Cosmetic Surgery

Lasers in Tattoo Removal: Which Laser is the Best?

November 5, 2013 by Dr.Deepak 5 Comments

Although there is no any lasers that is 100% efficient in removing tattoo. Several new laser techniques are being tried for tattoo removal. Among them Q-switched lasers seems to work well and is quite effective in removing tattoo. Being said that, you should be aware that there are several limitations of lasers.

The effectiveness of your laser tattoo removal will depend on several factors like, the correct use of laser by your professional based on several factors like your tattoo pigment, size, its complexity and your skin color. Multiple color tattoos will need variety of lasers of different wavelength, single laser may not work. There is no guarantee that your tattoo will be removed completely with out any scarring or hypo-pigmentation. It is difficult to predict about the number of treatment session that you may need for tattoo removal. It again depends your tattoo characteristic and laser used.

If you feel insecure about laser tattoo removal, you can ask for a spot test with particular laser. This will help both you and your doctor to evaluate the tattoo response to that particular laser. The tattoo can be reevaluated after a month, and if the response is good with out any complications you can proceed with that particular laser. After the laser treatment procedure you should always avoid sun in the area of tattoo to minimize the complications like scarring or hypo-pigmentation.

Depending on your tattoo pigment, your skin color and other factors, four wavelengths lasers are currently in practice which is listed below.

Ruby lasers:

The Q-switched ruby lasers at 694 nm wavelength are used to remove blue, black and green tattoos. Both Q-switched ruby (694 nm) and alexandrite (755 nm) are more effective in removing green and blue colored tattoo than with Q-switched Nd:YAG (1064 nm ) lasers.

Alexandrite Lasers:

Alexandrite lasers at 755 nm wavelength are good for black, blue or green tattoo. Alexandrite at 755 nm is excellent for black pigmented tattoo and has good success rate for blue and green pigmented tattoo too, but doesn’t work for red color tattoo or other pigments.

Double frequency Nd:YAG:

For red color tattoo, double frequency Nd:YAG lasers at 532 nm is the best option. Purple and orange colored tattoo respond good as well. However, it doesn’t work for yellow colored tattoo.

Q-switched Nd:YAG:

Q-switched Nd:YAG laser at 1064 nm is works well for removing tattoo in darker skinned patients. It is now widely used for the removal of black or blue colored tattoo.

As there is no specific pigment dedicated for tattooing and people often use multiple colors during tattooing, so it is hard for specific laser to absorb some pigments. The effectiveness of laser tattoo removal depends on the pigment. The laser pulses must be absorbed by tattoo in order to react and destroy the pigment particle. If there is no absorption there is no reaction resulting in failure tattoo removal.

As tattooing has become more popular among younger generation and several unknown ink are being used. It is wise to know the ink composition before you plan for getting a tattooing. This will help both you and your doctor to get it removed with out any complications; if in case you want it removed in future.

Does Laser Hair Removal Work?

November 4, 2013 by Dr.Deepak 4 Comments

There is a not specific laser that works perfect on every individual. However, there are several lasers that provide successful hair removal depending on your skin type, hair color. Some of the commonly used lasers are ruby lasers, alexandrite lasers, diode laser,Nd:YAG lasers and Intense pulsed light sources. If these hair removal devices are best used according to your skin type, hair color and by an experienced, well qualified professional, you may get a permanent hair removal.

Long pulsed Nd:YAG lasers are best and safest in dark individuals, whereas diode lasers and alexandrite lasers are most effective for light skinned individuals. However, permanent removal of white or blonde hair may still be unsatisfactory with such lasers. Blonde, gray or white hairs are not sensitive to most lasers, as hair must have pigment to be treated effectively, and blonde and white hair have very low melanin pigment in their hair follicles. Being said that, its not that easy and quick to remove hair in dark skinned individuals because of excess melanin interference.

To overcome such problems chromophores are currently being tried that is absorbed selectively by hair follicles and provides temporary target for laser treatment. But, problem still may arise because chromophore may not penetrate into all depths of the hair follicles. That is why it is always wise to seek experienced and well qualified professional for your hair removal, so you may not encounter those problems in expert hands.

