American Medical Association Family Medical Guide - American Medical Association [777]
The Procedure
Chemical peels using AHAs require no anesthesia or sedation. Your doctor will apply the AHA solution to your clean face with a sponge, pad, or brush, carefully avoiding the eyes, eyebrows, and lips. The procedure takes about 10 minutes.
For a chemical peel with TCA or phenol, you will probably be sedated, but you won’t need anesthesia (the chemical solution itself contains an anesthetic). Before you have a TCA or phenol peel, your face will be thoroughly washed. A TCA peel takes about 30 minutes to complete. (You may need more than one application to achieve the results you want.) A phenol peel takes about 1 to 2 hours. During a phenol peel, your doctor will probably monitor your heart with an electrocardiogram (ECG; see page 559) to make sure the phenol is not affecting your heart.
After applying the solution to your face, the surgeon will wait about an hour for a protective crust to form naturally over your face. He or she will then coat your face with a layer of petroleum jelly or cover your face with strips of waterproof adhesive tape. The petroleum jelly or tape must stay in place for 1 to 2 days. If tape is used, a crust or scab will form after the tape is removed.
After the Procedure
AHA peels sometimes cause stinging, redness, flaking skin, dryness, irritation, and occasionally crusting of the skin, but these side effects are temporary. You won’t need to use a facial cream or covering. Your doctor may recommend an AHA-based face wash or cream to apply at home once or twice a day for a few weeks. Most people see an immediate improvement in previously rough, dry, or sun-damaged skin. You will need to use a sunblock for several weeks after your peel.
A TCA peel can cause some tingling or even throbbing pain, for which your doctor can prescribe a pain medication. Depending on how deep the peel penetrated, you may also experience significant facial swelling, which will subside in about a week. You will see your new skin appear in a week to 10 days, when your skin should be healed enough to allow you to return to work. Be sure to avoid sun exposure and use a sunblock for the next several months.
Phenol peels cause significant swelling, and your eyes may be swollen shut for a few days. You will have to consume a liquid diet that you can sip through a straw for the first few days. Complete healing from a phenol peel can take many months, although you should be able to return to work in a couple of weeks. Your face will be healed enough by then to hide the facial redness with makeup.
After a phenol peel, the skin on your face will no longer be able to make pigment, which means that your face will never tan again and is more vulnerable to damage from the sun. You will have to protect your skin from the sun for the rest of your life. Phenol peels sometimes cause unwanted results, such as uneven skin color or scarring. However, most people who have phenol peels are satisfied with the dramatic improvement in their appearance. The effects of phenol peels can last up to 20 years.
Retinol Treatments
Retinol treatments are skin-rejuvenating techniques that you perform at home. Retinol is a prescription gel or cream containing tretinoin, a substance that is chemically related to vitamin A. Skin preparations containing retinol reverse some of the skin damage caused by sun exposure, including fine lines, wrinkles, and age spots. The gel form is generally stronger than the cream. Doctors often prescribe retinol to people who are planning to have a chemical peel (see previous page) to pretreat their skin—retinol thins out the top layer of skin, which allows the chemical peel solution to penetrate more deeply. Retinol also is prescribed to treat severe acne.
Applying Retinol
It is best to apply retinol right before going to bed. Wash your face with a mild soap or cleanser, pat your face dry with a towel, and then let your face completely dry for about 15