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  • Improvement in skin quality and texture may be seen with the use of chemical peels, laser and light devices, dermabrasion, and skin needling.

  • All approaches share the common mechanism of controlled wounding and stimulation of a healing response in the skin.

image Beginner Pearls

  • Use a pre-peel regimen of either topical tretinoin or hydroquinone cream to improve efficacy and outcomes.

  • Be consistent in application technique and document all the parameters of the treatment process (pre-peel regimen, degreasing regimen, and peel regimen) to achieve consistency and predictability in results.

  • Feather the peels around the hairline and the chin to prevent a sharp demarcation, particularly with medium and deep peels.

image Expert Tips

  • Medium-depth chemical peels are an excellent modality for the treatment of diffuse actinic keratoses.

  • Multiple studies have shown that a combination approach using a topical regimen with serial chemical peels can improve melasma.

  • Phenol peels have also been used as an adjunct to, or a less invasive alternative to, blepharoplasty.

image Don’t Forget!

  • When applying the peel, numerous parameters such as the pretreatment regimen, degreasing regimen, type of application, length of peel application, and end-point should all be considered and documented.

  • Pretreatment with topical tretinoin daily for 2 weeks prior to the procedure results in a more rapid, uniform, and even frosting of the skin compared to no pretreatment.

image Pitfalls and Cautions

  • Evaluate for any areas of inflamed skin on the day of treatment. These regions will have greater uptake of the peel solution and may create a deeper than intended reaction.

  • Be cautious when using newly opened chemical solution bottle for the first time. The clinician should be particularly vigilant about clinical endpoints. On rare occasions, the concentration advertised on the label may not accurate.

  • Avoid accidental treatment of eyebrows/eyelashes/hair when using IPL, as this device can be used for laser hair removal with longer pulse durations. At best, the inadvertent treatment of eyebrows results in a temporary loss of hair, and at worst it can lead to permanent decreased hair density.

image Patient Education Points

  • The consultation appointment is key in establishing rapport and realistic expectations, including that a series of treatments may be needed.

  • Patient selection is critical given the discomfort, extensive healing process, and potential for adverse events associated with phenol peels.


The aged appearance of the face is caused by multiple factors including skin texture and quality, volume loss, and muscle movement. These factors contribute variably in each person depending on environmental exposure and genetic differences. In fact, when comparing people of a similar age, there can be a dramatic difference in the apparent age due to these factors. Improvement in skin quality and texture may be seen with the use of chemical peels and laser and light devices. Although other modalities, such as dermabrasion and skin ...

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