Chemical Peels | Cosmetic Surgery Affiliates

Okay, so this time of the year as it gets into fall and there's less daylight and exposure to UV light, a lot of people are taking this opportunity. They're either covered up and bundled up inside to consider facial rejuvenation. And the range of procedures that often can help people during this time are non surgical and surgical. I like to think of it very simply as that there are structural changes that happen with age due to loss of fat, depositing of fat, and ptosis or fall or drop of certain tissues.

And so in those cases, those really do require a surgical restructuring. And so we're going to leave those today and just talk a little bit more about the non surgical procedures. Now, non surgical may imply to some, oh that's so much easier to recover from. And oh no big deal. Lunch time this, breakfast that. And I just say that is not a very accurate way to look at these procedures. Some of these can be incredibly powerful. And as well as the recovery can be significant.

So I like to think of it as climbing a ladder. And so we've got the first rung of the ladder and we come onto our ladder and we grab on to it. So what's on that first rung, the entry level procedure which is non surgical. These things include management of skin which may include alpha hydroxy acids, salicylic acids, even glycolic acids, retinoic acid, or retinols that are included in comprehensive medically guided skin care regimens. These are things that should be done on a daily basis and done throughout life. That sounds like a heck of an expenditure. Well, I have to admit it is. It is. If you added up a real lifetime and gosh forbid if I did that in all the things that I do, I'd probably stop doing all the things I've ever done.

But the reality is if people are looking for an improvement of quality of skin and that translates to an improvement of well being, self esteem and how one carries themselves throughout life, then this is an expenditure well made. So when a person thinks of management of skin they really should think of a daily regimen which is as simple as possible but yet effective. Now when people start skin care management really important they understand what often happens is people start down a pathway and they give up. They say I hardly see a difference after thirty days. Well, let me just give you a little clue. You're not going to see much of a difference in 30 days. You're really not assessing the effectiveness of skin care regimens until about 120 days after you start.

So if you're going to make the commitment at all, make it for six months at a minimum. It's really your cutting yourself short. You're not giving yourself the opportunity to really see the results. This is an accumulative process. And to give it two weeks and say oh I just kind of lost interest. Well, save your money. Go on a cruise. Enjoy life.

All right. So there's skin care management maintenance. That's something that should be integral to the rest of your life. Most people started perhaps even in their early 30s, mid 30s, and continue it. There are different lines. There are certain advantages of certain lines. What we're really seeing today in the lines of skin care is a minimalist approach. Where we're using less bottles, less series of product one, product two, and product three. And then the evening product four, product five, and product six. That is honorous. It's too much. It's time consuming. It's exhausting. You run out of one. You don't run out of the other.

Annoying. So what we see now is we have compilations. We've got products which are in one bottle that are in many cases mixed at the time of pressing down on the trigger. And the two products are mixed and you can apply them thus saving time, ordering, clutter on the desk, all of those things we're familiar with. But you really have to think of this as a long term plan. It's like having high blood pressure. It typically never goes away. You can't just stop your medicine. So you have to think, all right what am I going to do and how can I maintain the quality of my skin? So, that's the first rung in the ladder. The next rung in the ladder is something a little bit more involved. And with each rung in the ladder, we're seeing longer courses of recover.

Sometimes more difficult and sometimes increased complications depending on skin type. And skin type includes the degree of laxity, degree of damage, as well as coloration and pigmentation. So all of those things have to be weighed in a doctor assessment. None of these things should be prescribed over the telephone. Certainly not over watching a YouTube video. That would be crazy because the complications can really be devastating.

All right so the first run in the ladder, things like glycolic acid peels, salicylic acid peels. And what are the advantages of these? Well, they can be done in a relatively, you don't need IV sedation. You can little topical anesthetic if necessary. Many people will come in. Yet degreased. Which means you just go ahead and use the little acetone on the skin. It allows penetrants to the chemical. It's warm. But it's not unbearable at all. Patients get pretty bright as far as red because there's a heat response. As well as some irritation. And that can be repeated about once a month. The superficial peels. And this is the second rung in the ladder. The superficial peel.

