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Peelings

What are chemical peelings?

The peelings are procedures capable to correct marks, spots, many of the alterations of aging and to improve the appearance and the quality of the skin.

 The peeling removes a layer, that soon is regenerated and it receives a new aspect through cells that stay in certain points of the skin and with reproduction capacity.

There are several types of peelings.  Then, one method that removes skin layers that can be controlled and dominated by the doctor has peeling effect. There are chemical peelings that use the chemical effect of substances; there are physical peeling that makes abrasions in the skin and the peeling with LASER, the Resurfacing with Laser that makes the withdrawal of the skin with the action of the luminous energy of the Laser.

In this article, we will treat more specifically the chemical peelings.

peeling

How does the Peeling act?

The skin is formed by two main layers the epidermis and the dermis. The Epidermis is subdivided in 5 very thin layers: Extratum, Corneum, Lucidun, Granulosum, Spinosum e Basale and Dermis in 2 thicker layers:  Papillary and Reticular

Dividing the two layers, it is the basal membrane, responsible for the regeneration of the skin. The basal membrane is continued by the annexes of the skin, as the pilous follicle and glands. It is the basal membrane that is responsible for the regeneration of the skin after deep peeling.

Explaining in a simple way, the peeling removes layers of the skin and it creates a cellular regeneration starting from the basal layer and from the annexes that will generate a better skin.

The peelings can be very superficial, superficial, medium and deep depending on the area of the skin that it reaches.

 Level of Peeling Layers and Treatable Problems

Level of the Peeling

Layers

Treatable Problems

     

Level 1

Very Superficial Peeling

External layer of epidermis

Peeling Very Superficial, Superior Layers of the Epidermis, very superficial spots, roughness, skin without shine, desquamative skin, skin "dries", "tired" and "battered skins"

     

Level 2

Superficial Peeling

Epidermis

superficial spots, roughness, fine rugosities, active acne

     

Level 3 –

Medium Peeling

Epidermis , Papillary Dermis and  Superficial layers

Of Reticular Dermis

Wrinkles, stains, acne scars, furrows

     

Level 4

Deep Peeling

 Epidermis, Reticular Dermis

Aging of the skin, very deep scars of Acne

The very superficial peelings act on the corner layer that is an amorphous layer, it’s very superficial and protects the skin, and on the most superficial layer of the epidermis.  A new epidermis and corner layer will regenerate and produce a softer skin.

The superficial peeling acts a little more deeply, but still in the level of the epidermis, correcting superficial alterations of the skin.

Medium Peeling acts more deeply close to dermis and it removes deeper lesions.

Deep Peeling, reaches the deepest layers of the dermis and acts on the deepest lesions, as wrinkles, laxity, spots and scars and it attenuates furrows. It is the deepest that it gets to reach in a peeling.

The regeneration always happens starting from the basal layer that is the layer with regeneration capacity. It is the peeling with the best results, but with the most complex procedure and the most difficult recovery. It is not a simple procedure. A good plan should be done before performing this type of peeling.

The general principle is that if a lesion that we want to treat is deep in the skin, the peeling should reach this depth being efficient in its elimination. If the lesion is in the surface, the peeling doesn't need to be so deep. The deeper is the peeling, more careful it should be  performed, and more cares are necessary in the after peelings, then that is not only the type of peeling, but the depth  that is applied in which determines the results and the risk of the treatment.

The freckles and the superficial melasma, as well as the light roughness of the skin are in the epidermis. The deep or mixed melasma or, the post -inflammatory hyper pigmentation, the actinic keratoses, the superficial wrinkles and the acne reach the epidermis and the dermis, and the deep wrinkles and the acne scars are in the dermis.

Then, depending at the place of the skin reached, we will have the depth of Peeling that can be efficient and she can opt for the one that will give the best result.

Then, to correct a certain problem, it should be made a certain peeling; peeling isn’t a sort of magic solution, but an excellent combat weapon to the skin problems. If it is well used and well performed, it will bring satisfaction to the patient, but exaggerating expectations should be discouraged. Then, when there is a problem, rather than seeking a peeling, it is necessary to perform a consultation, and the doctor, knowing the several peeling types, we will know how to prepare the skin and indicate the best procedures, in the appropriate moment.

