๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
Introduction
CHAPTER 78 Approaches to Facial
Rejuvenation
Min Deng Brandon Coakley Naomi Lawrence Patrick K. Lee
SUMMARY
Improvement in skin quality and texture may be seen with the use of chemical
peels, laser and light devices, dermabrasion, and skin needling.
All approaches share the common mechanism of controlled wounding and
stimulation of a healing response in the skin.
Beginner Pearls
Use a pre-peel regimen of either topical tretinoin or hydroquinone cream to improve
efficacy and outcomes.
Be consistent in application technique and document all the parameters of the treatment
process (pre-peel regimen, degreasing regimen, and peel regimen) to achieve consistency and predictability in results.
Feather the peels around the hairline and the chin to prevent a sharp demarcation,
particularly with medium and deep peels.
Expert Tips
Medium-depth chemical peels are an excellent modality for the treatment of diffuse
actinic keratoses.
Multiple studies have shown that a combination approach using a topical regimen with
serial chemical peels can improve melasma.
Phenol peels have also been used as an adjunct to, or a less invasive alternative to,
blepharoplasty.
Donโt Forget!
When applying the peel, numerous parameters such as the pretreatment regimen,
degreasing regimen, type of application, length of peel application, and end-point should all be considered and documented.
Pretreatment with topical tretinoin daily for 2 weeks prior to the procedure results in a
more rapid, uniform, and even frosting of the skin compared to no pretreatment.
Pitfalls and Cautions
Evaluate for any areas of inflamed skin on the day of treatment. These regions will
have greater uptake of the peel solution and may create a deeper than intended reaction.
Be cautious when using newly opened chemical solution bottle for the first time. The
clinician should be particularly vigilant about clinical endpoints. On rare occasions, the concentration advertised on the label may not accurate.
Avoid accidental treatment of eyebrows/eyelashes/hair when using IPL, as this device
can be used for laser hair removal with longer pulse durations. At best, the inadvertent treatment of eyebrows results in a temporary loss of hair, and at worst it can lead to permanent decreased hair density.
Patient Education Points
The consultation appointment is key in establishing rapport and realistic expectations,
including that a series of treatments may be needed.
Patient selection is critical given the discomfort, extensive healing process, and
potential for adverse events associated with phenol peels.
CHAPTER 78 Approaches to Facial