Chemical skin peel

A chemical skin peel can be a dramatic rejuvenating procedure. Skin improvement gives a youthful dimension never obtainable by surgery alone. The skin looks younger because in essence younger skin is being created. It takes time and commitment but in the end your skin will be just beautiful.  Patients must be motivated and have a longterm perspective. The reward is a dramatic and longterm improvement in skin texture, which we believe is not obtainable by any other modality.


FAQs about this procedure




 

 

What is a croton oil peel?

A croton oil peel is a chemical peel. A chemical peel is a skin-resurfacing procedure in which a chemical solution is applied to skin to peel away the top layers. The skin that grows back after a chemical peel is smoother and younger.

Chemical peels can be done at different depths — light, medium or deep — depending on the depth of the skin damage. Deeper chemical peels produce more-dramatic results, but also involve longer recovery times.

Look at the diagram below to see where the different layers are and where different types of peels act on the skin. The croton oil peel can be applied as a superficial, medium or deep peel, according to the needs and the will of the patient.

TD-CP-SkinSection

The croton oil peel (also called modified phenol peel or Hetter peel) is a chemical treatment that can penetrate deeply into the skin. The croton oil peel is a specially formulated peel based on recent publications and research. The procedure is performed under general anesthesia by a licensed doctor and takes 1 to 2 hours, including preparation and recovery from anesthesia. The croton oil peels require 5-10 days of recovery depending on the depth of the peel.

The modified peel can be done on the entire face for an overall skin rejuvenation, or only in localized areas such as under the eyes for "crepey" lower lids or around the mouth to remove the vertical smoker's lines. Localized peels are possible but carry the risk that there will be a mismatch in coloration, therefore good judgment must be exercised. Localized peri-oral peels can be done, peeling to a medium depth at most. The color takes 8 to 10 weeks to blend adequately. An excellent location for segmental peeling is the eyelids.

Advantages

The Croton oil peel can cover the whole spectrum of peels, from superficial to deep. A deep peel can produce dramatic improvement in skin texture, tone, skin tightness, scars and wrinkles. This deep chemical peel is the only to truly address the textural changes of the severely damaged skin caused by sun damage, smoking and aging. When the skin re-grows, it will not “remember” the blemishes that were there before. As the new skin develops, a new band of collagen in the dermis will grow along with a thicker epidermis. The skin is really put back 10 years in time (not only in appearance but in real fact). By improving the deep structure of the skin, the Croton oil Peel results in dramatic and permanent change of sun damaged and wrinkled skin. The end result is healthier skin that is radiant, smoother and thicker. After the peel, the patient will have essentially new facial skin.

We typically use this peel as an adjunct to facelift. It enables the treatment of the vertical lines around the lips and mouth that are not affected by facelift. It is also very effective in the treatment of crepey eyelid skin that is not redundant enough for excision.


Main advantages:

  • Tighter skin—Following this peel, patients also will show between 25 – 30% facial skin tightening.
  • Less age spots and pigmentation problems
  • Less wrinkles around the mouth, crow’s feet, forehead furrows and cheeks.
    The Croton oil peels are impressive for peri-oral wrinkles (those around the mouth) and of the lower eyelids. These areas can be done isolated with much less recovery time.


 

Disadvantages of deeper peels

Deeper peeling results in a greater degree of improvement but also requires greater recovery time.

The first two weeks or so after a deep peeling, you better stay at home. For three months you will be very red. Only then it starts to get better, slowly. And you must totally stay away from the sun for half a year, or your risk compromising the result.

It takes time and commitment but in the end your skin will be just beautiful. 

Indications: Are you a good candidate for a deep peel?

A deep chemical peel is not for everyone. If you don't have much sun damage and just want a little improvement (like you would see with microdermabrasion), a superficial or medium peel is what you need. Light peels go with little or no downtime are a great option for people who can't or don't want to take time off work for healing. The deep peels are reserved for patients who are seeking significant, long-lasting effects and who are willing and able to take the time to carefully follow pre- and post-procedure care instructions.

There are many things to consider prior to having a Croton oil chemical peel.

  • Health—You must be healthy and not have medical conditions that would impair healing.
  • Of work—You must be able to commit about 10-14 days to be off of work. Patients should expect to spend 10-14 days off work, have crusting, swelling and peeling for 1 week. After that makeup can be applied and patients are able to return to work. You should plan on your recovery week to be calm and quiet.
  • Protocol—You must follow a prescribed skin care protocol before and after your peel.
  • Sun exposure—You should limit sun exposure for several weeks before and after your peel.


How do you prepare for a croton oil peel?