The depth of the peeling depends on the applied substance that is applied; in the application technique (brush, cotton swab or gauze), in the previous preparation of the skin with topical treatments, in the preparation that precedes immediately the procedure with cleaning and oiliness withdrawal, in the skin type (thin, thick), in the location and on the duration of the contact with the skin (mainly the glycolic acid peelings). Then a lot of variability can be obtained, and the indication of peeling should be up to the doctor who knows all the possibilities.  

In a general way, the deeper is the peeling, the better are the results, but bigger are the risks and the difficulties in the post-peeling. Several agents can perform peelings, and a same agent can get different depths. Among them we have the Retinoic Acid, the Salicylic Acid, the Jessner Solution, the Resorcinol, and the Trichloroacetic Acid - TCA, Blue Peel, Alpha hydroxyl acids, Glicolic, THE Phenol, THE 5-Fluoracil, Alkapeel and others. The peelings with marks are usually variants of these materials, organized in a way to facilitate for the doctors and the patients.

The Naturale Clinic uses the Kacowicz © Method, that gathers a series of different peelings, one for each indication and that reaches all of the depths and can correct most of the treatable problems by peeling.

The freckles and the superficial melasma, as well as the light roughness of the skin are in the epidermis. The deep or mixed melasma, the post-inflammatory hyper pigmentation, the actinic keratoses, the superficial wrinkles and the acne reach the epidermis and the dermis, and the deep wrinkles and the acne scars are in the dermis.

Then, depending on the place of the skin reached, we will have the depth of Peeling that can be efficient and we can opt for the one that will give the best result.

There are also the called sequential peelings. Although we know that a sequence of medium peeling will never be a deep peeling, we also know that a sequence of medium peeling is more than an isolated medium peeling. Then for the patients with deeper lesions and who don't want to submit the difficulties of recovery of the deep peelings, we can use a sequence of medium peelings. In this alternative, we used Midpeel or Neopeel, from 3 to 4 peelings in intervals from 30 to 60 days. With that, although we don't reach the same results of the deep peeling, we can obtain a considerable improvement in a lighter way.

Another peeling used in a sequence way  is Urucum Peeling or Bleach-Pulse Urucum , applied monthly in a series of 6 sessions, with specific indications for spots and melasma.

Planning, application and expected results.

The peeling follows a series of routines that should be obeyed strictly, the results depend of them.

The individual variation is large, and only the doctor's evaluation can conclude, exactly, the best conduct, but we will try to give an idea, so that a planning is made.

The - consultation

The peeling is a medical procedure and they should be following the classic principles of the Medicine. As in any other area, also in the medical aesthetics, the doctor's examination is the beginning of any efficient programming of treatment. Each patient has a type of manifestation of their aesthetic problems that should be correctly identified for the efficient correction.

The treatments are personalized for each patient, and they should be initiate with a consultation, where will be identified the problems and guided eventual examinations to precede the procedure. After a wide explanation, it will be chosen the type of peeling to be applied; If very superficial, superficial, medium or deep.

b – The preparation of the skin.

The very superficial peelings don't need preparation, but the others depend on a preparation related to the depth. The preparation is performed with creams that will prepare the skin. It doesn't present spots in the post-peeling and so that, it heals with more easiness. The preparation phase varies from 30 to 60 days. Alkapeel and Body Peel don't need preparation, Midpeel and Neoppel preparation of 30 days and Multipeel Phenol Light preparation from 30 to 60 days. The preparation is performed with creams prescribed at the own clinic.

c - Place of Application of Peeling.

The most superficial and medium peelings are clinic procedures, because they don't need any help of painkillers to be used. Already the deep peelings need analgesic. Although they can be applied in the own clinic, we prefer to apply in our Day Hospital where there is larger safety for the patient and for the doctor.

d - The activities in post-peeling. 

