Skin Rejuvenation with a Chemical Peel

A chemical peel can address wrinkled, blemished, sun-damaged or uneven skin coloration, using chemical peeling or laser vaporization to remove the top layers of the skin.

Length of surgery:	One or two hours for a full-face chemical peel in our accredited outpatient office surgery suite. Phenol chemical peels require longer patient observation.
Anesthesia:	Local with monitored IV sedation in our accredited operating room.
Side effects:	Trichloroacetic Acid (TCA) and Phenol peels: Temporary throbbing, tingling, swelling, redness; acute sensitivity to the sun. Phenol: Permanent loss of ability to tan; permanent lightening of the skin.
Risks/Complications:	Temporary tiny whiteheads, infection, scarring, skin allergies flare up, fever blisters, cold sores. Heart irregularities (rare) and abnormal skin color changes (permanent) associated more with phenol peels, but can be seen with strong TCA peels. Reaction to anesthesia.
Recovery:	New skin shows in 7 to 14 days for phenol. Normal activities in two to four weeks. Full healing and fading of redness in three to six months.
Permanence:	Trichloroacetic Acid Peels (TCA) are temporary except with stronger strengths; phenol peels are more permanent, although new wrinkles may appear as skin ages, especially with excessive sun exposure.

The following instructions are designed to answer your questions regarding the "do's" and "don'ts" following a chemical peel procedure. Both the patient and family should read this handout several times and become thoroughly familiar with its contents. It has been your doctor’s experience that faithful adherence to these instructions tends to result in the smoothest postoperative healing. Whenever a question arises, you should refer to this handout. More than likely, you will find the answer. If questions remain unanswered, please ask your surgeon or his physician assistant. We ask that you place your initials at the bottom of each page to indicate you have read this handout and sign on the last page.

Discomfort or Swelling

Expect a moderate to severe amount of swelling in the areas treated. This will be especially true for the areas around the eyes and lips. This is only temporary. Swelling reaches its peak by the second or third day and should begin to decrease by the fifth or sixth day. The patient can help minimize the amount of swelling by keeping the head elevated about 30 to 40 degrees when reclining (above the heart) and by sitting, standing, or walking around as much as possible. Cold compresses used 20 minutes out of the hour will help reduce swelling. Sometimes the prescribed medications may help reduce the swelling, but gravity and time are more reliable.

Skin Appearance and Care

Within 24 to 36 hours, the peeled area will resemble a severe sunburn, with or without blisters, and the patient may notice oozing from the skin. This is expected because, as the superficial layers of the skin begin to separate from the deeper layer, serum accumulates between them and the peeled regions are converted to a "water blister." Approximately 24 hours following the procedure, the patient should begin gently washing the peeled area with body temperature or cool tap water. This is most easily accomplished by standing in a shower and using only the fingertips. The patient should NOT use a wash cloth. This washing must be repeated at least six times per day. Following each washing, Vaseline should be applied to the peeled areas in a generous amount to act as a moisturizer to prevent dryness and crusting and to promote healing. It is very important to avoid sun exposure and to use sunscreen products DAILY for the first six months. The new skin will be very delicate like a newborn baby’s skin. It will take time for it to toughen up and build natural resistance to the sun and wind.

Pertinent Facts You Should Know

Fair complexioned individuals tend to get better results from this procedure than individuals with more pigment in their skin. Thick, tough, deeply wrinkled, and oily skinned individuals may require a two-staged procedure for the best results (i.e. a second peel or “touch up” of some areas at a later date.) Like painting a rough textured wall, deep creases may require more than one coat. Peeling alone is not indicated for treatment of sagging tissues. Although the new skin may be somewhat tighter, surgery may be required to remove excess skin and tighten the deeper tissues.

The solution stings as it is applied, but this generally lasts for a matter of seconds. The stinging sensation will resume later in the day after the procedure but will be eased by pain medication. The sedatives and local anesthetics used during the procedure generally reduce to a minimum any anxiety and discomfort the patient feels. Considerable swelling may occur for a few days. The patient must be prepared to accept this temporary distortion of appearance to achieve the desired end result. It is best to alert family members about this prior to the procedure so as not to alarm them. Be prepared to spend a quiet week at home, especially after a full-face peel.

This is an out-patient procedure performed in our accredited surgical suite. We will be seeing you frequently in the first two postoperative weeks and you may require a driver, particularly in the first week to ten days. With proper adherence to postoperative care and instructions, scarring is rare. The importance of following the postoperative care regimen can’t be understated. How you take care of your skin determines the final cosmetic result. Full-face peels are never done at the same time as a facelift, but can be done three to six months later. Segmental peels (around the eyes or mouth) can often be done at the time of a facelift.

A peel is a surgical procedure, therefore, all risks that apply to a surgical procedure must be considered. Female hormones, including birth control pills, can be continued before and after a peel. However, at the first sign of increased pigment or change in skin color, they must be discontinued, possibly for up to six months. Remember the new skin will be much like a newborn baby’s. The texture and color will be somewhat different from untreated skin and may require a camouflage makeup to blend any contrast. Peeling (and dermabrasion) will not reduce pore size. A pore is the opening to the skin surface of a hair follicle or oil gland. In general, the size of the opening is not improved by resurfacing procedures. Skin peels, whether they are with chemicals, lasers, or dermabrasion, can often produce dramatic improvement in the texture of facial skin. They may be the best treatment available to your surgeon to help you obtain a fresher, more youthful facial appearance. However, they are not appropriate for every patient and your surgeon will decide whether you are a good candidate.

