Chemical pilling

At present chemical peeling is the procedure most frequently used in the cosmetologic practice to correct a number of cosmetic skin defects.

Chemical peeling is known to be a controllable damage of skin integuments, initiating indirect skin regeneration and remodeling. When protecting itself against damaging, the skin starts increasingly synthesizing collagen and other components of intercellular substance, hence the smoothing of the skin integument relief and pronounced rise of the skin tone (lifting effect) take place, this being the necessary component of correcting the signs of ageing.

The idea of treating the skin to improve its texture and smooth out wrinkles is far from being new. Excavations in the Ancient Roma constantly demonstrate confirmations of what may be undoubtedly called a fore-runner of modern dermabrasion. Our ancestors used to select dense materials of the stony nature, as a rule, and grind skin literally, rejuvenating it and removing scarry alterations. Guided and controllable process of removing some number of epidermal and dermal layers together with existing defects, and initiation of restoring all destructed layers anew have received the name “dermabrasion” or “peeling” (from the English verb “to peel” - to clean, exfoliate, change the skin). The era of modern peeling has rather an intriguing beginning. It is known that a pioneer of this method in dermacosmetology and plastic surgery was an American physician Mackey who had used phenol for rejuvenating skin treatment since 1903, but only in 1952 he disclosed the formulation of solution and the results of his own work in this direction. Another American physician – Lagasse – had actively worked with phenol since the 30-thies but also kept the procedure technique in secret. Chemical peeling gained a real popularity only after 1962, when a number of scientific articles were published, discussing the properties of phenol, indications to peeling and morphologic skin changes under this procedure. At present the basic indications are strictly defined for chemical peelings, which – according to the depth of its effect on the skin – are divided into:

• Superficial chemical peeling (leads to exfoliation of the superficial epidermal layers or entire epidermis, up to the papillary dermal layer)
• Median chemical peeling (leads to the programmed chemical burn with consequent exfoliation of epidermis and derma, up to the upper area of reticular layer)
• Deep chemical peeling (is performed using compositions containing phenol and sometimes croton oil; in so doing the maximal destruction takes place, up to the middle of the retinal dermal layer; phenol peeling eliminates depressed and atrophic scars, smoothes deep facial wrinkles: the skin surface becomes tightly tensed, i.e. the facial skin lifting effect is observed to be able of being retained during 5-8 years)

The deeper is the skin damage, the higher is the risk of complications: scars, pigmentation and dermatitis. That is why there exist strict indications for selecting this or that type of peeling. Say, if all the age-related skin alterations and variously originated scars are available – the choice is the median-deep peelings. It should be kept in mind that after these types of peeling certain rehabilitation period (from 10 days to 6 months) will be required. To prevent complications, more thorough home and professional after-peeling care is necessary. Superficial peeling is a good method for patients up to 40 years old, in whom the age-related alterations are not considerable. Excellent results may be obtained after 8-12 procedures: the skin appearance, turgor and elasticity are improved markedly.

The most popular is the superficial chemical peeling with fruit acids, which is reasonably regarded to be the most conservative among the others: The acids used are, inter alia: alpha-hydroxy acids (АНА), found in many fruits. These are lactic, malic, citric and glycolic acids. This type of peeling is the safest, well tolerated and gives good results.

The most studied is glycolic acid. It has the smallest molecule among all AHA, providing a high penetrative capacity. For this reason, it is most widely used in cosmetology. Recent investigation show that preparations based on hyaluronic acid are very effective in correcting skin surface irregularities, hyperpigmentation, small wrinkles and loss of elasticity and turgor. Possibilities of chemical peeling are not limited to the esthetic effect only.

The method is used in such skin diseases and conditions as:

• General age-related skin flaccidity, skin deficits; first of all, deep wrinkles and scars reaching retinal dermal layers
• Impairments of the skin integument elasticity (prophylaxis and correction)
• Acne, postacne
• Treatment and prophylaxis of molluscum contagiosum, papilloma-viral infection
• Dyschromia
• Actinic dermatitis
• Skin chrono- and photo ageing (thickening of the skin integument after long exposure to the sun)
• Lentigious rashes
• Seborrheic and actinic keramomas
• Small wrinkles
• Superficial scars, striae
• Coarse skin relief
• Large-size pores
• Epidermal rashes (freckles, chloasmas, keratotic neoplasms)
• Rashes localized in the epidermis and dermal papillar layer (epidermo-dermal and dermal chloasmas, hyperpigmentations, multiple small superficial wrinkles and scars)
• Ichthyosis and xerodermia
• Preparation for deep dermabrasion (resurfacing) and skin-plastic operations; and also as a supplemental method in benign neoplasms

Chemical peeling expected effects:

• Improvement of the skin appearance, turgor and elasticity
• Correction of hyperpigmentation
• Smoothing of the skin profile, reduction of the skin pore size, leveling of the skin small wrinkles
• Activation of metabolic processes in the skin, hence improvement of the face color: the skin becomes more denser and resilient
• Stimulating effect on the skin is reached indirectly, via an inflammatory reaction in response to a strictly dosed chemical damage
• Whitening effect

Clinical effect of any peeling depends on the depth of action and the chemical agent used. It is not a secret that the deeper is an injury, the more the skin tries to protect itself against the damaging factor, and therefore we receive greater result from the peeling procedure.