There are no any quick hair removal methods; every laser hair removal treatment needs at-least 4-6 treatment session at 6-8 weeks interval, depending on your skin type, hair color and the good hands of the professional performing your hair removal with selective laser for your skin type. Yes, laser hair removal works perfectly if chosen wisely.

What to Choose – A Closed or Open Rhinoplasty Surgery

August 19, 2013 by Zenisha Leave a Comment

Cosmetic procedures have become so common in recent years, as people have started using it to change the way they look and feel. One of the facial features that some have started to change is the nose. The surgery of the nose is medically known as rhinoplasty. The cosmetic procedure on the nose is something that should only be done by an experienced surgeon. It takes a long time for the surgery and it should only be done by those who really need it. In terms of the rhinoplasty procedure, there are two common methods which include open rhinoplasty and closed rhinoplasty. Throughout the rest of this context, we will look into both types of methods and see which is best for most.

Open Rhinoplasty

With the open rhinoplasty cosmetic procedure, the surgeon would begin by making an incision on the near exterior nose. An incision is usually made on the columella, which is what splits your two nostrils. Since the cut is made near the outside, it is very common to notice some minor sign of surgery. The surgery works this way because the cartilage becomes visible and allows for the surgeon to make changes with the tissue. It has been known that this method causes some level of swelling. One disadvantage may be that the extra dissection during open rhinoplasty may result in weakening of the intrinsic support mechanisms of the nose. So there is possibility for the nose to change its shape and size during the healing phase. To overcome this issue, your surgeon will use specific grafts to support the structure.

You should consult with your medical professional before making your decision, but open rhinoplasty is usually best for patients who require a complex operation. Surgeons usually like to see the cartilage when performing the surgery, which allows the surgeons to better visualize the anatomy in an undistorted way that helps to make a better diagnosis of the anatomical problems that need correction. If the incision and suturing is done properly, the scar is almost invisible. There are a few advantages to this open rhinoplasty approach.

Closed Rhinoplasty

With the closed rhinoplasty cosmetic procedure, the incision would be made on the inside of the nose. With the incision on the inside, it allows the scar to be on the inside, rather than being visible on the outside. Depending on the complexity of the nose surgery you need, it may be possible to use this method. The closed rhinoplasty method is usually reserved for those who require a simple procedure requiring a few adjustments. No matter how experienced a surgeon may be, it is very hard to carry out major nose work using the closed rhinoplasty method.
Closed rhinoplasty procedures are usually done on people who have an overall good nose structure. This method would be used to remove very minor detail on the nose, but not to reconstruct the nose. With this cosmetic procedure, patients would experience far less swelling, a quicker healing period and requires less time in the operating theatre.

Before you make your final decision, you should consult with your medical professional and surgeon to see which method is best for you. Both technique can yield equally good result if performed carefully, no one technique is superior to the other. An experienced rhinoplasty surgeon can use either technique. The choice of either open or closed rhinoplasty will be based on the most appropriate method that can help achieve the desired result. Most major nose work is done with the open rhinoplasty method, as it is the best possible method for the best result.

Laser Hair Removal Facts

August 13, 2013 by Dr.Deepak Leave a Comment

Unwanted hair is a universal cosmetic problem. Many traditional hair removal methods exist, including shaving, tweezing, waxing, bleaching and some chemical depilatories. Although these methods are effective, inexpensive and simple, but are unacceptable to many men and women, as none of them are permanent and it have to be done on daily or weekly basis. Furthermore these methods may be painful and may be complicated by folliculitis, hyperpigmentation and scarring. Only electrolysis can give you the permanent solution, but the method is very impractical for the treatment of large areas and needs highly qualified professional.

Recently several lasers and other light source have bee developed and approved that specifically target and destroy melanin in the hair follicles while avoiding damage to surrounding skin. These lasers are able to treat large areas in relatively short time with permanent removal.

Some lasers that have been used for laser hair removal:

Normal mode ruby lasers (694 nm)
Normal mode alexandrite lasers (755 nm)
Pulsed diode laser (800 nm)
Long pulsed Nd:YAG lasers (1064 nm)
Intense pulsed light source (590–1200 nm)
Q-switched Nd: YAG lasers
Carbon suspension–Q-switched Nd: YAG laser
Photodynamic therapy

Is Laser Hair Removal Permanent ?

