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    Chemical peel appeal

    In the age of ever-advancing technology, where the sexy, glamorous laser seems to be changing the face of cosmetic dermatology, the chemical peel, though underpromoted, still has a place and a purpose, says Helen M. Torok, M.D., a Medina, Ohio, dermatologist. "Chemical peeling has been around for decades. It is here to stay," she says. However, chemical peels are "underutilized, underpromoted and underrated, as they are not as glamorous as lasers," she says. "Yet, the results can be spectacular and cost-effective when they are done by a trained expert, especially the medium and deep peels."

    Peels are classified into three categories — superficial, medium and deep. Each type has its own benefits. "Superficial peels include Jessner's peels, salicylic acid peels, glycolic peels and light trichloroacetic peels," and "are great for acne, rosacea, fine lines and pores," Dr. Torok says.

    Minimal discomfort can be expected, and both superficial and medium peels take between 35 and 45 minutes.

    A step up from a superficial peel, but not quite a medium peel, is the AFA peel, which is a patented peel that works well for melasma, says Joel Schlessinger, M.D., a cosmetic dermatologist in Omaha, Neb. "This procedure is quite effective and combines a clay mask along with an amino acid filaggrin-containing antioxidant. It offers something that none of the other peels contain, as it is derived from rare earth clay, and is a two-step peel."

    There is little or no downtime, he adds. Medium peels include 30 percent to 50 percent TCA peels and Jessner's and TCA peels combined. These peels improve melasma, pigment disorders such as lentigos, deeper wrinkles and acne scars, Dr. Torok says. Mild to moderate discomfort can occur.

    Deep peels, which take between 65 and 75 minutes, include phenol peels and 75 percent and higher TCA peels. These peels reduce severe wrinkling, aging and scarring, but severe pain is also expected, Dr. Torok says.

    The procedure begins with alcohol and acetone scrubs of the face to remove all oils and residues, so that the peel begins with an even landscape. Then the acid is applied in even strokes, starting with the forehead and then moving down the face, stopping at the angle of the jaw, Dr. Torok says. "The skin will get red and start to have a little swelling. With lighter peels, there is very little desquamation, but with the deeper peels, the face will swell for five to seven days, and then actually shed a whole layer," she says.

    "The new skin will be bright and clear without any freckles or pigmentation." After healing, a strong sunblock of at least SPF 45 must be used to protect the newer, sensitive skin, she says.

    Risks include infection, scarring, pigmentation problems, unsatisfactory results and possible unevenness, Dr. Torok says, and patients with active infections (including herpes simplex) and those who refuse to avoid the sun should not have a peel.

    Patients who are good candidates and choose to have the procedure will see their melasma, freckles and dull skin disappear, and will reap the benefits of collagenesis with new collagen formation, she adds.



    Even so, sometimes a peel is not enough, Dr. Schlessinger says. "I offer laser treatments if a peel cannot get the desired result," he says. "Peels, microdermabrasion and lasers are treatments that can work together for benefits to sun damage, melasma and wrinkles."

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