The best way to ensure success, speed the healing process and prevent complications such as pigmentary changes is to adequately prepare the skin before the peel. The purpose of this process is to regulate cell function and reduce the risk of postoperative alteration of pigment.
Skipping or shortening the preparation has resulted in intense and excessively long erythema.
This treatment increases the risk of sunburn. Care should be taken (shade, sunblock, etc.) to protect treated skin.
7 weeks before peel—Start preparation with ointments for one skin cycle of 6 weeks
A normal skin renewal cycle of the epidermis takes about 6 weeks (the amount of time it takes for a keratinocyte to mature, reach the stratum corneum, and exfoliate). Start with the preparation 7 weeks before the peel, stop 5 days before the peel.
This ointment regimen can result in erythematous, flaky skin that the patient must accept as a normal effect. In about 6 weeks the damaged top layers of skin are replaced by new layers of healthier cells. One or more of the following symptoms can be expected: dryness, peeling, redness, sensitive skin, itching, burning, wrinkles may look worse, acne may look worse. Such reactions indicate that the treatment is being used effectively and that the skin is responding and skin restoration is in progress. This reaction indicates the initial lack of skin tolerance, which the program is meant to build up. If the irritation is too much, you can use the cortison rescue cream, but not for more then one week at a time.
Oily skin requires proper washing to remove sebum. Mix the requested amount of ointments in the palm of your hand and apply evenly on the entire face, including eyelids, extending tot the hairline, over the ears, and ending with a feathering motion (specially in the neck). Massage until the cream is completely absorbed. Morning:  hydroquinone + sunblock + glycolic acid Evening: tretinoine + hydroquinone Mix  the ointment in the palm of your hand with the other evening or morning ointments.
  • Tretinoin Apply once daily in the evening. Tretinoin is the most important ointment of the regimen. Tretinoin has a normalizing effect on epidermal cells (keratinocytes). It also decreases epidermal melanin content and has been show to facilitate the formation of new collage in the dermis.
  • Hydroquinon—Hydroquinone is applied twice daily (morning and evening). The action of hydroquinone is short-lived. Thus, skin should be saturated twice daily. Hydroquinone is a topical depigmenting agent that specifically targets the melanocyte system to interfere with the formation of new melanin. The purpose is to suppress and regulate melanocytes to prevent postinflammatory hyperpigmentation.
  • Glycolic acid—Glycolic acid is applied once daily in the morning to help accelerate exfoliation of the upper layers of the epidermis. This will increase the effectiveness and the penetration of Tretinoin and Hydroquinone.
  • Sunblock—Apply sunblock in the morning under makeup. Reapply often while in the sun. Avoid prolonged exposure to the sun until 6 months after the procedure.
  • Hydrocortisone—If the irritation (redness, itching, extreme dryness) is too much, you can use the cortison rescue cream, but not for more then one week at a time.
5 days before the peel
The use of the ointments should be stopped 5 days before the peel to allow settling of the epidermis.
3 days before the surgery until one week after the surgery
  • Antiviral medication—The possibility of a herpetic outbreak is real and antiviral prophylaxis is routinely used. Valacyclovir hydrochloride 500 mg, one tablet administered 2 times daily is begun 3 days before the procedure and continued for 1 week after peeling.
Morning of the peel:
  • No ointments or makeup—don't apply anything to the skin the morning of the peel

Procedure

  • General anesthesia—The procedure is performed in general anesthesia with continuous heart monitoring (as phenol has the potential to cause irregular heartbeats in some patients)
  • Skin cleaning—The skin is thoroughly cleansed before the croton oil is applied to ensure an even take up.
  • Croton oil application—The peeling solution is applied to the area to be treated whereupon the skin immediately turns white or "frosted" in appearance.
  • Antibiotic and anesthetic cream—An antibiotic and anesthetic cream is applied over all the peeled areas.The remainder of the tube is placed in a container and given to the patient after the operation. The purpose is to moisturize the peeled skin to prevent crusting, to provide analgesia and to prevent infection.