Effectiveness of laser hair removal is strongly related with hair color, skin color and laser device used. Research has shown that fair-skinned people with dark hair are most likely to obtain permanent hair removal in relatively few sessions of hair removal depending on the device used. However, people with blond grey or white hair are unlikely to obtain permanent hair removal because of low melanin in their hair follicles. While dark skinned type may not be treated completely because of the melanin interference. To overcome those difficulties chromophores are currently being tried which is absorbed selectively by hair follicles and provides temporary target for laser treatment. But, problem still may arise because chromophore may not penetrate into all depths of the hair follicles. Several treatment sessions may be required to obtain permanent result.

You should always discuss with your doctor if you have the following history:

History of herpes simplex
History of hypertrophic scarring or keloids
Recent medications like accutane or any photosensitizing agents
Any previous treatment that you have tried
If you are treating hyperhidrosis (excessive abnormal hair) condition causing this should be identified like hormonal, familial, any drugs intake or tumors.

Preparation for your Laser Hair Removal

Things you should remember to obtain effective, permanent laser hair removal and to avoid complications

Strict sun avoidance and used of broad spectrum sunscreen is advised at-least 5-6 weeks before laser, if you are planning to remove on sun exposed parts.
You should not wax or pluck your hair at-least 6 weeks before treatment.
If you skin is dark or suntan, bleaching cream may be used with doctor consultation 6-8 weeks prior to treatment to obtain effective result.
Shaving and depilatory creams may be used 1-2 days before the treatment.
If you have herpes, you may start prophylactic antiviral with doctor consultation.
You may also start oral antibiotics if required, especially if laser treatment includes perianal and nasal areas.

Laser Hair Removal Treatment Day

You should be free of any makeup and cosmetics and the area to be treated should be clean. Before the procedure begins topical anesthetic cream are applied and covered with plastic wrap for around an hour or so, to make sure you won’t have any pain or discomfort. Your treatment time may depend on the size of the area to be treated.

After Treatment Care

Ice packs may be applied to reduce pain and minimize swelling
Although pain medications are not required, you may take if it’s hurting you.
If you were on prophylactic course of antiviral or antibiotics it should be completed.
If there is any epidermal injury, you doctor may advice topical antibiotics ointments twice daily.
If redness or swelling persists your doctor may prescribe mild steroid cream
You should strictly avoid scratching the area
Strictly avoid sun and use sunscreen of atleast SPF 30
Makeup may be applied the next day if you don’t have blisters or crusts.
You make notice shedding of hair casts during first week after treatment, this is absolutely normal and not a sign of hair re-growth. The hair follicles damages during the treatment process continue shedding for a week.

Laser Hair Removal Side Effects

Swelling and redness is common in all individual and usually lasts a day or two.

If you have history of herpes, herpes simplex outbreak may occur if you had not taken prophylactics already before treatment.
Long term side effects like permanent scarring and skin change are rare.
Temporary skin darkening or lightening may occur which will be back to normal gradually.

Laser hair removal is a million dollar business, so many online and offline services are available claiming for a permanent solution. Be warned not to follow any fake advertisements or testimonials and promise that give. Always go with a reputed and well experienced dermatologist or a cosmetic surgeon. It is your complexion; don’t ruin it for some cheap laser hair removal or fake services.

Getting Rid of Eye Bags with Laser Surgery

August 11, 2013 by Zenisha 1 Comment

Our eyes say a lot about us, as it is one of the predominant features of our face. From facial expressions to distinct eye correlation, people can really understand someone using their eyes. For many people, the eyes are one part of the face that begins to show several signs of aging, whether it may be baggy eyes or dark circles under the eyes. The signs of aging will vary from one person to the next, but people will begin to notice changes throughout their mid 20’s. This occurs when the skin under the eye becomes so lose, that it has begun to hang rather than stretch.

The most commonly known reason as to why someone may experience these baggy eyes or dark circles is due to sunburn. Exposure to the sun is by far the most harmful for our skin, so it is crucial that you wear the proper concentration of sunscreen lotion. Additionally, the region below our eye lid has a certain amount of fat in them, as this is completely normal. When you drink or eat anything that contains high levels of sodium, it would cause the fat portion under the eye lid to absorb more water content. Increased water causes baggy eyes and people choose to remove it through cosmetic surgery.

