World renowned cosmetic surgeon Dr.Vijay Sharma - A specialist in Chemical peeling, Facelift,liposuction,breast augmentation,buttock lift,Hair transplantation

CHEMICALS PEELS

      It doesn't help much that wrinkles are known by such face-saving euphemisms as "smile lines" (which suggest a lifetime of good belly laughs), or "crow's feet" (which imply experience and maturity), or "brow furrows" (which might indicate years of deep concentration). You want them off your face anyway.
      And today there is an extensive menu of treatment options to remove not only wrinkles, but also other skin imperfections such as patchy pigment spots (also known as 'age spots') and scar irregularities.

FOR MEDICAL EDUCATION

One of the most aggressive of these options is chemical peeling or the 'Chemi-Peel' as it is known. It involves applying an acid solution to the skin that results in a controlled burn. As the layers of old skin flake off, the new skin that is laid down is smoother and firmer.
Chemosurgery' is particularly suitable for treating fine lines or shallow wrinkles such as those around the lips, near the eyes (crow's feet) and fine creases in the cheek area.

IS A CHEMICAL PEEL FOR YOU?

      The ideal patient for a chemical peel has been described as the fair-skinned person with multiple fine wrinkling brought on by years of sun exposure,
• Deep peels, in particular, are not recommended for darker-skinned or even olive-skinned people    (Asians or Hispanics, among others). In the dark-complexioned, the treatment often leaves red or    dark blotches along with whiter spots. Usually this discoloration fades after several months, but it    could last for several years.
• Those with heart or kidney disease are poor risks for phenol peels because the chemical causes    irregular heartbeats, especially if too much is applied too fast or the body can't flush it out quickly    enough. (TCA does not have this drawback).
      That is why, pre-surgery, a complete history, physical examination and urinalysis must be done to rule out infection or damage to the kidneys. Phenol is known for its deleterious effects on the kidneys even in normal healthy persons, particularly if it is applied so rapidly that too much of it enters the bloodstream. If the fine kidney tissue is destroyed due to high concentration of phenol before it can be eliminated, the patient will develop uremic poisoning.
      All plans for chemosurgery must be abandoned if the pre-operative screening shows evidence of abnormal kidney function or disease.
• Chemosurgery must also be avoided by all patients who have diabetes or liver disease.
• In those who have herpes simplex, the trauma can cause the virus to flare up, leading to painful    sores or even vision damage if the corneas become infected. (Taking the drug, acyclovir, before
   and after the procedure, may however ward off the virus).
• Those who scar easily or who develop thick "keloid" scars are at higher risk of being marked by
   the chemicals.
• The phenol peel carries substantial risk for patients with certain qualities of skin, such as skin
   which has undergone radiation treatment or which has suffered burns. Such skin lacks
   regenerating cells and will not heal well after chemical treatment.
• A person with poor nutritional status could suffer delay or complications in the healing process
   and should avoid any type of chemical peel.
• If your problem is sagging facial skin and/or deep wrinkles, a chemical peel will not get rid of
   these for you. Your procedure of choice should be a face lift (which will excise excess skin and    smooth out deep wrinkles), followed by a peel to improve shallow lines and wrinkles that still    endure.

