The newest American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) annual survey suggests chemical peels remain popular among surgeons and cosmetic patients. More than half of facial plastic surgeons responding indicated chemical peels are in strong demand.
AAFPRS President Fred G. Fedok, M.D., who practices in Foley, Ala., tells Cosmetic Surgery Times that he has been performing chemical peels since the early 1990s and has lectured and published on his experience. The most popular chemical peel at his practice, he says, is a combined medium depth 35% trichloracetic acid (TCA) and Jessner's Solution peel.
Dr. Fedok says he does the peel in the office setting, with limited or no anesthesia. He uses the peel combination to correct mild to moderately severe skin issues, such as various brown tone discolorations, including lentigenes, short-term melasma and fine to moderate rhytids.
“It will freshen the skin, improve skin tones and do limited tightening,” Dr. Fedok says.
Providers can change the medium depth peel's penetration by altering skin preparation, degreasing, changing the application time or the number of times the peel is applied, according to Dr. Fedok.
“It has a wide application regarding skin types, as well as age range,” he says.
Dr. Fedok also combines the combination peel with other chemical peel agents or laser resurfacing. For example, he might treat part of the face with less unfavorable changes with the 35% TCA and Jessner’s peel and apply a deeper acting agent, a phenol-based peel, in areas with more severe rhytids.
“I have performed similar combination treatments with lasers and dermabrasion,” he says.
NEXT: Peel vs Laser
Peel vs Laser
When optimally used, peels treat the skin surface more consistently than many devices, according to Dr. Fedok.
“Therefore, if one is treating uneven skin tones, lentigines [and] very fine rhytids, chemical peels are in many ways the historic gold standard,” he says.
But results are highly dependent on the agent used and the practitioner’s experience.
“These medical grade peeling techniques do require clinical experience,” he says.
Some of the new fractionated and minimally ablative laser devices can achieve comparable results to the peel, but it’s more expensive to use the devices compared to the low-cost alternative of peeling, according to Dr. Fedok.
NEXT: Chemical Peel Pearls
Chemical Peel Pearls
Dr. Fedok offers these words of wisdom for achieving optimal peel results.
“First, candidate selection is important. Keep in mind both the Fitzpatrick and the Glogou scales,” he says. “In this regard, your most favorable peel candidates will have lighter skin tones.”
Make realistic choices for clinical peel targets. For example, profound skin laxity may be better treated with a surgical, rather than a resurfacing, procedure.
Consider a pretreatment skin preparation with bleaching agents and topical tretinoin, and use antivirals, especially if treating near the lips.
Have appropriate informed consent via patient discussions.
Follow the patient closely post procedure.
Disclosure: Dr. Fedok reports no relevant disclosures.