With the proper laser surgery treatment, you would be able to get rid of puffy eyes, bags under the eye and dark circles below the lid. Through laser surgery, the bags would be removed without any incision. The laser beam is strong enough in draining fluid content within your body. The lymphatic system in our body is responsible for removing fluids in the tissue layers, so when you drain the fluid from below your eye lids, it goes into your secondary tissue layers. At this time, the lymph system takes action and begins draining the water content from within your tissue layers.

Certain lifestyle changes have also been known to help with removing eye bags. Some of the things you can do to make sure that you are on the right track are; changing your sleep pattern or position. This is sometimes a short-term issue for some people as they just have not been getting enough sleep. When you have a fever or are very sick, it would also cause you to have puffy eyes. Before treating any of this through cosmetic surgery, it is important that you find out whether there is an underlying issue causing any complications. For many people, lifestyle changes have actually worked effectively, which then required no work at all.

Laser surgery is done with a high sensitive low power beam, which is safe to use around the eyes. A cover would be placed around the eye, to ensure that there are no reflections on your eye. In getting rid of eye bags, you should always consult with your dermatologist to know whether you have sensitive skin that may get a reaction to the laser treatment. For most people, laser surgery works with no apparent side effects, as you are given medications for post-reactions.

What Should You Know About an Eyelid Cosmetic Surgery?

August 4, 2013 by Zenisha 1 Comment

When you meet someone, regardless of whom it may be, the first thing you do is make eye contact. Seeing their eyes gives you an overall impression of the other person. If your eyelids are sagging or have wrinkles, it may be noticeable to those who have close communications with you. This happens as you age, or it may occur in some just naturally. The medical term for eyelid lift is blepharoplasty and it is not too common in our society, but many people do consider it as an option to make changes to their appearance. Depending on what you need changed; the eyelid surgery could be done on the bottom or top eye lid.

There are a few types of eyelid surgeries that can be carried out, but again, it depends on what you want as the final result. The first type of eyelid surgery is known as transconjunctival blepharoplasty. Transconjuctival blepharoplasty or lower eyelid blepharoplasty is for those patients who have bags or puffiness under the eyes. It is useful in removing the excess fat of the lower eyelid. This procedure is performed by making a small incision inside the eyelid which leaves no visible external scars. This technique may sometimes be combined with several other techniques depending on the amount of skin excess, wrinkles and line of the lower eyelids and laxity of the lower eyelid.

The other type of surgery is known as double eyelid surgery, sometime referred as Asian blepharoplasty, which creates a natural crease in the eyelid that appears when the eyes are open, but not when they are closed.

With the use of an eyelid lift, you will really be able to change the facial expression of your face. Some people have eyelids that really give a bad impression of them, and this surgery can help turn that around. For some, the sagging eyelid may cause blurry vision, and this procedure may be what they need, in order to start seeing clearly again. Pricing for an eyelid lift will vary between the various cosmetic surgeons, so it is important to get a quote from various doctors. A cosmetic procedure such as this one will not be covered by your medical insurance, so everything would have to be out of pocket. The pricing will include all the medications that will be given to you.

You should be considered as a good candidate for eyelid surgery before the surgeon will even consider you. A good candidate is someone who is in good health, no any chronic diseases, blood disorders etc. The recovery period after the eyelid surgery will vary from individuals to individuals, but the average time is about six to eight weeks. For a week, following the surgery, you should not look at direct light. Doctors recommend that patients wear an eye patch or dark sunglasses. Additionally, no physical work should be done for a week, as you don’t want to pull any nerves. Contacts should be avoided for the same period of time.

So, if you’ve got fat skin, loose skin or sagging skin over your eyes; this may be the right type of cosmetic procedure for you. Again, you should consider speaking with your medical professional and surgeon before making the final decision to go through with the surgery. Consider all the possible benefits of eyelid surgery and see if it is something you would like to go through with.

Sclerotherapy for Spider and Varicose Vein Removal

August 2, 2013 by Dr.Deepak 1 Comment

Although recent advance in laser vein removal technology has given various options to treat spider veins and varicose veins, sclerotherapy still remains the primary treatment of choice. Sclerotherapy procedure involves injecting a sclerosing solution directly to target vein. The solution causes the vein to collapse with scarring which usually fades after several weeks. In some cases it might take months and multiple sclerotherapy treatment may be required.