But some people will go on and say well okay what's that good for. Well that's good for fine lines and wrinkles. It's good for modeled pigmentation. But deeper pigmentation, deeper lines and wrinkles as people get older, acne pitting, scars and things like that, this is not going to really affect that. It's just a feel good level which is just above going to a spa. And these are physician supervised always.

The next wrung in the ladder is what's medium depth chemical peel. These are typically trichloroacetic acids or TCA peels. And they run a rang of percentages. They can go from 10% in combination with some other chemicals, but still achieve a moderate depth peel. More aggressive and more improvement of coloration, pigmentation, hyper pigmentation, melasma, or cheek related malar, rash or pigmentation. And then you can work your way up to 35% TCA. And that is, that's aggressive. That is where you place on these chemicals. Most patients will require some for of IV sedation. And we do numb up the areas of the face. And then once the patient is nice and numb and comfortable, we do what's called a Jessner solution which allows the deeper penatrants of the chemical. And then 35% trichloroacetic acid. These patients will see a significant fluffing of skin.

It does in effect chemically cook the outer layers of skin, results in exfoliation of the epidermis. And penetrates with heat and chemical energy down into what's called the reticular dermis, through the papillary dermis. So deep, 700 microns which just about a millimeter into the skin. In doing so, what does that do? It creates a significant improvement of the pigmentation which is seen in the epidermis. Number two, fine lines and wrinkles. And third is the long term benefit. Which typically results in tightening and increased collagen formation which is the big, the goal. The real pot of gold of the treatment is generating more tight collagen in people that are thinning or have lost elasticity of their skin.

These chemical peels can be repeated typically at the absolute earliest is every three months. I would say on average people consider every six months to annual. If you really think about some stars and people that you might be well known on TV or Instagram, and you wonder how in the world does so and so's skin look so good. And it didn't just pop up. Because they did chemical peels. And they did it every year. I will speak just of one notable celebrity who's made very public her use of chemical peels. That's Jennifer Aniston. She annually has a very thorough chemical peel and feels that that has been the number one source of keeping her skin youthful into her late 40s now.

So chemical peels can be very aggressive. There's even one more rung in the ladder, higher than that. Which is laser skin resurfacing. Laser generates a great deal of heat. So there are some drawbacks to this, what we call the gold standard and the most aggressive means of improving skin tightening. We have to select our appropriate patient. If we've got very dark skin it may not be the appropriate candidate for it. We may have to use more moderate methods and repeat it. The laser however is the gold standard. And what does that mean?

It provides the most consistent, highest level of skin improvement that is available. It definitely requires IV sedation. It can be done throughout given areas, areas that require deeper penetrants for example around the eyes and maybe around the mouth. We can like a re-stat like a temperature thermostat in your house, we can adjust it up and adjust it down. And in that way treat those areas more aggressively. And other areas of lower need have less recovery. And we can turn the laser down in those areas. So technology gives us the advantage of consistency every single time we step on the pedal that creates the laser function, it does exactly what we ask. Every time. Every single time.

So the consistency is really its selling feature. And its aggressiveness. Now the down side to that is pigmentation and immediately after the procedure there can be severe pigmentation on darker skinned individuals. So we have to pre treat them for typically two weeks to one month on a special skin care lotion to minimize that effect. And then if a person does develop that post inflammatory hyper pigmentation we really have to go on and treat through a regimen for sometimes even two months to really get the pigment to calm down. In every case we've seen that occur, but it does require attention in the darker skinned individuals. But there results can be dramatic.

So that's a really nice, I hope, overview of management of skin. Integration of a skin care plan, and your options as far as treating your goals appropriately from either the first rung in the ladder, superficial peels, more aggressive peels, or the gold standard the laser.

Thank you.