Post-Operative Warnings

Never "pick" at crusts or pieces of skin overlying the treated areas. Keep the area moist with Vaseline and allow the crusts and dead skin to peel off on its own over time. Picking at the crusts or dead skin greatly increases your risk of infection and scarring. During the first seven days after the procedure, the delicate new skin is forming under the crusts and peeling skin. It will take approximately 10 to 14 days for the crusting to disappear leaving the intensely pink new skin. The lower eyelid region is usually the last place for the crusting to disappear. Fingers and other non-sterile surfaces harbor bacteria and oils that can irritate the new skin. Avoid touching the new skin except to clean and lubricate.

Never wear a shower cap, wig, or other hairpiece that comes in contact with treated skin. This may contribute to delayed healing and jeopardize an otherwise good result. Always keep the treatment areas clean and moist. Watch closely for early signs of a herpes simplex virus (HSV) outbreak (cold sores or fever blisters) especially if you have a prior history. They usually appear around the mouth/lips first, but can appear anywhere on the face. Classically, you will feel an intense burning or tingling sensation at the site of an outbreak before you develop tiny clear blisters surrounded by a red base.

You will be given a prescription for an antiviral medication to help prevent an outbreak. However, it is not 100% successful. Herpes simplex, while alarming, rarely causes any permanent scarring. However, alert your surgeon if you suspect an outbreak. Do not apply makeup to peeled areas until approved by your surgeon. He will give you specific instructions on how and when makeup can be applied. A water-based, hypoallergenic makeup should be used in the beginning.

Occasionally, small white cysts or pimples appear in the treated areas. These are blocked oil glands and will disappear in two to three weeks without treatment. Do not squeeze or "pop" them. If they persist, your surgeon will help you with them. The intense pink color will gradually fade over the following weeks, but can persist at declining intensity for three or more months. It tends to last longer with a chemical peel or dermabrasion than for laser resurfacing. During this time period, exposure to heat, cold, wind, or emotional upset (fear, anger, crying, etc.) can cause the skin to turn intensely pink. This is due to increased blood flow to the surface of the skin or “blushing.” This phenomenon will also disappear in approximately three to four months.

Medications

When discharged from the clinic, the patient will be provided medication or a prescription for pain. This should be taken “as needed” according to the directions on the bottle. A prescription for Zovirax (acyclovir) will also be provided. Occasionally, other medications may be prescribed. Please follow the directions as written on the bottle(s).

Resuming Activities

EYEGLASSES: If the area around the nose has been peeled, you must wait two weeks before wearing any type of eyeglasses. The pressure of the nose pieces on the treated skin must be avoided.

SUN EXPOSURE: The patient must avoid all sun exposure to the treated areas for at least eight weeks. Excessive pigmentation may occur if the peeled areas are exposed to sun too early after peeling. Therefore, activities such as golf, tennis, fishing, etc., are to be avoided in the initial eight weeks. Following that time, a wide brimmed hat and a good sunblock must be worn when in the sun for more that a few minutes.

SKIN CARE: Continued use of moisturizers is the best way to nurture the new skin. A greaseless, non-comedogenic product is best to maintain the new smoother, softer texture.

RETURNING TO WORK AND SOCIAL ACTIVITIES: The average patient returns to work and social gatherings about two to three weeks after the peel or as soon as makeup can be worn. Activities involving sun exposure must be avoided for eight weeks. The exact time will be different for each individual according to skin type and the amount of residual redness and swelling.

ATHLETICS: Strenuous athletic endeavors should be avoided for one month. Activities involving exposure to extremes of heat, cold, or wind (snow skiing, water skiing, etc.) should be avoided for six months as they can damage the new skin. It will take time for the new baby skin to toughen up and endure pre peel activities.

Post-Operative Clinic Visits and Accomodations

The patient will usually be seen in the office the day following the peel procedure and at several intervals the first week or two. Those intervals will vary according to each patient and the extent of peeling. It is of vital importance that the patient keeps the appointments because the surgeon will need to monitor your postoperative progress closely. Consider staying in a hotel the week following surgery if you live too far away to make frequent trips to the office.

If only small areas are peeled or "touched up," the patient should be able to return home immediately after the procedure. REMEMBER, swelling, crusting, and redness are expected with every chemical face peel. You may be alarmed at the facial appearance for the first week. Time and diligent skin care will help you obtain a better result. REMEMBER, close adherence to the postoperative care regimen is vital to avoid complications that might jeopardize the final result. REMEMBER, it is perfectly normal to experience a period of depression following this procedure. Reasons this can happen include:

1. A let-down from the excitement leading up to surgery.

2. A hangover from the sedative and pain medication.

3. A disappointment that you look worse instead of better in the initial postop period.

4. These feelings are temporary and are not uncommon.

REMEMBER, to contact our office if you have any questions or concerns before or after the procedure. Dr. McMenamin will call you daily in the initial postoperative period. His home phone number will also be given to you. Write down your questions so he can address them for you when he calls. Our office staff will also be available to you during business hours at (916) 564-8888.