blueberry jessner peel
Katie,
The blueberry jessner peel is considered to be a mild to moderate
facial peel.
Heather
CHEMICAL PEELS
Having acid applied to your face probably doesn’t sound like
something you’d want done, but it is the foundation of a very
popular cosmetic procedure known as the chemical peel. Chemical
peels can give your skin a healthy, "just refreshed" look, or can be
aggressive, taking years off of your appearance. Just like other
cosmetic procedures, there is a wide range of varying chemicals used
and techniques that can be overwhelming if you have to decide which
is best for you. Fortunately, this is one area where the physician
will often guide the patient to the chemical peel most appropriate
for their condition as well as the patient’s skin type. Listed below
are some of the realistic vs. unrealistic goals of chemical peels.
This may be helpful if you are trying to decide if this procedure is
right for you.
Realistic Goals of Chemical Peels:
Chemical peels can correct (sun) damage.
They can reduce mild scarring.
You can experience a reduction or eradication of your wrinkles.
Improvement of dark skin discoloration is possible.
Chemical peels can remove excessive or stubborn blackheads.
The peel may temporarily reduce excessive skin oils.
Unrealistic Goals of Chemical Peels:
It cannot remove or reduce the appearance of blood vessels on the
skin.
It is impossible to truly change pore diameter. However, by removing
blackheads, the pores may actually appear less pronounced after
treatment.
This is not a procedure to get rid of keloidal types of scars
Chemical peels are not a facelift.
This is typically not appropriate for improving dark skin
discoloration in people of color (Asians, African Americans,
Caucasians of Mediterranean extraction, Hispanics, etc.)
There are a variety of different chemicals used for the purpose of
rejuvenating the skin in what are called "chemical peels". If the
skin condition is predominantly superficial, then a milder, less
caustic ingredient is selected. If deeply placed conditions exist,
then far stronger products with matching levels of potential
complications may be necessary.
Chemical peeling agents that perform mild or moderate peels
typically provide a safer peel that has less associated long-term
side effects. These peels work on the epidermis and possibly the
most superficial portion of the dermis (known as the papillary
dermis).
Deeper peels go midway into the dermal layer (into the reticular
dermis), almost invariably leaving a permanently lighter skin tone.
Instead of being able to tan as in the past, this lighter skin often
freckles instead. These deeper peels should not be undertaken
lightly, and you need to make sure in advance that the peel
technique will be feathered into the scalp line and performed down
the neck, possibly even the décolletage, or you may find that you
have a highly noticeable line marking the difference in your
original skin tone and the new one that is on the face.
The glycolic acid peels (ranging from 70%-99% glycolic acid
compound) and the beta-hydroxy acid (salicylic acid) peels (ranging
from 20%-30% salicylic acid in a microsponge delivery system) are
among the most effective chemical peels.
Glycolic acid peels work by diminishing the cohesion of the skin
cells (corneocytes) at the innermost levels of the surface layer of
the skin (stratum corneum), by stimulating this layer of skin in its
renewal process, increasing skin thickness, and promoting the
formation of new epidermis and new dermal collagen. This process
will result in skin shrinkage, reduction of wrinkling and "crepe-
paper-like" skin, softening of "crow’s feet," and often helping to
lighten hyperpigmentation.
The salicylic acid peels or Beta-Lift peels are effective in lifting
the topmost layer of skin by dissolving the "glue" (desmosomes)
which binds it to the underlying epidermis, triggering a "burst" of
cell division which accelerates skin cell production and shedding.
Its developer, Douglas Kligman, M.D., Ph.D.(who is the son of Albert
Kligman, M.D., Ph.D., the founder of Retin-A), developed it for the
cosmetic treatment of sun-damaged skin, hyperpigmentation (including
melasma, "liver" or "age" spots, and freckles), superficial lines,
and "weathered" or rough skin. The salicylic acid peels are often
more intense than the glycolic acid peels.