There are various classes of sclerosing agents available that are used for spider vein removal or varicose vein removal . These agents includes detergents (Polidocanol, Sodium tetradecyl sulfate, Sodium morrhuate, Ethanolamine Oleate), Osmotic agents (Sodium chloride solution with dextrose, Hypertonic sodium chloride solution) and Chemical irritants (Polyiodinated iodine, Chromated glycerin). The most commonly used agents are hypertonic saline, sodium tetradecyl sulfate, polidocanol, and chromated glycerin.

Are You the Right Candidate for Sclerotherapy?

Not all patients may be a good candidate for Sclerotherapy. Sclerotherapy is usually indicated for the following reasons:

Pain, burning and night cramps
Major perforator reflux
Lateral venous system varicosities
Major tributaries of greater and lesser saphenous veins
Cosmetic purposes to improve the appearance of spider and varicose veins

Prior to sclerotherapy, your dermatologist will examine your veins with details past and present history of any disease and decide if you are a good candidate for Sclerotherapy. Sclerotherapy is contraindicated if you have the following:

Pregnancy ( can be done after pregnancy)
Known allergy to sclerosing agent
Arterial obstruction
Reflux at sapheno-popliteal or sapheno-femoral junction
Obesity
Non-ambulatory patients
Deep Vein thrombosis

Sclerotherapy Side Effects and Complications

Although Sclerotherapy is a safe procedure, few complications may occur which will subsides within few weeks.

Bruising may occur immediately after procedure which will clear within few days.

Swelling or edema may occur after procedure which can be managed and prevented with compression stockings.

Post Sclerotherapy hyperpigmentation: This is a common complication which clears within 6 months, may rarely persist for a year or more. Bleaching agents (hydroquinone), exfoliants (retinoic acid, trichloroacetic acid or phenol), Cryotherapy, and other laser treatment may help improve the pigmentation, but studies shows these agents have limited success in treatment of post Sclerotherapy hiperpigmentation. Few studies have shown Q-switched ruby lasers have excellent outcome.

Telangiectatic Matting: It refers to the appearance of new groups of fine telangiectasias at the site of previously treated veins. This usually resolves spontaneously within 3-12 months time.

Cutaneous Ulceration and Necrosis: Cutaneous ulceration may occur with all the sclerosing solutions, even if it’s on the hand of skilled dermatologist. Sclerosing solution may sometimes leak out into the skin through the small puncture sites of vessel cannulation and cause necrosis. This is usually managed and prevented by injecting normal saline in a ratio of 10:1 over sclerosant into the leakage site.

Allergic Reaction: Some people may have allergic reaction to the sclerosing agents but this is usually uncommon.

Superficial Thrombophlebitis: Superficial thrombophlebitis is a rare complication of Sclerotherapy, although recent reports indicated that the incidence is higher than previously suspected. It can be managed by leg elevation and the use of compression and regular use of aspirin or other nonsteroidal anti-inflammatory medications.

Pulmonary Embolism: Pulmonary embolism is extremely rare complication. It has been associated with injection of large quantities of sclerosing agent at a single site.

What is Cryotherapy and How Does It Work?

August 1, 2013 by Dr.Deepak Leave a Comment

What is Cryotherapy?

Cryotherapy, also known as cryosurgery, is one of the popular dermatologic procedures. It is cheap, easy to use and gives good cosmetic result. Because of its fewer side effects, ease of use and good results, it has been the treatment of choice for many of the skin lesions like seborrheic keratosis, actinic keratosis, skin tags, warts, molluscum contagiosum, dermatofibroma etc.

How does Cryotherapy works?

Though there are several cryogen liquids, liquid nitrogen is the most commonly used cryogen because of its low boiling point and ease of use. Cryotherapy is done in doctors’ office and need no special preparation. Your doctor may apply liquid nitrogen with the help of spray gun, a metal probe or a cotton bud. When liquid nitrogen is directly applied to the lesion for few seconds, as per required depth and area of freeze, the targeted tissue is frozen resulting is tissue injury. This procedure lasts few seconds and need no local anesthesia. For more extensive and large lesion local anesthesia may be applied prior to procedure.

