Chemical Peel

Chemosurgery

Chemical peel, or chemosurgery, is a technique for restoring wrinkled, scarred or blemished facial skin. Aesthetic chemosurgery involves application of skin which will be replaced during the healing process with a fresh, new skin surface.

Indications

Chemosurgery typically is performed to improve fine wrinkling over the forehead, about the eyelids and cheeks, and around the mouth. The extent of the procedure depends on what changes are desired and what your surgeon deems appropriate.

Preoperative Consideration

A consultation with a plastic surgeon is the first step an individual should take if considering chemosurgery. The patient should discuss candidly his or her expectations about looking and feeling better after surgery, while keeping in mind that the desired result is improvement, not perfection.Emotional stability is one of the most important factors to be established before any aesthetic surgery is undertaken. A “new” face does not your appearance and renews your self-confidence, but the rest is up to you.

After examining you, the surgeon will discuss other variables that influence the decisions involved in the procedure, such as age, heredity and various individual characteristics of the skin; and personal habits such as alcohol intake, nutrition and smoking. These same factors, to some extent, will determine how long the result of chemical peel will last. It has been found that chemosurgery is generally not as effective in treating individuals with darker, oily complexions.

Chemosurgery can minimize the effects of aging, such as fine lines and wrinkling. It also can treat the effects of superficial acne or remove other skin blemishes associated with pigmentation problems. For treatment of scarring and deep pits that often result from severe acne or chicken pox, the surgeon may recommend a surgical procedure called derma-brasion. In this procedure a mechanical device is used lo abrade, or remove, the top layers of the skin.

Chemosurgery is not a substitute for a facelift, or rhytidectomy, but rather a complementary procedure often performed in conjunction with it. Just as a facelift cannot eliminate fine vertical lines near the upper and lower lips or "crow's feet" around the outer edge of the eyes, neither can chemosurgery eliminate loose, sagging or excess skin.

In addition to explaining the surgical technique to be used, the surgeon will discuss other specific details of your case, including where the operation will be performed and what the surgery realistically can accomplish. Further factors to consider before
electing chemosurgery, such as risk and cost, should be discussed with the surgeon at this time.

Thousands of chemical peels are performed successfully each year. Nevertheless, you should he aware of the potential risks of surgery and specific complications associated with chemosurgery. Post-operative complications such as infection, scarring and abnormal pigmentation are occasionally seen. Poor healing resulting in excessive scars formation may necessitate a second operation. Risk of complications can be minimized by closely following your surgeon's advice on follow-up care during the healing process.

Fees and operative facility costs of chemosurgery vary widely depending on the length and complexity of the procedure. Additional surgical expenses will depend upon where the operation takes place and the anesthetic used.

Since chemosurgery generally is carried out on an elective basis, most insurance plans normally do not offer coverage. However, you may be able to deduct the cost as a medical expense on your income tax return. Fees for elective surgery usually are paid prior to the operation.

The Surgical Procedures
On your surgeon's recommendation you may be operated on in the surgeon's office, in an outpatient surgical facility or you may be admitted to a hospital. Before surgery, you will be given medication to alleviate tension and relieve discomfort that may occur during the procedure.

 

Hemosurgery patient , shown before the procedure with frown lines on forehead, crow’s feet and wrinkles under the eyes, and fine wrinkling around the cheeks and mouth.

When the entire face is to be treated, a chemical solutions is applied to “peel” off upper layers of skin in the shaded areas.

  
In chemosurgery, a chemical solution is applied to the areas to be treated. ln a chemical peel of the entire face, the liquid is applied to all areas except eyes, brows and lips. For many chemosurgery patients, the mouth is the only area treated. It can be done alone or in conjunction with a facelift operation. However, a full face peel cannot be done when a facelift has been performed.

A burning sensation may be experienced when the solution is applied, but should pass quickly as the chemical itself acts as a local anesthetic.

When performing chemical peel to minimize wrinkles, the surgeon usually will cover the face with a "mask" composed of strips of adhesive tape with openings for the eyes and mouth. When the peel is done primarily for skin blemishes or pigmentation problems, tape may not be used.

Depending on the extent of the surgery, the procedure usually lasts for one hour or longer.

  

In some cases, the mouth is the only area treated; it can be done in a limited fashion in conjunction with a facelift operation.

Mask of adhesive tape usually covers the face for a day or two.

  
Postoperative Recovery
After surgery, there is some discomfort that is controlled by medication. Abnormal sensations, such as itching and tingling, may be experienced as the skin heals. These sensations can be alleviated with cool compresses and appropriate medication.

If a mask has been used, it will be removed a day or two after chemosurgery. A crust or scab to protect the new skin will develop over the areas treated within twenty-four hours. It is removed by gentle cleansing with soap and water, and the application of ointments, creams, or moisturizers. A patient who was admitted to a hospital will be released at this time.

Following removal of the crust, the exposed skin layer will take on a deep red color, not unlike severe sunburn. This will gradually turn to a pinkish hue. When the new skin has been regenerated completely after several weeks, it will permanently be a bit lighter in color than it was before the surgery. Tiny whiteheads, or milia, may appear and usually can be washed away with a soap cloth. Stubborn cases can be treated quickly by the surgeon.

After chemosurgery, the patient will have tighter, smoother skin that is relatively free of blemishes and wrinkles in the areas treated.

  

A protective crust or scab forms over the face’s new skin. Creams and gentle cleansing remove the crust, leaving bright pink skin exposed. Redness subsides in several weeks when the skin is fully regenerated.

The postoperative patient with tighter, smoother skin.

  
There will be improvement in the skin as evidenced by a younger fresher appearance of the face. Swelling and puffing out of fine lines and wrinkles shortly after surgery may show more dramatic results than is the case when final healing is complete. Fine lines may reappear as the swelling subsides, but they will not be as prominent as before chemosurgery. Exposure to direct sunlight should be avoided completely for the first three weeks to prevent uneven skin tone. Skin pores may be a little larger following surgery. The skin is generally not able to tan smoothly following chemosurgery, therefore, it should be protected from prolonged exposure to the sun. Light exposure is permitted for the next several months only when the patient wears a sun blocking cream.

Although you may be up and about in a day or two following surgery, your plastic surgeon will advise you on the proper schedule for resuming your normal routine. To permit proper healing, you should refrain from strenuous activities for two to three weeks. The decision on when to return to work depends on the individual's degree of swelling and discomfort. Using cosmetics usually is permitted three weeks after chemosurgery.

This is an introduction to chemosurgery. When considering plastic surgery, you should feel comfortable asking your surgeon for any additional information you might need.


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