Peels use vegetable or chemical substances which, depending on the strength of their active product, their concentration or their duration of application, will destroy the surface layer of the skin, i.e. all or part of the epidermis and may even reach the superficial dermis, depending on the desired purpose.
The different peelings:
• Fruit acid peels (glycolic, lactic, mandelic…)
• Peels with so-called weak acids (lactic, salicylic) whose action stops at the granular layer with an interesting but moderate exfoliation.
• Resorcinol peels, like Unna paste, whose active ingredient is 50% resorcinol.
• Peels with phenol (hydroxybenzene) and croton oil, the concentration of which makes it possible to peel light, medium or deep, depending on the area to be treated, the extent of the defect to be corrected, the quality of the skin and the desired purpose. The toxicity of phenol, particularly cardiac, hepatic and renal, well known by your practitioner, requires a well-coded application protocol.
• Peeling with trichloroacetic acid (TCA), the concentration of which also allows a light, medium or deep peeling.
Duration of hospital stay
30 minutes to one hour.
Under local anesthesia.
Average length of stay
24 to 48 hours.
The procedure can be performed on an outpatient basis.
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The purpose of the consultation is to assess the request, clarify the indication, inform the patient of what can and what will not be treated and explain all the facts about this type of intervention. The wishes must be realistic and in accordance with the processing possibilities. The purpose of these peels is to bring a more or less great improvement so that the result obtained brings satisfaction.
The preoperative preparation of the skin is important in order to optimize the result. Skin cleansing, fruit acid or vitamin A acid creams, antibiotic coverage, are sometimes prescribed by your surgeon during the 2 or 3 weeks preceding the procedure to prepare your skin so that it arrives at the time of the procedure in the best possible local conditions.
There is no need for anesthesia for light and superficial peels that will only generate a simple exfoliation by simply peeling the skin.
Anesthetic creams can bring a certain comfort. Progress is expected on this type of anaesthetic cream. Taking a sedative or relaxant is sometimes helpful.
A local anaesthetic or neurolept-analgesia can only be used for extended medium or deep peels.
After cleaning and disinfecting the skin and installing the sterile fields, the product is applied according to a protocol (concentration, duration of application) specific to each type of peeling and according to the importance of the defect to be corrected, the area to be treated, the quality of the skin and the desired purpose.
• Fruit acid peels improve skin radiance.
• Light and superficial peels peel the skin, exfoliate, have an action on the complexion and produce a refreshing effect. They only interest a part of the epidermis:
-Scrubbing when they only concern the superficial cornea layer of the epidermis -Exfoliation when they concern the granular layer of the epidermis
• Medium or deep peels, on the other hand, produce a real abrasion that can destroy the epidermis and the superficial part of the dermis, the papillary dermis: it is a controlled chemical burn. This control is done by your surgeon thanks to the choice of the type of peel, its concentration or its duration of application. It depends on the importance of the defect to be corrected, the area to be treated, the quality of the skin and the desired purpose.
Then this destroyed epidermal or dermo-epidermal layer will be restored thanks to natural healing phenomena from the elements of the basal dermo-epidermal membrane and pilosebaceous annexes: this therefore implies a healing time where the skin remains fragile and requires careful care.
It is this restoration of the skin surface that will create a smoother appearance by erasing more or less, the imperfections that one wants to treat.
In addition, dermo-epidermal healing will take place with a certain amount of skin retraction, giving a real cutaneous "tensor" effect, which varies in importance depending on the case.
As the light and superficial peels only carry out a simple exfoliation, the after-effects are simple and marked by redness and epidermal fragility. Advice on protection, especially sun protection, and hygiene are essential. The application of appropriate protective creams leads to the consequences.
Medium to deep peels, on the other hand, produce a controlled chemical burn that destroys the epidermis and the upper part of the dermis. Immediately after treatment, the dermis is exposed, resulting in redness, swelling and oozing.
Local, attentive and very careful care, based on fats or bandages, will be carried out until complete healing, obtained in 10 to 15 days. If properly managed by your surgeon, this local care will prevent the appearance of scabs, which even if undesirable, may eventually form and should not be torn off to respect the underlying healing process in progress and not risk a possible residual scar.
Then, after the 10th day, emollient creams for sensitive skin, appropriate make-up and sun protection are recommended to camouflage the red or rosy appearance of the treated skin for 2 to 6 months.
It is this restoration of the skin surface that will be done with a smoother appearance by erasing more or less the imperfections that one wants to treat.
The skin may be uncomfortable, dry, fragile, irritable, intolerant to usual cosmetics for several weeks.
A general treatment (analgesic, anti-inflammatory, antibiotic, anti-herpetic, anti-pruritic) can be prescribed in parallel.
With fruit acid peels and light and superficial peels, the complications are exceptional: they rarely cause pigment disorders, on the contrary, they have a rather regulating and refreshing effect on the complexion.
• Microbial infection • Acne flare-up
• Milium grains (small white cysts)
• Hyperpigmentation (especially on dark skins): early and almost always transient, it is often due to premature exposure to the sun.
• Hypopigmentation: often permanent, appears less frequently and later
• Persistent redness
• Healing disorders and hypertrophic scars are possible but rare. They show excessive destruction, scratching, failure to respect the fragile re-epidermisation of the beginning of the healing process, and infection that is poorly or late treated.
• Allergy: products used for skin disinfection or care can also cause an allergy, so it is important to consider all the allergies the patient has had in their lifetime.
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