After the skin has frozen, it turns white and it takes 2-3 minutes to thaw to normal skin temperature. Rapid freezing and slow thaw causes maximum tissue damage and is most suitable for the treatment of malignancies. While, rapid thaw causes fibroblasts to produce less collagen, which is more useful in the treatment of hypertrophic, keloids or benign skin lesions in areas prone to scarring.

As cryotherapy treatment causes our skin’s basement membrane to separate, this results in blister formation. The area that has been treated is most likely to blister within few hours. Blistering may be associated with clear, read or bloody fluid inside it, which is normal and harmless. Some individuals may experience mild to moderate pain at the site following the treatment. Oral acetaminophen or other NSAID’s may be taken if pain persists for longer period.

After few days blister dries up and scab forms. No any special treatment is needed during healing process. Just make sure to keep the area clean. You may gently wash the area once daily. If the procedure is done on the area of repetitive friction, dressing to the wound may be done to avoid trauma. Although secondary infection is rare, please consult your doctor if you experience pain, swelling, redness and discharge from the site.

The scab on the face usually peels off after a week, while, it may take 2-3 weeks for hands and even more 2-3 months for the scab on the lower limbs, as healing is often slow on the lower limbs.

Is Cryotherapy Safe for Everyone?

Although well tolerated with less side-effects cryotherapy is not for everyone. Cryotherapy is not suitable for patients with cold tolerance, cold urticaria, cryoglobulinemia, history of Raynaud disease and pyoderma gangrenosum. Please talk to your doctor about your present and past history if you have any.

Cryotherapy Side Effects

Although safe, cryotherapy may still leave hypopigmentation, especially on dark skinned individuals. Complications can be divided into 4 sub-groups:

Immediate
Delayed
Prolonged but temporary
Permanent

Immediate complications may include mild headache, blister formation and pain in the site.
Delayed complications may include hemorrhage, infection, and excessive granulation tissue formation. Infection although rare, is more likely to occur on lower legs as it takes more time to heal on lower limbs.
Prolonged but temporary complications include pigmentary changes (both hypopigmentation and hyperpigmentation), change in sensation and milia which gradually fades after few months.
Permanent complications are very rare but include nerve damage, alopecia, atrophy, keloids, scarring and hypopigmentation.

How to Minimize Pores with Laser Treatment?

August 1, 2013 by Avinav Leave a Comment

Are you struggling to get by with everyday activities with the fear that people may notice your large pores? For some people, this is a cosmetic issue worth addressing, as it could lead to other skin conditions in the future; primarily acne. When you have large pores, it makes it easier for infections, bacterium and makeup particles to seep into your skin. Once particles get beneath your primary skin layer, it may or may not cause skin reactions. Large pores are essentially openings on your skin, which may look like depth spots. The cause of large pores is still unknown, but much of it has been linked to DNA, genetics, exposure to the sun and increased bodily oil production.

A laser system is used to minimize large pores, as incisions do not help at all. Part of the treatment is done manually as well, through a process known as resurfacing. Prior to the treatment, you would be asked to completely wash down your face with warm water. When you face has been dried, a numbing cream would be applied about an hour before the procedure. The one hour wait time is to ensure that your skin and its pores absorb the contents of the cream. After an hour of waiting, the cream would have set well into your skin, so it is removed and laser treatment will begin. In most cases, the cosmetic procedure for treating large pores only takes about fifteen minutes.

The recovery period is only a few hours, as there is no real pain involved. You can get back to your everyday dealings right after treatment. However, even after your treatment; you will still not have all the sensation back on your face as it takes about an hour more to completely lose its effectiveness. Since a laser treatment was used on your skin, it may show a little redness or swelling, but it usually disappears after two to four days. During this time, the doctor may give you a prescription medication to ease the swelling and redness on your skin. One thing you need to remember is that makeup and lotions should be avoided for a few hours after treatment!

Through various sessions that are spaced out every two to four weeks, you would notice a change in the size of your pores. If you had wrinkles or lines on your face, this laser surgery treatment would have made it better as well. Since the laser beam imposes heat on your skin, it allows the sebum glands to become fully lose and tight again. When this happens, your skin would be less likely to show signs of aging. Going to the appointment sessions after your laser treatment is important, as this is how you will minimize your pores. Depending on the extent of the treatment, your costs will vary as well, so that is something you should definitely consider looking into!

