Medium peels are usually performed with trichloroacetic acid. These peels are only performed once every couple of years. Medium peels have the same benefits as light peels and in addition remove larger wrinkles and precancerous skin lesions because of deeper penetration. The draw back is that a medium peel makes the skin on the face look like severe sunburn for one week. If you have multiple precancerous skin lesions this is better than using Efudex which makes the face look sore for six to eight weeks. A person having a medium peel must stay in for one week to recover from the procedure. This type of peel is also better than liquid nitrogen because it treats small precancers that are to small to be seen with the naked eye. Like a medium peel, liquid nitrogen also takes one week of recovery time but is only good for treating larger precancerous skin lesions.

Deep peels get rid of large wrinkles and can have results as dramatic as a face-lift. This type of peel has a recovery time of 1-2 months. This peel is being done less since the introduction of laser resurfacing. I do not do this peel.

Side Effects:

The first week after the peel the skin will be red and swollen. The skin will also burn and may weep slightly. Peels can sometimes cause persistent redness of the skin. The most common side effect after a peel is brown discoloration of the skin. This is usually reversible but can rarely be permanent. This side effect usually occurs only in those who have had sun exposure after their peel and who are not compulsively using sunscreen SPF 25 or higher.

If you get cold sores, a peel can cause them to flare. Since most people have been exposed to cold sores, all patients must take a prescription medication to prevent a flare.

Precautions:

If you have any of the following problems, you need to let the doctor know so some precautions can be taken: Facial Warts, Prior bad reaction to a peel or dermabrasion, Past herpes simplex (cold sores), If you have a history of sun allergies, Recent radiation treatment for cancer, If you form keloid or hypertrophic scars (thick scars), If you are now pregnant or breast feeding, Accutane use within the past six (6) months, Sun burn or significant sun exposure in the last two days, Surgery or cryosurgery within the last six weeks to the area that you plan to have treated.

What to Do Before Your Peel:

Each night before you go to bed, starting at least two weeks before your peel, you need to start applying Retin-A cream or alpha hydroxy acid lotion to the entire face and to any other areas that will be treated.

At least three to four weeks before your first peel, stop using exfoliating sponges. All forms of hair removal should be stopped at least three to four weeks before your peel.

Two days before the treatment you must start taking acyclovir 400 mg, 2 times per day or famciclovir 500 mg, 2 times per day.

Come to the office with a fully cleansed face. No cologne, after shave, or cosmetics should be applied. Also try to avoid shaving the day of your peel.

How the Peel is Done:

First, the doctor or his assistant will review the possible side effects of a peel with you and give you a consent form to sign.

Next, your skin will be cleansed thoroughly and degreased with acetone.

Jessner's solution will then be applied to one area of the face at a time. The solution will be left on the skin for several minutes. The skin will burn and tingle.

Next the doctor will apply 35% trichloroacetic acid. During this time the burning will be very intense. Cool compresses will then be applied followed by ointment. During this time the skin will begin to feel better.

What to Do After Your Peel:

For 7 days after the peel, clean the skin with warm water using Lever 2000 liquid soap. Use your fingertips since the skin is very sensitive at this time. Avoid the use of abrasive or exfoliating sponges. After washing, pat dry with a clean towel, then apply the recommended ointment. To avoid the possibility of scaring, please do not peel, pick, scrape, or scratch the skin.

Three (3) Advil, Nuprin, or ibuprofens (200 mg) are to be taken 3-4 times daily with food to reduce swelling and discomfort.

After the seven day period, start applying Retin-A cream or alpha hydroxyacid lotion to the face each night after washing the face with Cetaphil Lotion. In the morning and afternoon wash the face with Cetaphil Lotion then apply 4% Solaquin Forte.

For one week after the peel, acyclovir 200-mg, 5 times per day or famciclovir 500 mg, 2 times per day must be taken. This medication is available by prescription only. This will keep cold sores from spreading to the freshly treated skin. Failure to take this medication can lead to severe scaring. Call us immediately if you feel a cold sore coming on. You may also be given an antibiotic.

Avoid sun exposure, this includes tanning beds. Sunlight on the skin after a peel can cause brown discoloration of the skin. You must use a sunscreen of SPF 25 or higher every morning before going outdoors. Apply the sunscreen over the 4% Solaquin Forte. Good sunscreens are Presun Ultra SPF 30 gel or Ombrelle SPF 30 cream. With trichloroacetic acid peels, scarring and brown discoloration of the skin is unlikely unless you go to a tanning salon after having the treatment or lie out in the sun. Daily sunscreen use should continue indefinitely to prevent new photo damage from occurring.

You may start wearing make-up one week after the peel providing you do not have any crusting or tenderness.

If you have persistent redness in an area after the first week, let your doctor know right away. Persistent redness of the skin can lead to brown discoloration of the red area and a scar if it is not treated right away.

For at least one month after the peel, you should not have hair removed by any technique because it can cause severe irritation of the skin. Also hair removal while using Retin-A can cause scabbing of the skin.

Do not take Accutane for at least six months after your peel. There are reports of scarring in people who have taken Accutane after a peel.