Chemical Peels: How do they work and are they really that effective??

What are they and how do they work?

There is a variety of chemical peels available on the market.  They are designed to improve the appearance of the face. Chemical peels can help to:

 

• Reduce fine lines under the eyes and around the mouth
• Treat wrinkles aused by sun damage, aging, and family history
• Improve the appearance of mild scarring
• Treat certain types of acne
• Reduce age spots, freckles, and dark patches due to pregnancy or taking birth control pills (melasma)
• Improve the look and feel of skin that is dull in texture and color

 

Some are available over the counter, and others, usually the more effective and potent formulations, are available by prescription from your plastic surgeon or dermatologist. 

Chemical peels work by accelerating the exfoliation of the skin process.  They can be used every so often (usually under the care of a physician) to help rejuvenate the skin. Plastic surgeons may also use chemical peels at the same time when a blepharoplasty or facelift is performed to help reduce the fine-wrinkles that surgery often doesn’t help improve.

Chemical peels are chemicals that improve and smooth the skin’s texture by removing the outer most damaged layers.  It can help improve fine wrinkles, skin blemishes and slight pigmentary changes. 

The three most common types of chemical peel categories (from most strongest peels to mildest peels) include the:

1)      Phenols (DEEP Peels)

2)      trichloroacetic acid (TCA), and

3)      alphahydroxy acids (AHAs) such as glycolic, lactic, or fruit acids (MILDEST peels)

Standard TCA Chemical Peel stored in a bottle.

Your doctor will use a precise formula customized to your skin to fit your best needs and wishes.  If you are interested in a mid peel to produce a smoother, brighter looking skin, mild peels such as AHAs would be suitable.  AHAs can often be applied weekly to obtain the best result as well. 

TCA peels are medium-deep peels that can improve fine wrinkles, skin blemishes and pigmentary changes.  The recovery time is usually 1-3 weeks and depends on your skin type and the TCA concentration used.  Patients should be warned that although TCA is a mild peel, some can respond with significant redness and slight discomfort for up to 2 weeks.  Darker skinned patients should be careful with higher TCA concentrations since it can change the skin color within the treated areas.   TCA peel treatment often takes 10-15 minutes and the peel depth can be adjusted depending on the desired outcomes. 

Phenol peels are the strongest of the peels and penetrate deep skin layers.   As a result, it can improve deeper facial wrinkles.  Recovery takes several weeks and can be very discomforting.  Phenol peels should be reserved for special cases under direct care of a plastic surgeon. I don’t like to perform phenol peels and would rather use laser resurfacing.

 

How to plan for a chemical peel.

Once you and your doctor have decided that you are a good candidate for a peel, you may need to be pretreated with a prescription medication to allow optimal penetration of the peel throughout the skin layers.  I like to give Retin A prior to treatment when using TCA 20% or more. Depending on the peel, you may need to arrange for someone to drive you home after the surgery as well.

 

What to expect the day of the peel.

You may be given mild sedation during the procedure, but usually not necessary with lighter peels such as AHA or TCAs.  Most peels can be performed in the office and the whole procedure can last 10-15 minutes. It’s normal to experience a slight stinging sensation for several minutes.  This is the peel working within the skin.

 

What to expect after your treatment

It is common to experience some flaking redness to the skin. Adequate lubrication to the areas peeled should be performed using aquafore. This helps prevent the skin from drying. Deeper feels can often cause significant facial swelling. You may be prescribed a daily wash to help in the healing process.

The effects of the peel may be subtle at first, but within time, you may detect a healthier shine to your skin. The effects may not be permanent, and repeated, lighter peels (maintenance peels) can help improve the general texture of your skin.

 

Pre treatment of face and eyelids. Note the mild skin blemishes and fine wrinkles around her eyelids.

 

Post treatment after undergoing full face chemical peel.  This photo was taken 8 months after procedure. No further surgery was performed.  Note the "fresh-appearing" look to her face along with the improvement in her fine wrinkles and skin blemishes.

 

What causes the "bags" or "dark circles" under your eyelids???

So many of my friends and patients ask me what causes the dark circles under their eyelids and what can be done to treat them?