Depending on the depth of skin damage, the duration of recovering period, the probability of complication development and expression are determined.

The extent and depth of acid action depend on a number of factors:

• Concentration
• рН

The lower is pH (i.e. .the more acidic is a solution, the stronger is its action and the deeper an acid penetrates the skin). Neutralized peelings under any concentration are less effective.

Contraindications to glycolic peeling:

• fibroblastic diathesis with the risk of forming keloid scars
• increase predisposition to scar formation
• aggravated skin diseases
• individual intolerance of the peeling ingredients
• general somatic disease, including acute respiratory viral infection (ORVI)
• uptake of ROACCUTAN preparation (it must be discontinued about 6 month before the procedure)
• injuries in the region of peeling application; break of the skin integument integrity
• pregnancy and lactation
• unbalanced psychical states
• mid-severe and severe acne rashes
• active-phase herpes
• thin sensitive skin
• atopic dermatitis
• chronic urticaria

Prepeeling preparation

Before performing the peeling procedure a specialist’s consultation is required for the purpose of determining the skin type, presence of the skin rash, scars, wrinkles, etc. After examination a prepeeling preparation starts in the home conditions, and the main course of in-room procedures is made up.

How does the skin look in the intervals between procedures?

Light desquamation is possible, which is eliminated with creams. Under enhanced action on certain skin area (postacne, scars, etc.) a thin crust may occur, and desquamation may be seen.

Postprocedure limitations

During a week after peeling it is undesirable to attend solarium and be exposed to to the open sun. This is associated with the possibility of an uneven pigmentation development. On sunny days it is sufficient to use protective creams.

Postpeeling care

Home-used preparations are prescribed for more dynamic skin recovery progress. When selecting preparations, patient age, skin type and condition (wrinkles, acne, postacne, etc.) are taken into account.

Thus, peeling permits to give the skin a new health and stimulate it, i.e. to make the skin more beautiful - effectively, without severe trials and big expenses.

Median ТСА-peeling

Median peelings include the trichloroacetic acid (TCA) peeling. It enables many cosmetologic problems to be resolved, helps eliminate superficial wrinkles and promotes the skin relief smoothing. This type of peeling is also quire effective in correcting post-inflammatory defects (scars) in acne patients. This is a reliable, effective and completely controllable peeling. It is entirely stable in a broad pH interval and gradually releases active substances at increased (from 35,5оС) temperature only, in a direct contact with the skin. Dermatologic median peelings are constantly controlled by a specialist, thereby providing a reliable and predictable result. Absolute transparency together with uniform distribution of active components make it possible to reach considerable stimulation of fibroblasts, ensure excellent skin desquamation and minimize the possibility of developing side effects.

Contraindications to median peeling:

1. Pregnancy and lactation
2. Autoimmune diseases
   • Glomerulonephritis
   • Scleroderma
   • Tireotoxic goiter
   • Systemic lupus erythematosus
   • Dermatomyositis
   • Keloid disease
3. Oncologic diseases
4. Uptake of systemic retinoids
5. Aggravated herpetic infection
6. Break of the skin integument integrity

Before performing the procedure

It is compulsorily to carry out the prepeeling preparation (during 7-10 days) with home-used preparations, and perform a number (at least 3-4 procedures) of superficial-median peelings (with an interval of 10-14 days).

To reduce the risk of pigmentation, it is compulsorily to use (during 3-5 weeks before chemical peeling and during a month after) preparations blocking the activity of tyrosinase – an enzyme necessary for melanin synthesis.

After the median peeling one may observe:

• Severe erythema (skin reddening) during 3-5 days
• Skin tightening during 36-96 h; occurrence of small- and large-laminar desquamation (self-rejected)
• Sensation of burning and swelling during the first 24 h
• Skin photosensitivity increase (protection against UV-light is compulsory)

Possible side effects:

• Occurrence of blisters
• Puffiness
• Itching

Treatment course

Single course, but should the necessity arise (e.g. deep postacne scars), an additional course of procedures is required.

Time of effect

The final result becomes visible at days 8-10.

Apart from chemical there are other peelings:

• With the help of ultrasound
• Via mechanical dermabrasion
• Using lasers
• Using enzymes

The Medical Сlub cosmetologists have created their own concept of performing peeling procedures to reach the three objectives:

• Procedure effectiveness
• Process safety and controllability
• Peeling procedure simplicity and comfort

Our specialists together with a patient discuss the expedience of selecting this or that type of peeling. With due regard for a patient’s wishes and taking into account all contraindications, they make up individual programs and control results at all procedure stages.