Over the past ten years, anti-aging facial procedures have become increasingly popular, sometimes surpassing traditional plastic surgery in terms of demand. Minimally invasive procedures can help maintain a youthful facial appearance with little time and low risk of complications. Chemical peels are one of the most popular non-invasive skin rejuvenation procedures, and each type of peel has specific indications for improving facial aesthetics. But, despite the simplicity and reliability of the procedure, complications after peeling can occur even for an astute and experienced cosmetologist. The task of the doctor – perform the procedure correctly and safely.
Chemical peels cause damage to the skin, followed by re-epithelialization, which ultimately improves the appearance of the skin by improving its texture, eliminating pigmentation and refreshing tone. Peeling components penetrate to different depths of the epidermis and / or dermis, depending on the chemical composition, concentration and / or duration of the peeling action, and are applied to open skin areas.
Types of chemical peels and features of their application
Superficial peels (e.g. glycolic acid (HA) and salicylic acid (SA)) are used as adjunctive treatments for acne to improve penetration of topical agents, relieve post-inflammatory hyperpigmentation, and reduce the appearance of superficial scarring.
Depending on the concentration of trichloroacetic acid (TCA), peeling can be superficial or median, and is effective for the treatment of skin photodamage (including actinic lesions), melasma and acne scars. Combination peels such as Monheit (Jessner's solution combined with trichloroacetic acid) and Brody combinations (a combination of liquid carbonic acid and trichloroacetic acid) can be used for deeper penetration to help improve the appearance and texture of skin with more pronounced wrinkles.
It is important to remember: TCA peels, how to neutralize the danger
Types of complications after chemical peeling
Chemical peels are becoming increasingly popular for facial rejuvenation, either alone or in combination with other minimally invasive treatments, but complications can occur after peeling.
Complications after peeling can be as follows:
- prolonged erythema and pruritus,
- delayed wound healing,
- infections,
- textural changes in the skin,
- acne or milia induction,
- pigmentation changes such as post-inflammatory hyperpigmentation or hypopigmentation,
- scars.
Deep chemical peels (such as phenolic peels) necessitate specialized care in some cases, such as pacing, because phenol can disrupt blood circulation due to its cardiotoxicity.
The clinician should fully evaluate the patient's Fitzpatrick skin type and take a detailed history focusing on possible prior sun exposure, including any history of burn blistering, suspected skin cancer, isotretinoin use, presence of keloids, likelihood post-inflammatory hyperpigmentation or poor wound healing, severe herpetic infection of the face or lips.
Erythema and pruritus are a normal reaction to re-epithelialization, which usually resolves in 30-90 days, depending on the depth of the peel. This complication is easily relieved by application of cold wet gauze or cold compresses when needed, administration of antihistamines, keeping the skin hydrated with non-irritating emollients similar to petroleum jelly or emulsifying creams.
Deeper peels (eg, phenol and TCA > 30%) or combination peels may require anti-anxiety medications (eg, benzodiazepines) or oral sleeping pills (eg, zolpidem, trazodone, or doxepin) for those who experience excessive great restlessness during healing.
Persistent erythema is a common complication in deep and combined chemical peels, especially if several components are used. The correct setting in the patient's expectations becomes extremely useful when he knows well what to expect in the post-peel period. Erythema can be easily treated with topical corticosteroids in combination with skin emollients, sun protection.
If severe erythema, itching or pain persists for more than 3-7 days after peeling, then it is necessary assess the likelihood of contact dermatitis or infection (fungal, viral, bacterial). If induration occurs due to erythema, this may indicate the upcoming formation of scar tissue. In this case, injectable or topical corticosteroids may be needed to prevent scarring.
important to remember: Phenol Peeling: Risks and Complications
Scars are the most severe complication after peels and are fortunately rare (reported to occur in less than 1% of cases after median peels). Higher concentrations and multiple components of any peel should be used with caution as this method is more likely to lead to complications. Application of peeling on the area around the eyes or on other areas of the skin – not on the face (for example, on the neck) may be associated with more serious complications after peeling.
Scars are most common in the lower part of the face due to active facial expressions during wound healing. Avoiding isotretinoin at least 6 months before peeling may reduce the risk of scarring. Strategies for scar management include the use of occlusive dressings (eg with silicone gel), triamcinolone injections into the lesion, laser treatment, radiation procedures, surgical excision.
Depigmentations such as hypopigmentation or hyperpigmentation can occur after peels of any depth and are more likely in patients with Fitzpatrick skin types IV-VI. Hyperpigmentation is often temporary and is the result of post-inflammatory changes, but the use of bleaching creams (such as those containing hydroquinone, kojic acid, azelaic acid, and/or ascorbic acid) and sun protection can help prevent it.
Interesting: What can chemical peeling do in skincare
Hypopigmentation is a manifestation of the destruction of melanocytes during deeper chemical peels. A two-week excimer laser treatment may be an option for facial hypopigmentation resulting from chemical peels. Testing before using the product at least 2-4 weeks before superficial and median peels, the correct choice of product according to the individual scheme for each patient can help to avoid unnecessary pigment changes.
Bacterial and viral infections are rare in association with chemical peels. Reactivation of the herpes simplex virus can be prevented by antiviral prophylaxis with valaciclovir 500 mg twice daily, starting 2-3 days before the procedure and ending 7 days after the procedure. Bacterial infections such as staphylococcal folliculitis are usually the result of poor wound care or predisposing factors such as acne or eczema. If a complication occurs after peeling, it is possible to treat the skin with empiric antibiotic therapy (for example, cephalosporins or doxycycline).
Acne may occur during the re-epithelialization process and can be treated with oral antibiotics, topical azelaic acid, low-dose steroid injections, or low-dose isotretinoin if needed.
Thus, early recognition of peeling complications when they occur is of paramount importance in preventing the long-term effects of chemical peels.
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