Dark circles within the lower eyelids can be caused by several factors and each one has different ways for correction. For instance dark circles can be from any of the following factors:

1)    Hyperpigmentation of the skin (which can be caused by certain medications) and even worsened during pregnancy
2)    Age-related decent of midface of cheek fat which results in a larger deficiency of volume at the lid-cheek junction
3)    Prolapse or herniation of the eyelid fat pockets (bulging fat pockets)
4)    Thin skin allowing the underlying muscle and blood vessels to show
5)    Underlying allergies or rosacea

You should have a complete examination by either a dermatologist or a plastic surgeon to first evaluate the etiology of the “dark circles.”  Treatment depends on what the etiology is and can range from the following regimens:

1)    Filling of the lid-cheek junction and the midface with some form of filler material. I prefer Restylane or fat grafting to this area.  This is done in the office with the assistance of a topical anesthetic. The procedure can take as little as 15 minutes if using Restylane and can go home afterward without any problems.
2)    Lower lid blepharoplasty or eyelid surgery (removal of lower lid skin and/or fat) with the possibility of using a filler material
3)    Skin bleaching or brighteners
4)    Chemical peels or laser treatments
5)    Control of allergies/rosacea

Upper and lower lid swelling from underlying allergies and contact dermatitis.

 

Notice the decent of the midface resulting in a hollowing of the lower lid.  This results in a shadowing effect that appears like dark circles.

 

 Herniation or bulging of lower lid fat pads from age-related changes.

 

What is the most common type of skin cancer found on your eyelids and face???

1) Basal cell carcinoma.

2) Melanoma

3) Squamous cell carcinoma

 

Answer: Basal cell carcinoma. Basal cell carcinoma is a type of nonmelanoma skin cancer, and is the most common form of cancer in the United States. According to the American Cancer Society, 75% of all skin cancers are basal cell carcinomas. Basal cell skin cancer almost never spreads. But, if left untreated, it may grow into surrounding areas and nearby tissues and bone. Basal cell can also grow around the eyelid.  It is most common in fair skinned individuals with a history of prolongued sun exposure.  It is important to have any new bumps or moles around your face, eyelids and body evaluated by a dermatologist or a plastic surgeon.

Figure 1.  Basal cell carcinoma of the lower lid.  Notice the loss of lashes and the raised, pearly appearance of the lesion.

All you ever wanted to know about Botox and more….

 

 

Botox quickly became a household name over 10 years ago and we all know the well-glamorized shiny immobile foreheads and the lack of expression it caused in its early days of use.  However, physicians have come to respect it and use it in a way to allow their patients to have a more natural and youthful look while still preserving some function to the facial muscles.

Botox belongs to the family of Botulinim neuromodulators which also includes Dysport. These neuromodulators act to temporarily paralyze the action of the muscle at a cellular level.  Botox is the most commonly known type of neuromodulator while Dysport is becoming more and more popular among patients and physicians.  Both types are safe and effective For the sake of this blog, we will refer to the group of Botulinim neuromodulators as Bot-NMs.

According to American Society of Plastic Surgeons, Bot-NMs are the single most common aesthetic procedure performed in men and women in the US. A large percentage of the users are young women between the ages of 25 and 35, comprising nearly 30-40% of patients.  However, a recently increasing amount of men are receiving Bot-NMs as well. Both men and women today are more health conscious – and want to look as good as they can.   

Bot-NM is most commonly administered to the following sites:

1) Forehead wrinkles.  Horizontal wrinkles (or creases) along the forehead that are seen at rest and with movement can often be reduced with Bot-NMs.

2) Glabellar folds or wrinkles. These are wrinkles noted best when frowning and they occur right where the nose and forehead meet in between the eyebrows.  Treating this area can allow for a more “relaxed” look.

3) Crow’s feet.  These are the wrinkles that form around the corner of the eyelids and are most prominent when one smiles.

Physicians that are experts in using Botox can also use it for other parts the face to achieve slight elevations in the brow positions (referred to as a Botox Brow Lift) and treating eyelid asymmetries.  It can also be used to treat “bunny lines” around the side of the nose most noticed when smiling, lip wrinkles (referred to as smoker’s lines) and the help change the appearance of the corners of the lips as well.