If you are currently taking or have taken Accutane within the past
six months, you are not a candidate for chemical peels. Patients
with healing wounds from recent surgery, patients with active herpes
simplex (fever blisters or cold sores) on their face, patients who
have had radiation therapy to their face (or to the area which they
wish to have peeled), or patients who have had cryotherapy in the
past month should not have a chemical peel. A tendency toward
hypertrophic or keloidal scarring may also make you not a good
candidate for a peel. It is essential that you use very effective
photoprotection after a peel; thus, if you are unwilling or unable
to do so, you should not consider having a chemical peel.
The ingredients and concentration obviously play a very big role in
determining the ultimate depth of the chemical peel. However, other
variables can make a difference such as whether a pre-peel de-
fatting preparation was performed, the amount of chemical applied,
and the length of time the chemical was allowed to stay on the skin.
Another important factor is which area will be treated. The
variations in skin thickness can affect the ultimate peel outcome.
For instance, the face usually heals far more rapidly and typically
experiences far fewer complications (such as discoloration, scar
formation and infection) than areas such as the backs of the hands
or neck.
Chemical peels are classified as being SUPERFICIAL or DEEP. The
superficial peels include the naturally occurring fruit acid peels,
or the chemical resorcinol. These peels need to be performed about
six times. The deep peels include the TCA (or trichloroacetic acid
35%) peels, which only need to be performed once.
THE SUPERFICIAL CHEMICAL PEELS:
Very Superficial:
This really isn’t a true peel, more of an exfoliation. The most
superficial layers of the stratum corneum (at the top of the
epidermis) is removed or thinned during exfoliation. Most chemical
peels have a preoperative regimen of using exfoliating agents such
as Renova, Tazorac or a strong glycolic acid cream for 2-4 weeks
prior to the actual procedure. This helps the chemical peeling
agents penetrate more deeply and evenly. The use of these exfoliants
also have the obvious beneficial properties of smoothing out
thickened rough areas, helping self tanners go on more evenly and
helping other skin rejuvenation products reach deeper tissues.
Additionally, there has been good evidence that vitamin A exfoliants
can help stimulate collagen deposition.
Superficial:
Superficial chemical peels remove skin through a portion or the
entire epidermal layer. These are the "refreshing" forms of skin
peels. They can also help with reducing the appearance of very mild
blotchy skin discoloration, remnant acne discoloration and help
cleanse the pores. This is the most common form of peel that you
would find performed in a spa or by an aesthetician. Higher levels
of glycolic acid are typically used by physicians falling toward the
Medium range.
Resorcinol peels can cause a slightly deeper peel much like sunburn.
Superficial peels do not interfere with your normal everyday
activities, so you need not take time off work or stay at home out
of the public eye. In other words, these peels are a full treatment
program over several months. The peels should be performed weekly,
as they contain a concentration of ingredients which are far higher
than those sold over the counter or applied by beauty therapists. It
is also important not to abandon this treatment prior to having had
the full course, because the treatments are cumulative and the
previous one enhances each subsequent treatment. The ideal number of
treatments is six. Several days after each of the peels, flaking or
light peeling of the skin will occur. Subsequent weekly peels have
their strength and length of application adjusted according to your
individual previous response. It may be important to combine the
regular applications at the clinic with an ongoing treatment, which
you perform yourself, using special creams, on a daily basis. After
your treatment, it is recommended that you have a peel done every 2
to 3 months as on-going maintenance.
Active ingredients used in mild to moderate chemical peels: Glycolic
Acid (AHA), Salicylic Acid (BHA), Lactic Acid, Jessner’s Peel (a
combination of salicyclic acid, resorcinol and lactic acid mixed in
ethanol), Resorcinol, TCA (Trichloracetic Acid) TCA is used in a
variety of peeling regimens such as AccuPeel and the Obaji Blue Peel.