YOUR CHOICE OF PEELS

      Depending on the condition of your skin, and the results you're looking for, you have a choice of three kinds of chemical peels:
      I. The Phenol Peel known as the deep peel, uses phenol as the active ingredient in a chemical mixture that penetrates not only the skin's superficial upper layer (the epidermis) but also the topmost layer of the lower-lying dermis. The chemical penetrates to a depth of 0.3 to 0.4 mm, producing first- and second-degree burns.
      The phenol peel has been used by surgeons - with varying degrees of success and disaster - since the early 1900s.
      The burning action of the phenol is self-limited by the fact that, as it penetrates, the acid combines with proteins in the skin and coagulates to form a barrier that prevents deeper penetration. It is this barrier, therefore, that prevents third-degree burns from occurring. (When phenol is diluted, it is absorbed all too soon by the skin before perfect coagulation has taken place. Thus, dilution increases the danger of adverse reactions.)
      The acid is applied usually under a sedative or a general anaesthetic (if the patient is anxious or nervy).
      The application, using a cotton applicator or brush, is done slowly and deliberately to avoid too much of the phenol being absorbed too rapidly by the skin.
As the skin is stroked lightly with the chemical solution, it first blanches and then becomes red and swollen. The sharp, stinging sensation that the patient initially feels disappears in minutes since the phenol itself has an anaesthetic effect.
      After the application is complete, the surgeon may use a mask of adhesive tape over the entire treated area; the purpose is to delay drying, thus prolonging the period of action of the chemical.
Six to eight hours after the tape mask has been applied, the face becomes swollen, the eyelids frequently swell shut. This is expected and is relieved with cold compresses. The pain lasts for the first several hours after the application, and is treated with painkillers.
      For the first 48 hours after the chemi-peel, the patient is instructed to remain in bed resting, keeping his face as immobile as possible in order not to disturb the tape mask and the underlying burn.
After 24 hours, some fluid may seep from beneath the mask. The swelling is constant, and somewhat frightening - even horrific - at this stage.
      After 48 hours, the tapes, carrying on their undersurface much of the dead outer layer of skin, are removed. This is naturally painful, and the patient requires the use of a sedative/analgesic beforehand. Removing the tape mask exposes the new skin underneath - raw, tender and red. Its surface resembles that of a second-degree burn. The new skin is dusted with an antiseptic powder, which helps to form a caked crust. After three to six days, during which the powder applications are repeated, a skin ointment is applied over the crust to soften it and hasten its separation from the face. Approximately seven days after the peel, the entire crust falls away with a gentle washing with soap and water. Many physicians at this stage use a steroid cream to reduce inflammation and soften the treated area.
      The newly-formed skin will be bright pink and abnormally sensitive to ordinary stimuli; it must be kept moist with a skin cream or oil, or else it will dry and crack. But two weeks after the peel, the patient can start using light make-up. By the end of the first month, the pinkness about the face begins to recede noticeably. The skin texture returns to normal, and at the end of three months both colour and quality of the skin should be close to normal. Until this happens, however, the patient is committed to using face make-up.
      The primary effect of the deep peel seems to be its action in realigning the loose, wavy collagen fibres of aging skin into compact, parallel strands. The dermis increases in bulk, strengthening the structural support of the skin. And blood supply to the treated area increases. The 'new and improved' cosmetic effect peaks in three to six months.

POST-PEEL PRECAUTIONS

      It is important to maintain certain precautions for upto six months following a deep skin peel:
I.) Since the peelant removes a great deal of the melanin (pigment) in the skin, a large amount of the skin's protection against the sun's rays has been lost. The peeled patient is therefore advised to avoid sunlight for at least six months, especially the mid-day sun, to wear protective headgear, and a suitable sun block. Exposure to the sun can cause permanent dark patches to develop.
      For the same reason, you'll have to avoid using birth control pills, estrogen or the photosensitizing drugs such as the antibiotic tetracycline. And women who've had peels must avoid getting pregnant.
Patches that develop if the above don'ts are ignored usually show up in the first six months after the peel, but they can develop at any time.
II.) Trichloracetic acid (TCA) Peels brush the skin with a mixture of trichloracetic acid and a bleaching agent. The procedure takes about five minutes. This is a "superficial" peel, in contrast to the "deep peel" (phenol).
      The strength of the acid must be carefully controlled; in strong concentrations, TCA carries a higher risk of scarring than a phe nol peel.
Depending on the condition of your skin, you may need just one TCA peel, or several, six to eight weeks apart.
III.) The Glycolic Acid Peel is the most recent entrant into the field of chemical peels. Because it is a "light peel" that attacks only the top few layers of skin, it's growing in popularity as a rejuvenation agent for not just the face but as a shoulder-to-shin peel - the so-called 'whole-body peel'. Its milder action means that it has fewer of the irritating side-effects and recovery time of the deeper peels -- phenol and TCA. But it also means that its cosmetic benefits are far less dramatic - it's more like a "freshening" peel that reduces fine wrinkling, coarseness and blotchiness.
      The glycolic peel uses glycolic acid, a mild-mannered substance derived from sugarcane. (This is the same substance that is used in the so-called AHA - alpha-hydroxy acid - skin creams, only the peel uses a much stronger concentration and therefore produces quicker, more effective results).
      The strength of the glycolic peel is also likely to vary, depending on whether you do it at a beauty salon, or at a dermatologist's or cosmetic surgeon's office. The salon-strength exfoliation is likely to use a 25 to 30% concentration of glycolic acid which doesn't do much for deep wrinkling and pigmentation problems. The doctor-administered peel will use a 50 to 70% concentration, under anaesthesia.
      But both, salon and physician peels, are usually recommended in a series of at least four, with follow-ups every two weeks until you're satisfied with the results.
      If you're tempted by the prospect of an unlined face but abhor the very idea of a chemical touching your face, there's now the laser peel, touted by some as the least risky.