Recovery and aftercare

Early phase of the recovery (7-10 days)
What to expect? The appearance on the first day can be quite impressive. The early phase of the recovery lasts 7 to 10 days as the skin gradually reepithelializes. Deeper peels may require 14 days.
  • Oozing—During this period, the skin is swollen, moist and oozing serous fluid which become crusts when drying up. Crusting may be uneven, and some areas may heal faster than others due to variable depth. Somewhere between two and seven days, you'll probably wonder if it was all worth it. Be reassured, however, that you're experiencing normal healing.
  • Swelling—Depending on the depth of the peel, you may be considerably swollen and generally unrecognizable.
What to do?
  • Take your medication—This medication will be given to you.
    • Ibuprofen—Narcotic pain medication is prescribed for postpeel discomfort. If properly managed, the peel should not be overly painful. Ibuprofen 800 mg administered three times daily is recommended
    • Medrol—To control the swelling the day after the operation we start a short course of Medrol, 4 tablets a day.
    • Antiviral medication—is to be continued until 7 days after the procedure (2 tablets a day)
  • Antibiotic-Anesthetic ointment followed by paraffine-vaseline ointment— Keep the skin constantly moisturised with the ointment to prevent drying and crusting, apply the ointment several times a day. When the antibiotic-anesthetic cream is finished, use the paraffine-vaseline ointment we gave you during your preoperative consultation. As soon as the skin is nicely healed (after 7 - 10 days) the ointment becomes less necessary.
  • Leave the crusts—Don't pick or dislodge any crusts to prevent scar formation. After your wound has completely epithelialized (grown new upper skin), you can apply coverup makeup and resume normal life activities.
  • Washing instructions—From day two onwards you can begin to shower gently. This means a very weak stream or deflecting the main thrust of the water with a hand and letting the water trickle onto the face.
Next phase of the recovery (about 2-3 months)
Stay out of the sun until any redness has faded. If you need to go out, apply a sunscreen with a protection factor of at least 25, which has both ultraviolet A and B protection. You should use sunscreen for at least six months after treatment. Always use foundation over sunscreen. Failure to do so can result in blotchy skin pigmentation requiring further treatment.
What to expect?
  • Redness—The next phase of the recovery is notable for redness due to revascularisation of the new skin, which predictably lasts between 8 to 12 weeks and is usually well tolerated with camouflage make- up. Intense erythema can be seen with deeper peels and can be improved with judicious short-term use of topical steroids.  Patients who have fared well in the first phase may now experience a paradoxical depression because they are eager to normalise their lives but may feel inhibited by the erythema.
What to do?
    • Emollient—After day seven to ten reepithalization is usually complete and the skin dries. You may apply the vaseline-paraffine ointment or an emollient free of fragnances and irratating products in areas where the skin feels really tight. The skin should be kept comfortable, not too dry, to avoid cracking, and not too moist, to avoid maceration of scab and premature skin separtion.
    • Tretinoin—After two weeks you should use the tretinoin ointment again as before the peeling. If you feel your skin cannot tolerate it yet, apply every other day until every day regime is tolerated again. Continue the use for 4 weeks.
    • Hydroquinone—Idem as tretinoin.
    • Sunscreen—Apply standard the sunscreen in the morning for 6 months. Sun avoidance is advised.
    • Makeup—Makeup can be used to cover up the redness. Always use foundation over sunscreen.
The final result won't be evident until the redness is gone.

FAQ

FAQ Before operation

I have been treated for skin cancer on my face for the past three weeks with efudex topical creme 5%. I would like to know approximately how long would I have to wait before getting a croton oil peel.

The skin needs to be completely healed and I would wait a minimum of 8 weeks. By the way, a croton oil peel may be as curative and protective as Efudex.

Can the croton oil be used under the eye area for crows feet and the under eye wrinkles?

An excellent location for segmental peeling is the eyelids. Lower eyelid skin in particular responds very well to a croton oil peeling. When peeled appropriately, the thin eyelid skin contained within the borders of the orbital rim is very forgiving, and healing is well tolerated and easily camouflaged with makeup or glasses. Another advantage of the lower eyelid peel is that it can easily be done with the patient under local anesthesia and in a gradual fashion. If a patient requests a quicker recovery, a lighter peel can be done and repeated in the future with additive effect. The lower eyelid can ultimately be peeled to the patient’s satisfaction.

This is one of the best applications of the croton oil peel and is a good starting point for those who are reluctant to begin with a full face peel.

FAQ After operation

How long do I have to wait before I can shave again?

You should wait until the skin has completely healed, which takes about 10-14 days.

A few weeks ago I had a croton oil peel. Now I have some dark spots in my face. What should I do?

These darks spots are signs of postinflammatory hyperpigmentation (PIH). This This is a frequent and transient (so temporary) complication of croton oil peeling. Permanent problems have not been seen. Best is to continue the daily application of tretinoïn- and hydroquinone-ointment that you have received from us before the peeling for 3 to 6 weeks. It will help to remove the hyperpigmentation. Also it is very important for you to stay out of the sun until 6 months after the peeling and use the sunblocker that we gave you.

You still have another question? Please let us know. We will answer your question and if generally applicable add it to the FAQ of this page.




Complications

Transient complications during recovery phase:

  • Milia or acne— Milia (small raised cysts or white spots on the face) can occur during the first 6 - 8 weeks after peeling, and may last from a few days to many weeks. Acne can also develop as treated skin heals due to previous acne or the use of oily creams on newly formed skin.
  • Dark spots—These spots are signs of hyperpigmentation. This is a transient (so temporary) complication of chemical peelings. Best is to continue the daily application of tretinoïn- and hydroquinone-ointment that you have received before the peeling, starting 6 weeks after the peeling. Also it is very important avoid long sun exposures and use a sunblocker every morning the first 6 months after the peeling.

  • Changes in skin color—A chemical peel can cause treated skin to become darker than normal (hyperpigmentation) or lighter than normal (hypopigmentation). Hyperpigmentation is more common after superficial peels, while hypopigmentation is more common after a deep peel. Changes in skin color are more common in people who have darker skin and can be permanent.Hyperpigmentation may be seen during the recovery period. It is transient and responds well to tretinoin and hydroquinone 4%. Sun protection is important in preventing hyperpigmentation, and permanent problems have not been seen when adequate sun protection is used.
  • Scarring—Rarely, a chemical peel can cause scarring, typically on the lower part of the face.