Alkapeel allows immediate returning to activities, Body Peel, although gives visible action, it allows restricted activities, but with some restrictions at about 6 days. To Midpeel and Neopel, we have some restrictions of 6 days and Multipeel Phenol Light, restriction of 14 days.

e - Degree of difficulty.

The degree of difficulty of a peeling is determined by the moment of application and for the recovery.

Alkapeel is very simple, and very pleasant of being applied, and there isn’t recovery phase because the results are immediate. Body Peel and MidPeel have small application difficulty and recovery. Neopeel has a medium difficulty of application and simple recovery, already Multipeel Phenol Light has the largest application difficulty and recovery.

f – Results.

In general line, the deeper is the peeling, larger are the difficulties and best are the results. The results are proportional to the point of the skin that the peeling reaches. The best result and the most impressive is the Multipeel Phenol Light, but, because of the difficulties, they should be applied only in the most serious cases of aging.

g- Sequential Peelings.

The sequential peelings are applied in the clinic in intervals from 30 to 60 days for the medium peelings and from 3 to 4 weeks for Urucum Peeling or Bleach-Pulse Urucum.

Types of Peeling.

There are several peeling types, and then any method that removes skin layers that can be controlled and dominated by the doctor can have the peeling effect. There is the chemical peeling that use the chemical effect of substances, the physical peeling, which makes abrasions in the skin and there is the peeling with LASER or Resurfacing with Laser, which makes the withdrawal of the skin with the Laser action.

Modified Chemical Peelings.

They are the traditional chemical peelings, modified by modern techniques of chemistry, which offer advantages in use, as better control for the doctor and easiness of performance and recovery of the patient, with better results. One of the most known modified peelings is the peelings of Catalyzed Phenol from the Kacowicz© Method, which are the used at the Naturale Clinic. 

b- Kacowicz © Method. 

It is a peeling method, developed by Dr. Kacowicz, which includes the peeling of Phenol, among them the peeling of catalyzed phenol, a very known deep peeling and used all over the world and other modified peelings, besides the sequential peelings of phenol. They exist for several indications and depths. Among them, we have Alkapeel known like the  "Peeling of the Weekend", a very superficial peeling, The Urucum Peeling or Bleach-Pulse Urucum , used for treatment of spots, the Lightpeel plus that is a superficial peeling of faster recovery.  Body Peel is used for striae and alterations of the body skin. Midpeel and Neopeel are already peelings of phenol medium, used for the lesions of the face, and Multipeel in their three versions; Light, Light-Light and Catalyzed Phenol that are versions of deep peelings.

c- Sequential Peelings.

A so much used technique from the Naturale Clinic are the sequential peelings, in this alternative, we used Midpeel or Neopeel in sequence from 3 to 4 peelings in intervals from 30 to 60 days. With that, although we don't reach the same results of the deep peeling, we can achieve a considerable improvement in a lighter way. Another peeling used in a sequential way is the Urucum Peeling or Bleach-Pulse Urucum, applied monthly in a series of 6 sessions, with specific indications for spots.

Kacowicz © Method

Depth

Peeling

Characteristics

Very Superficial

Alkapeel

Alkaline

Superficial

Urucum Peeling or Bleach-Pulse Urucum

Peeling to Spots

Light peel Plus

Piruvic Acid

Medium

Body peel

Peeling for the body

Midpeel

Phenol

Neopeel

Phenol

Deep

Multipeel Light

Phenol

Multipeel Light-Light

Phenol

Multipeel Phenol Catalyzed

Phenol

Sequential Peelings

Midpell

can be used separately or in sequence

Neopeel

can be used separately or in sequence

Urucum Peeling or Bleach-Pulse Urucum

always used in sequence

Others modified peelings

Soft peel : Modified  with Trichloroacetic Acid - TCA

Mask  of ATA: Modified with richloroacetic Acid

Easy Peel: Modified with Trichloroacetic Acid

Traditional Chemical Peelings

Resorcine

Retinoic Acid

Jessner (Salicylic Acid, lactic acid, Resorcine)

Salicylic Acid

Glycolic Acid

Trichloroacetic Acid

Phenol

Physical peelings

Microdemoabrason

Dermoabrason

Resurfacing with Laser

 

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