FOR BEST RESULTS

      A chemical peel need not always be done on the entire face. You may decide to treat only certain areas, such as dark patches, circles around the eyes or pigment patches. But the application must not be done in hotchpotch fashion; this could cause a visible demarcation between treated and untreated areas. Because the new skin matures to a colour paler than that of unpeeled skin, if you treated, say, only the skin around the eyes and mouth, you could end up looking like a panda.
      Best results, especially with the deeper peels, are obtained on the face. This is because of the rich blood supply to this area and the abundantly regenerative powers of the dermis. A deep-peel treatment on the neck or limbs is more likely to result in scarring.

FOR MEDICAL EDUCATION

Both, deep and superficial peels are used to remove uneven pigmentation or (in fair-skinned people with sun-damaged skin) to remove pre-cancerous patches. But the vast majorities are done to erase wrinkles. Reputable practitioners however usually reserve deep peels for septuagenarians with substantial wrinkling.

THE COMPLICATIONS OF THE CHEMO-PEEL

      Chemical peels can have very good results on the right patient by the right physician. But - even done correctly - they aren't quick and easy makeovers. In the wrong hands such as those of someone who doesn't know the complications that can arise when you paint something as corrosive as lye on a face, peels can be quite dangerous.
      The complications of a chemical peel are much the same as those associated with a partial thickness burn:
      A minor risk is that, if the oil-secreting sebaceous glands are blocked as a result of the procedure, multiple tiny white spots appear after two to three weeks; these are cleared by lightly rubbing the affected area with a soft brush dipped in soap and water.
      l A more serious effect is hypo-pigmentation or loss of pigment, because of the destruction of the skin's pigment cells (melanocytes) by the chemicals. This is generally irreversible, although the whitened areas can, of course, be camouflaged with make-up.
      l If the face wasn't cleaned evenly and well beforehand, the chemicals may penetrate more in some places than in others, causing blotchiness
      l Swabbed over a closed eyelid, the chemicals have in some cases, eaten through to the cornea, causing distorted vision, but this is extremely rare.
      l If too much of the chemical was applied, causing deep burns, the skin will heal by scarring and possibly cause distortion of adjacent structures such as the eyelids or lips.
The chemicals used in chemotherapy can produce multiple hypertrophic (raised) scars. In a 1990 U.S. survey of 5888 plastic surgeons, 21 per cent reported that phenol scarred significantly, especially around the mouth and chin.
      To soften the scarring, steroid injections or dermal abrasion may be attempted. (See the chapter, "More Wrinkle Erasers"). But true deformities caused by chemical burns may call for plastic surgery corrections, including skin grafts.
      l Phenol toxicity is the most serious complication of the chemical peel. It can range from renal (kidney) and liver damage to poisoning of the medullary (brain) centres and cardiac muscles, which is characterised by vasomotor collapse, convulsions, respiratory failure, and ultimate death if not aggressively treated.

THE LASER PEEL

      The newest and reasonably risky - peel uses not a chemical but bursts of laser energy lasting less than a thousandth of a second to vaporize surface skin.
      Some of its users claim that the chief advantage of the Ultra Pulse Laser, as it is called, is control. Laser energy, they say, can be more precisely adjusted than chemicals that are brushed on. As a result, they report, they virtually never see the skin lightening or discoloration that is one of the possible adverse effects of a chemical peel.
      Of course, such a happy outcome is most likely to be obtained from a practitioner experienced in the use of the Ultra Pulse Laser which has been available only since 1993. And of course any doctor can legally buy a laser and do peels, so make sure your physician has had formal training in the procedure and has done at least a dozen operations.
      There is disagreement on whether recovery time in a laser peel is shorter, or longer, than in a chemical peel. And, of course, with either procedure, tanning remains a possibility during the healing period. So the skin must be protected during those 16 or so weeks with a sunscreen lotion.