Case report: complications after phenol peeling in the periorbital area

Chemical peels – an indispensable tool in the arsenal of a modern cosmetologist. Different compositions allow you to control the depth of penetration of active substances and eliminate problems that arise in certain layers of the skin. Sensitivity, redness, infections, scarring, post-inflammatory pigmentation – examples of complications that can occur after peelings even for experienced professionals. This article estet-portal.com describes a case from the practice of Dr. Xavier Gudarzyan (Xavier Goodarzian): dealing with complications after phenol peels in the periorbital area.<

• Complications after peeling: a patient's story
• Plan and results of treatment of complications after phenol peeling in the periorbital areaand

Complications after peeling: a patient's story

A 52-year-old female patient came to Dr. Gudarzyan with complaints of skin laxity, especially in the area of ​​the upper and lower eyelids. As a solution, the author offered the patient a

mosaic chemical peel:

in the periorbital area –
• phenolic;
in other areas of the face –
• Medium TCA Peel.

Before peeling, the patient's skin was cleaned, disinfected with alcohol and degreased with acetone. The procedure was carried out in accordance with the

protocol provided by the manufacturer.

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On

3rd day after peeling, predicted:

general swelling of the face and periorbital zone;
darkening of the skin of the face;
drying of crusts in the periorbital region;
mild erythema.

On

8th day after the procedure, no complications were observed. The doctor advised the patient to start using sunscreen (SkinTech Melablock with SPF 50).

On

day 11 there were no more crusts in the periorbital zone, however, the author noticed abnormally long healing and re-epithelialization in the medial portions of the eyelids.

To stimulate healing and prevent infection in these areas, the doctor prescribed

fusidic acid ointment. After 4 days, complete epithelialization of problem areas was observed. To reduce the severity of erythema, the doctor recommended that the patient use cream for skin care after peels IPLase, and also continue to apply sunscreen daily.

On the 20th day after peeling, thickening, erythema and hypertrophy appeared in three medial areas of the lower right, as well as the upper and lower left eyelids.

However, during a routine examination

on the 20th day, the patient complained of red spots around the eyes. The author identified three clear zones, which were characterized by induration, erythema, and slight hypertrophy. They were located in the medial areas of the lower right, as well as the upper and lower left eyek.

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Plan and results of treatment of complications after phenol peeling in the periorbital region 

To reduce inflammation and the risk of scarring, the author prescribed a

topical corticosteroid (Betnovate) to be applied twice daily to the affected areas.

After 4 days, the degree of redness was significantly reduced, and the lumps became less noticeable. However, to enhance the anti-inflammatory effect, the doctor injected 0.13 ml of

triamcinolone (Kenalog) intralesionally into the affected areas.

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In addition, for two weeks, the patient received

red light therapy (Dermalux LED) daily for two weeks. After completing the course of LED therapy, the following were prescribed:

• topical steroids (twice daily);
• topical silicone gel Kelo-cote (twice a day).

After

2 weeks the size of the hypertrophic areas decreased by half. The doctor injected another 0.12 ml of Kenalog and recommended continuing local therapy according to the above scheme.

After 1 week, the size of the hypertrophic zones decreased by a further two times. The doctor recommended continuing

topical therapy (topical corticosteroid and silicone gel).

After 3 weeks, the author injected another 0.17 ml of

Kenalog into the affected areas, after another 3 weeks – 0.05 ml Kenalog.

A little more than three months after the start of therapy, the signs of erythema and scarring have completely disappeared, the skin texture continues to improve.

4 weeks later, the author performed a

microneedling at a depth of 1 mm over the entire periorbital area. The procedure was repeated after 1 and 3 months to further improve skin texture.

Complications after peels: prevention and treatment

Patient on the 20th day after chemical peel, 1 and 3 months after the start of combination therapy complications (photo – Dr Xavier G clinic, taken with VISIA Complexion Analysis system)

A little

more than three months after the start of therapy for complications after phenol peeling in the periorbital region, the doctor and the patient were completely satisfied with the result – signs of erythema and scarring have completely disappeared, skin texture continues to improve. Patient applies sunscreen. daily

According to

Aesthetics.