ. Chemical Peels: Role of Chemical Peels in Facial Rejuvenation Today. Plast Reconstr Surg. 2020 Jan;145(1):58e-66e. doi:
10.1097/PRS.0000000000006346.

18. INFECTION
• Along with the continuation of antiviral therapy 7 days
postoperatively, patients with a history of herpes infection should be
closely monitored every 2 to 3 days.
• Persistent painful erythema should prompt a concern for a yeast
infection and be treated with two doses of fluconazole (100 to 150
mg).
• Infection stems from artificial nails or patients touching their face
postoperatively,
• The patient should be counseled that excessive application of moisturizers
could increase the likelihood of fungal colonization and limit the peel’s
effectiveness.Pathak A1, Mohan R, Rohrich RJ. Chemical Peels: Role of Chemical Peels in Facial Rejuvenation Today. Plast Reconstr Surg. 2020 Jan;145(1):58e-66e. doi:
10.1097/PRS.0000000000006346.

19. THANK YOU!