Chemical peeling as a practical method for removing rhytides of the upper lip

Exoderm—A Novel, Phenol-Based Peeling Method Resulting in Improved Safety

Exoderm is a newly developed chemical deep-depth peeling method that has been shown to exhibit excellent results in the treatment of a broad spectrum of aging-skin defects. The new formula is devoid of common undesired effects, such as cardiac arrhythmias, long-lasting erythema, depigmentation, and scar formation. Our experience with more than 4000 patients attests to the safety of the method. Exoderm compares favorably with other surgical and nonsurgical procedures for facial rejuvenation.

Outcomes assessment of combination face lift and perioral phenol-croton oil peel

BACKGROUND

Face-lift surgery when combined with perioral phenol-croton oil peel is an underappreciated tool for face rejuvenation. The procedure results in significant central face skin tightening and wrinkle reduction.

METHODS

A retrospective review of 47 consecutive patients who underwent simultaneous face lift and perioral peel was performed. The objective measures used to evaluate the change in appearance of the patients included (1) a validated patient satisfaction questionnaire, (2) an evaluation of apparent age, and (3) an evaluation of perioral wrinkles by independent reviewers using a validated model. The assessment of apparent age was performed as follows: preoperative and postoperative photographs were shown randomly to six reviewers, who were asked to estimate the patient's age. The apparent age was compared with the patient's actual age, and the reduction in apparent age was calculated. Improvement in perioral rhytides was evaluated by using the Glogau classification system (range, 1 to 4).

RESULTS

Survey results documented overall patient satisfaction, which was rated as 6.5 on a scale of 1 to 7 (with higher scores indicating greater satisfaction). Patients' postoperative apparent age estimate was 8.2 years younger than their real age (p=0.0002). The Glogau classification system score demonstrated a mean reduction of 1.15 (3.3 preoperatively as compared with 2.15 postoperatively, p<0.0001).

CONCLUSION

Outcomes measurements, including patient satisfaction, objective evaluation of wrinkle improvement, and significant reduction in apparent age, document the power of this technique.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

Lasers in skin resurfacing

Laser skin resurfacing has revolutionized the approach to facial skin rejuvenation over the last decade. It has also added an approach to managing both atrophic and hypertrophic scars. This paper will review the basic principles of laser skin resurfacing, the different lasers used, the approach to treatment and potential complications of the procedure, followed by a discussion of future prospects in the field.

Histology of laser resurfacing

The development of high-peak power or scanned CO2 lasers that precisely remove layers of photodamaged skin has provided a novel method of skin rejuvenation. Clinical data suggest that laser resurfacing provides comparable or better results than conventional methods of chemical peeling and mechanical dermabrasion, with a lower risk-to-benefit ratio. Histologic studies of the effects of these lasers on tissue have been helpful in establishing guidelines for appropriate clinical use of these lasers and insights into the mechanisms whereby facial skin rejuvenation is achieved.

Trichloroacetic acid peels revisited

Trichloroacetic acid (TCA) is a time-honored peeling agent that has no known systemic toxicity. Recent interest in reversing the effects of actinic damage has led to the utilization of combination therapies. Retinoic acid, solid CO2, pyruvic acid, Jessner's formula, and other agents have been used to increase the effectiveness of TCA and enhance peeling results. Repetitive peels with low concentrations of TCA can be effective for areas prone to scarring.

The chemical peel

The spectrum of chemical peeling encompasses a diverse group of peeling agents with the ability to produce a wide range of cutaneous burns. The most spectacular peels are produced by the phenol formulas. The physician, however, is restricted in the number of potential candidates as determined by skin color and potential toxicity. While not as impressive, trichloroacetic acid peels are an excellent modality for treatment of actinic keratoses, actinic dermatitis and lentigoes. Improvement of rhytides, skin tone, and texture can be impressive. Utilization of TCA may require repetitive peeling to obtain the desired result. With the alarming increase in the incidence of severe facial solar radiation as manifested by multiple premalignant and in situ malignant lesions, therapeutic chemical peeling has become an increasingly important procedure. The dermatologic surgeon can not only eradicate the multitude of facial lesions present but also markedly diminish the incidence of new lesions.