Chemical peels are the acceleration of exfoliation using a chemical agent. Very light peeling agents induce a faster sloughing of the cells in the stratum corneum, whereas deeper peeling agents create necrosis and inflammation in the epidermis, papillary dermis or reticular dermis. A chemical peel uses a chemical solution to improve and smooth the texture of the facial skin by removing its damaged outer layers. This is helpful for individuals who suffer from facial blemishes, wrinkles and uneven skin pigmentation. A chemical peel is most commonly performed to enhance appearance. Chemical peels may also remove pre-cancerous skin growths, soften acne scarring and control acne. In certain cases, health insurance may cover the peel procedure.
Chemical peels are commonly used for the following skin conditions:
• actinic keratoses,
• pigmentary problems like melasma
• producing skin smoothness
Chemical Peel Complications
“Caution is your friend, especially when you’re starting out with cosmetic procedures, or with a novice cosmetic patient,” says Marianna Blyumin-Karasik, M.D., a Miami private practitioner who spoke at the 68th Annual Meeting of the American Academy of Dermatology. “Less is more, especially when you’re starting out. Patients won’t be upset if you don’t reach an ideal result, but they will be very disappointed if you cause a complication — especially an unanticipated one.” Complications of chemical peels can include stinging, burning, redness, scaling, blistering, crusting, secondary infections, scarring and eye damage, depending on the peel depth. Trichloroacetic acid (TCA) and other peels also can produce frosting over the skin. “Warn patients about this in advance, so that they are not unpleasantly surprised,” Dr. Blyumin-Karasik says.
• The 2 main causes of complications are incorrect peel pharmacology and accidental solution misplacement.
• It is best to pour the solution in a secondary container rather than apply the solution spun around the neck of the bottle. Intact crystals may give the solution a higher concentration, if taken directly from its container.
• Saline and bicarbonate of soda should always be available for neutralization of acids.
• The use of blended chemical peels significantly reduces post-treatment downtime and the risk of complications.
Hyperpigmentation also can occur with various peels. “It’s more common with darker-skinned patients, especially Fitzpatrick type IV and above, and with poor sun-avoidance compliance,” she says. In the latter area, it’s imperative that patients of all skin types apply sunscreen even before leaving the office post-procedure.
“We see less and less scarring because the deep phenol-type peels are no longer in vogue, especially in the United States,” Dr. Blyumin-Karasik adds.
Avoiding peel-related complications requires taking thorough patient histories, including use of retinoids, abrasive skin cleaning procedures and other dermatologic treatments, Dr. Blyumin-Karasik says.
“Some physicians want their patients to avoid retinoids completely before procedures because of the possibility of severe irritation. Other times, especially if the patient is getting a peel for actinic keratoses or photodamage, it’s a good idea to prepare them with topical retinoids preoperatively to get a deeper, more even peel,” she explains. Dermatologists also must adjust chemical peel treatment plans if patients have rosacea, atopic dermatitis or seborrheic dermatitis.
Additionally, Dr. Blyumin-Karasik always instructs patients to keep their eyes closed and tell her what they’re feeling during procedures, “especially if they’re feeling severe burning or pain, which are alarming symptoms of significant skin damage that signal the surgeon to reassess the procedure immediately. I also make sure to drain any excess amounts of chemical peeling agent,” she says. “And I move from one side of the face to another, so there’s no possibility of the material dripping into the eyes or other industry-standardunintended areas.”
Tools for addressing complications post procedurally range from cooling fans to fractional lasers for scarring and hydroquinone for pigment changes.
Chemical Peel Costs
1. Start Up Costs are Low: Chemical Peel start up costs are very low ($2,000, assuming you have a treatment room and table)
2. Margin is high: the cost to provide a chemical peel treatment is $25 ($20 labor, $5 products) and the retail is typically around $125, so the profit is $100.
3. Patients repeat the treatment often: For success in chemical resurfacing, the patient needs to come back once a month, so with a chemical peel patient, one can make $1,200/yr.
Since its introduction in the US in 1996, microdermabrasion offers a simple, relatively inexpensive treatment for photoaging, with rapid recovery time.
Today, microdermabrasion is one of the most popular procedures in the US. In 2011, the ASAPS reported 499,427 microdermabrasion procedures were performed. It requires no anesthesia, and can be used on all Fitzpatrick skin types, and has minimal risk for dyschromia, infection or scarring.
Source: Photoaging by Rigel, Weiss and Lim, 2004.
Medical microdermabrasion is a resurfacing procedure with an abrasive instrument that mechanically sands the skin to remove some of the top skin layer (epidermis) and stimulate new skin growth. By removing the outer skin layers and smoothing the treated skin the physician can achieve a rejuvenated appearance. Using micro-particles, or a diamond-tipped wand, the plastic surgeon uses a device, like a fine sandblaster, to spray tiny crystals across the face, mixing gentle abrasion with suction to remove the dead, outer layer of skin. As with other skin rejuvenation techniques, more than one treatment may be needed to reduce or remove fine wrinkles and unwanted pigmentation.
This technique is used to treat substantial scarring, discoloration, and sun damage, as well as:
- reduce wrinkles
- tighten loose skin
- improve skin tone and color
- remove blotchiness
- eliminate damaged blood vessels
According to theAmericanAcademyof Dermatology (AAD), medical microdermabrasion treatments are often needed and should be spaced two to three weeks apart.
There are virtually no known side effects associated with microdermabrasion. The AAD advises that microdermabrasion does not require an anesthetic and involves little or no recovery time or downtime.
Patients can expect to pay more for medical microdermabrasion in major cities and in dermatologists’ offices. Average prices range from $125 to $180 in major urban center and $65-125 elsewhere.
Equipment costs for adding medical microderm typically costs around $200-500/month.
New Advances in Microdermabrasion Treatments
The Accelafuze system by Genesis Biosystems offers a new 3-1 combination therapy for medical microdermabrasion patients. First, a gentle, crystal-free peel of the stratum cornium is performed. After the aged cells of the skin are removed, an infusion of scientifically formulated topical serums is given specifically for the skin condition being treated. The infusion process is cool, soothing and extremely effective as the newly peeled surface of the skin drinks in the nutrients that are professionally applied through the Accelafuze process. The final stage is LED Light Therapy. It is applied to the treatment area, providing multiple benefits to complete the treatment regimen.
Dermabrasion and Dermaplaning
A more invasive form of skin resurfacing is dermabrasion (and dermaplanning).
Dermabrasion and dermaplaning help to “refinish” the skin’s top layers through a method of controlled surgical scraping. The treatments soften the sharp edges of surface irregularities, giving the skin a smoother appearance.
Dermabrasion is most often used to improve the look of facial skin left scarred by accidents or previous surgery, or to smooth out fine facial wrinkles, such as those around the mouth. It’s also sometimes used to remove the pre-cancerous growths called keratoses. Dermaplaning is commonly used to treat deep acne scars.
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