Chemical peeling

1. COMPARATIVE STUDY OF
PHENOL BASED CHEMICAL PEELING
Dr. Vijay SharmaDr. Vijay Sharma
PresidentPresident
Federation of Restorative and Cosmetic SurgeryFederation of Restorative and Cosmetic Surgery
Mumbai, INDIAMumbai, INDIA

2. Introduction
Chemical peeling or chemoabrasion means superficial destruction of epidermis
and upper layer of dermis with the help of 'cauterent' applied to the skin.
Chemical Agent:
I use the basic formula given by Baker (1962),
Contents:
Phenol (I. P.) 3ml
Distilled Water 2ml
Liquid Soap 8 drops
With and without craton oil.
In this series of 127 cases 53 were treated with the same formula (chemical
agents with craton oil), rest all the patients were treated without craton oil.

3. Mode of action
Mode of action is a most similar to emulsification of Dermis. The Coagulatory
activity of Phenol destroys the epidermis and upper layer of dermis which
remains in position as a scab and new growth of edpidermal cell, takes place
within 5-7 days while dermal regeneration occurs within 2-3 weeks.
Destruction of epidermis and upper layer of dermis results into the removal of
rough, pigmented, uneven skin, new epithelisation of epidermis with diffuse
tightening gives a smoother look. This firmness and elastic quality of skin are
because of thickening of dermal papillary layer due to horizontally oriented
collagen fibers; pinkness of skin can be explained by increased vascularity.
Microscopic studies to check the depth of penetration of phenol by measuring
the width of coagulated layer, which peels off in the form of fine scab, a depth
of 0.3 to 0.5 mm was observed in this series of study.

4. Histological Changes:
Histological studies have shown equalization of architecture of the collagen
tissue in the dermal layer as well as reduction into the quantity of Melanin
granules in the basal layer of epidermis.
Indication:
Sr. No Indication No. of cases No. of sittings
1 Fine wrinkles due to
ageing
57 One
2 Acne marks 12 Two
3 Deep acne marks 27 Two
4 Small pox marks 7 Two
5 Deep small pox marks 17 Three
6 Abnormal pigmentation 7 One

5. Technique or Procedure:
A combination of tranquilizer and analgesics are given before fifteen minutes
followed by small dose of Pentothol.
The face washed thrice with the help of Savlon (Chlohexidine).
Application of Antibiotic ointment for the eyes.
Single application of fresh Chemical solution over face-skin , followed by no
dressing and continues blowing of air over the face is the standard procedure
utilized on all these patients.Postoperatively sedatives were used frequently.
Next day onwards application of dry "Neo-sporin" powder over the face till the
scab comes off from the face. It takes around 7-12 days on an average.
In my series I have not applied any type of dressing or paper tapes over the
operated area. A cool breeze of air over the face by fan, helped the crust to dry
up faster.
Immediately after the application of chemicals, the coagulation of the protein in
the skin layer shows a white coloration of the skin followed by light brown
colour within first three days.

6. PRECAUTIONS:
I always give special instructions to be obeyed strictly and honestly as follows:
From Day One of Operation till scab peels off:
1. Avoid talking, chewing or unnecessary jaw movements
2. Take only liquids with the help of a straw
3. Ensure a continuous flow of cool air over the face to keep it as dry as possible.
4. Use a LISTERINE mouthwash twice daily or as advised.
5. Take the prescribed medicine regularly.
6. Cut your nails short and wear hand gloves at night to avoid unconsciously
scratching at your face in your sleep.
From the day after peeling to 24 weeks:
1. Avoid exposure to direct sunlight and/or a running T. V. screen or sharp / bright
electric light
2. Wash your face very gently and dab it dry with towel as shown to you by your
doctor. Avoid rubbing it with the towel
3. Apply a protective layer of moisturizing cream over your face at frequent
intervals.

7. COMPLICATIONS:
Sr. No. Complication Percentage
1 Irritation
(a) With Catlar & Sleep Anaesthesia
(b) With Anaesthesia
3%
89%
2 Edema 98.4%
3 Post Operative Itching 37%
4 Delayed peeling (more than ten days) 18%
5 Abnormal Pigmentation after peeling
(a) Within six weeks
(b) Within six to eighteen weeks
(c) After twenty-four weeks
4.2%
1.34%
2.1%
6 Dissatisfaction 9%

8. PHENOL TOXICITY:
Amount of phenol used for chemical peel does not have any toxic effects on
patients unlike those seen after systematic absorption in large doses. Phenol
has got the basic toxic effects on kidney, liver, medullary centre and
myocardium, in the form of vasomotor collapse, convulsion, respiratory failure
and sometimes death can occur if immediate treatment is not given. This
mainly occurs with the heavy doses of phenol injection or large burns through
carbolic acid.
In this series of 127 cases, entire face was covered and no ill effect was
observed in the postoperative period.
Spectrophotmetric studies were done to check the systematic absorption of
phenol one hour after the peeling, which revealed an average 0.54-milligram
per 100ml of blood level, of phenol.
None of the case had faced any serious toxic symptoms other than occasional
immediate postoperative palpitation and tachycardia. Few of the patients
showed the transient urinary signs like albumin, urea and granular casts after
an interval of 2-4 days. All the patients had under gone complete medical
checkup before and after the surgery.

9. Conclusions:
Chemical peeling is a good skin surface leveling technique for selective
patients who have wrinkles, uneven skin surface due to acne marks, or
smallpox lesion, it has got limitations of staging with deeper uneven surface.
Sr. No No. of Cases Percentage of Success
1 Fine wrinkles due to ageing 57 68.9%
2 Acne marks 39 36.4%
3 Small-pox 24 43.7%
Some important precaution of avoiding exposure to the light is must, and
no smoking. In certain percentage of patients, hyperpigmentation due to
lack of care by exposing to light or smoking has been observed and once
the pigmentation is developed then it may take a long time to go, for which a
repeat peel can be advised only after 24 weeks.

10. Result of two sittings of Chemical Peeling at a interval of 6 months for uneven
skin surface due to multiple acne pits.
Results

11. Result of one sitting of Chemical Peeling at a interval of 6 months for uneven
skin surface due to small pox scars.
Results

12. Result of one sitting of Chemical Peeling for uneven pigmentation of skin
surface
Results

13. Result of two sittings of Chemical Peeling for uneven pigmentation of skin
surface
Results

14. Result of three sittings of Chemical Peeling at an interval of 6 months a each,
for uneven skin surface due to small pox.
Results

15. Result of three sittings of Chemical Peeling at an interval of 6 months a each,
for uneven skin surface due to acne pits.
Results

16. Thank youThank you
Dr. Vijay Sharma, M.D.
Mumbai, INDIA