Can we Reverse Facial Ageing with Chemical Peels?

July 31, 2013 by Dr.Deepak 1 Comment

As we age, our skin undergoes several changes like wrinkles, fine lines, loss of radiance, hyperpigmentation, smoothness, skin tone and sagging of the skin. These manifestations are due to natural aging process and other environmental factors like excessive sun exposure, smoking, stress and various other factors. These skin changes can be treated by several skin resurfacing cosmetic surgery procedures, such as dermabrasion, chemical peeling, and laser skin resurfacing.

While laser skin resurfacing and dermabrasion are comparatively expensive, chemical peeling has become widely popular among the people for facial aging. Chemical peels have been used for many years for skin surface resurfacing, superficial scars and treating irregular pigmentation. Chemical peeling is safe, simple and cost-effective procedure if done with well-trained professionals.

What is Chemical Peeling?

Chemical peeling is a procedure where your skin texture is improved by controlled applications of one or more exfoliating agents to the skin. These agents cause controlled destruction of the layer of skin leading to exfoliation of the skin surface. As skin exfoliates, regeneration of the new skin surface occurs with much improvement in texture and surface abnormalities.

There are several types of chemical peeling agents and the classification of chemical peel is usually based on the level of injury and expected depth of penetration into the skin.

Superficial Peels: Epidermis to upper papillary dermis
Medium-Depth Peels: Papillary dermis to upper reticular dermis
Deep Peels: Mid-reticular dermis

Superficial Peels

Superficial peels are used in the treatment of mild photo-aging, acne, actinic keratoses, solar lentigines, and pigmentary disorders. Superficial peels have minimal effects on wrinkles and deep furrows and requires several treatment session (weekly or monthly) before desired results can be seen. These wrinkles and deep furrows improvement may be possible with medium or deep chemical peels.

Superficial Chemical Peeling Agents
Trichloroacetic acid (TCA)10%-25%
Jessner’s solution (Lactic acid+Salicylic acid+ Resorcinol+Ethanol)
Modified Unna’s resorcinol paste
Solid carbon dioxide
Alfa-Hydroxy acids
Salicylic acid
Tretinoin solution

Medium Depth Peels

Unlike superficial peels which usually requires multiple treatments, medium depth chemical peels are done as single treatment procedure. These peeling agents causes epidermal necrosis and significant dermal injury, resulting in increased collagen production during wound healing process over the next several months. These peels are used in the treatment of mild to moderate photo-aging, wrinkles, actinic keratoses, solar lentigines, epidermal growth and other pigmentary disorders.

Medium-Depth chemical peeling agents

Trichloroacetic acid (TCA) 35%-50%
Solid CO2 and 35% TCA
Jessner’s solution and 35% TCA
70% Glycolic acid and 35% TCA

Deep Peels

Deep peels are used in the treatment of moderate to severe photo-aging and advanced wrinkles. These chemical peels destroy the epidermis and progressive layers of the dermis and have extended period of healing following treatment.

Deep peeling agents:
Although, one may also use 50% or greater concentration of TCA to achieve this result, Phenol, a keratocoagulant is the only deep peeling agent widely used. The Baker’s formula for the preparation of phenol peel includes;
Phenol USP 88% – 3 mL
Croton oil – 3 drops
Hexachlorophene (Septisol) liquid soap – 8 drops
Distilled water – 2 mL

The medium-depth chemical peels and deeper chemical peels are now being replaced by laser treatment like laser skin rejuvenation.

Though the procedure is generally safe, complications may occur. The risk of side effects and complications increases proportionately with the depth of the chemical peeling agent. Superficial chemical peels are usually associated with the lowest risk of adverse reactions, whereas medium-depth peels can cause pigmentation disorders and sometimes scarring. Phenol peels are further associated with hepatic, renal, and cardiac toxicity.

Side Effects and Complications of Chemical Peels

Persistent erythema
Infection
Milia
Dyspigmentation
Textural changes
Fibrosis and scarring
Cardiac, renal, and hepatic toxicity (associated with phenol peels)