THE DEEP CHEMICAL PEELS:
The superficial peels extend 0.06mm to the papillary dermis, while
the deep chemical peels extend 0.45 mm to the upper reticular
dermis, causing extensive shedding of the upper skin layers. Your
skin will look as if it has had a very severe sunburn, so most
patients choose to remain at home and out of the public eye for 5-7
days. However you are welcome to leave the house, as long as you
don’t go out in the sun at all, exercise heavily causing excessive
sweating, or move your facial muscles more than absolutely
necessary, as this may cause premature peeling of the skin resulting
in scarring. Your skin needs to be pre-treated for two weeks prior
to the procedure, with Retin-A cream and hydroquinone cream. These
creams prime the skin, and prevent hyperchromasia (darkening)
occurring after the peel. The peel consists of a high concentration
of trichloroacetic acid (TCA), which burns, when applied. For this
reason, it must be applied in an operating room under very
controlled conditions, so that treatment can be given to help
prevent any pain. During the peel, your skin will blanche (whiten)
and then turn pinkish in color. Over the next few days, the skin
will peel extensively. It is important not to pick at it. You will
be given clear instructions on your follow-up skin care program at
home. Seven to ten days after the procedure, you will be advised to
continue using hydroquinone cream, and permit the use of makeup once
all the scabs have healed.
These complications can occur with the application of chemical
peels:
Excessive redness and peeling of the skin
Infection
Hypopigmentation (lightening of the skin color)
Hyperpigmentation (darkening of the skin color)
Scarring
Active ingredients used in deep chemical peels: Baker’s Phenol.
Medium:
This type of peel goes through the epidermis, down into the upper
most portion of the dermis known as the papillary dermis. Medium
peels are the level when complications are more likely to start. In
addition to the pre-peel use of exfoliants, the use of a skin
bleaching agent, such as 4% hydroquinone, and a broad-spectrum
sunscreen a month prior to the procedure, may be added for more
aggressive forms of these peels, or for patients who already suffer
from some form of skin discoloration. Inflammation from this level
peel may temporarily produce an increase in skin tone. Medium peels
are typically not appropriate for people with darker skin tones or
of ethnic background again due to the risk of irregular pigmentation
following the procedure.
Dealing with infection preventatively is important here. For non-
buffered glycolic acid and more commonly TCA peels, the use of
antiviral medication (herpes prevention) started before the peel is
performed is very helpful. The use of antibiotics is sometimes also
used. It is absolutely CRUCIAL that you not pick at the peeling skin
during the healing phase. This is a sure way to end up with an
infection and long lasting problems such as scarring or skin
discoloration. Often the use of emollients during the first few days
is incorporated in addition to the continued use of sunscreen, and a
very mild cleansing agent. Make-up is often avoided until the skin
has fully peeled away. Buffered peels such as the M.D. Forte
Glycolic Acid peels that range from 70-99% do not cause the type of
significant noticeable peeling that you can see with peels such as
AccuPeel. However, a series ranging from 6-12 Forte peels compared
to usually 1 of the AccuPeel are utilized. Skin sensitivity, degree
of skin concerns, time down, and cost will determine the selection.
Examples of chemicals used for a medium peel include: Glycolic Acid
70%+ (non-buffered), TCA 35-70%, combination peels such as solid CO2
followed by medium strength TCA, and glycolic acid followed by TCA.
Deep:
This peel goes through the epidermis, papillary dermis and into the
deeper portion of the dermis known as the reticular dermis. These
peels are not a simple procedure. Absorption of the active
ingredient, phenol, has been known to cause cardiac arrest and even
death. Patients who undergo phenol peels should be placed under
general anesthesia and on full cardiac and pulmonary monitoring.
This is one of those procedures that emergency back-up is going to
determine the outcome if something goes wrong. An anesthesiologist
should be present, and preferably have this procedure done in a
surgical setting, not just a room adjacent to the doctor’s office.
The down time from this procedure is obviously the longest, 2-3
weeks is generally required before you want to be seen in public.
Due to the depth of the peel leaving deeper tissue exposed, there is
an increase in photosensitivity to the sun.
Examples of ingredients used in deep peels include: Baker’s phenol
alone or under occlusion by tape.