Chemical lift with a phenol peel

National report - There are many different methods available for undertaking an aesthetically rejuvenating peel, practically effecting a chemical lift in patients.

Deeper peels are necessary to reach and "correct" deeper facial lines.

Rene Villedieu, M.D., an aesthetic dermatologist in Castres, France, who specializes in chemical peels, offered his know-how and insight on phenol chemical lifts.

Kacowicz method

"This multipeel effects a deep peeling, reaching as far down as the papillary dermis. I perform this peel using a phenol preparation that reduces the secondary effects seen in the classic phenols. The trick with the Kacowicz method is that I can control the depth of penetration of the peel in the skin," Dr. Villedieu says.

In order to maximize the positive cosmetic results and to enjoy the great reliability that the Kacowicz method offers, Dr. Villedieu says that the peeling must be executed exactly according to the procedural guidelines.

He adds that it is very important to inform and discuss in depth with the patient about all of the potential adverse effects of the peel, as well as the post-procedure clinical picture of the face. The patient must be psychologically prepared for the clinical picture of the desquamation that results from the peel. This may last for approximately 10 days following the procedure.

Multipeel procedure

The multipeel kit is made up of a pre-peel soap, a phenol solution, a catalyst and an epithelializing gel.

Dr. Villedieu divides the face into five areas: the forehead, the left cheek and left temple, the right cheek and right temple, the central facial area (nose, nasolabial folds, periphery of the mouth and chin) and the neck (the area only under the chin).

After cleaning the skin with a special soap, Dr. Villedieu begins the procedure by washing the skin with acetone, concentrating on the perioral skin and the deep wrinkles to be peeled. He then proceeds to apply the phenol solution to these five areas with a cotton wool swab, waiting five minutes before proceeding to the next area of application. He also carefully treats the upper and lower eyelids with a few phenol-logged cotton swabs. He stresses the necessity to apply the phenol solution 1 cm behind the hairline as well as over the eyebrows. The expected frosting begins immediately following phenol application.

Next, a layer of catalyst is applied to the phenol treated areas and allowed to dry. Then, a layer of the epithelializing gel is applied. The gel must be applied evenly for the first two days. During this time, the patient may not wash the face. After the 48 hours, a revision is done removing any excess gel as well as the first scraps of peeled skin.

On the third day of the treatment, the patient must shower every morning without using soaps or shampoos, and only tap-dry the face very gently using a soft towel. After each morning shower, the epithelializing gel is reapplied daily for 10 days.

Dr. Villedieu says that, "After 10 days, the restoration is complete. Now the patient must be very careful to protect her skin with soft moisturizing creams and avoid direct sunlight or use appropriate sun block creams for three months."

Although this deeper peel can be done without anaesthesia, Dr. Villedieu prefers to administer neuroleptic analgesics before beginning the peeling process. He also likes to keep his patients hospitalized for two days following the procedure for close observation.

He admits though, that the follow-up with patients is not so simple, even if the pain lasts only for 12 hours and the edema for two days, post-procedure.