 

How many units are typically injected?

This all depends on the physician and their personal experience with the product. Each botox vial is 100 units of botulinim toxin, and this can be diluted in however fashion.  Although the diluation is different, the total number of units to each area is still the same.  In my practice,  treating a typical glabellar or crow’s foot area ranges 20-40 units. For Dysport the potency is a little less than Botox so usually two times the units are required. 

 

What to expect from Bot-NM?

Physician communication is vital since excessive Bot-NM can result in the overdone look which was fairly common in its early use over 10 years ago.   The desired look is often a natural look resulting in reduced wrinkles at rest and during facial expression; although, maintaining some visible signs of facial expressions are important to a natural look. Expressing your desires to the physician are key.

Ask your physician about the Bot-NM process and whether they provide topical anesthesia (usually applied 40 to 60 minutes before procedure) or other ways to reduce the pain that is involved with the injection. With my experience, ice compresses to the regions of application 5 minutes before the procedure is sufficient and provides an excellent source of pain control and reduces the incidence of bruising that can often occur. The procedure usually  takes a few minutes.

Headaches can occur especially if it’s the first series of injections that you receive and when the injection is often placed too deep. 

How safe is Bot-NM?

Bot-NM is used to treat a variety of different medical conditions such as blepharospasm (uncontrolled blinking of the eyes), and migraines, excessive underarm and palm sweating.

Bot-NM procedures are non-invasive, which means there is no surgery involved.. Facial expressions will remain the same for the most part. There is little to no recovery time after a procedure. It is safe to have multiple Bot-NM procedures performed, plus Bot-NM procedures cost much less than other, invasive cosmetic surgery choices.

Over a period of time, the effects of Bot-NM gradually wear off, and the muscles return to their normal state. Because it wears off, it is safe to return for more Bot-NM injections every three or four months in order to keep smoother, younger looking skin.

Is it okay to be administered to young patients?

Bot-NM is safe to be administered to young patients that are healthy but show some early signs of wrinkles.  Some plastic surgeons do not feel it is appropriate to inject Bot-NM prophylactically to prevent wrinkle formation. However, this is often done especially to young 20 year-old women. Patients should be counseled about the role of Bot-NM and wrinkle formation and whether it is an appropriate procedure for them. 

 

Aesthetic Blepharoplasty and Fat Grafting to Lower Lids

Here I am performing an upper and lower lid blepharoplasty.  Once I have achieved the desired outcome in the lids, I prepare to perform the final step which involves stem-cell fat grafting to the lower lids. This allows for an optimal improvement in the tear-trough depression that often persists when they are not separately addressed. There are various ways that this area of the lids can be addressed, either through fat repositioning, skin or muscle redraping, or fillers.  Furthermore, there are various types of fillers that can be used; this particular patient wanted to use her own body's stem-cell fat to achieve this goal.

So what is Oculoplastic Surgery?

Oculoplastic Surgery is a speciality that blends in the two fields of plastic surgery and ophthalmology to allow for the best result in your eyelid surgery. Common procedures include blepharoplasty (eyelid lift) to remove excess skin and fat pockets from upper and lower lids, droopy eyelid surgery (ptosis surgery), brow lifting, and revisional eyelid surgery (which is often secondary to prior eyelid surgery, aging, or sun-related changes). Oculoplastic Surgery is also termed Ophthalmic Plastic and Reconstructive Surgery. There is only a handful of surgeons that have undergone this specialized type of training.

Untitled

So what is Oculoplastic Surgery?  Oculoplastic Surgery is a speciality that blends in the two fields of plastic surgery and ophthalmology to allow for the best result in your eyelid surgery. Common procedures include blepharoplasty (eyelid lift) to remove excess skin and fat pockets from upper and lower lids, droopy eyelid surgery (ptosis surgery), brow lifting, and revisional eyelid surgery (which is often secondary to prior eyelid surgery, aging, or sun-related changes). Oculoplastic Surgery is also termed Ophthalmic Plastic and Reconstructive Surgery. There is only a handful of surgeons that have undergone this specialized type of training.

Welcome to Dr. Zoumalan's new blog!