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Technology

Peelings

Natalia Mikhailova, dermatologist, cosmetologist, member of the American Academy of Dermatology (AAD) and the American Society of Laser Medicine and Surgery (ASLMS), certified trainer of ObvieLine SAS (France) and Cynosure (USA), scientific director of the Martinex Educational and Medical Center, vice-president of NOM, president of the All-Ukrainian public organization &quot;Union of Mesotherapists&quot;, chief physician of the author&#39;s clinics &quot;Reforma&quot; (Russia, Moscow) 
Arsen Matasyants, dermatovenerologist, cosmetologist, teacher at the Martinex Training Center (Russia, Moscow)

The word &quot;peeling&quot; is usually associated with skin peeling by patients, and even cosmetologists sometimes consider this procedure only as an exfoliation process. Indeed, peeling preparations were previously selected according to their keratolytic properties, but during the process of use it turned out that these products also have other positive qualities. For example, salicylic acid has proven itself as an excellent bactericidal, fungicidal and antiparasitic agent, to which addiction does not develop. This allows it to be used to combat hyperkeratosis, as well as successfully used to treat acne of any severity.

Another example: retinoic acid. Retinoic peeling not only provides significant exfoliation, but also perfectly brightens both epidermal and dermal hyperpigmentation without harming the skin. In addition, it stimulates the synthesis of endogenous hyaluronic acid and other glycosaminoglycans, helps smooth out fine wrinkles, providing non-injection biorevitalization of the skin. Retinoic peeling stimulates the synthesis of collagen and elastin, provides a lifting effect of such a degree of severity that in some cases it can compete with botulinum therapy and surgical lifting. Thus, at the moment there are peelings with different structures, mechanisms of action, depth of penetration and, therefore, a wide variety of clinical effects and indications for use. By skillfully working with these drugs, correctly combining them with each other, you can solve almost any cosmetology problem.

Features of the procedure

However, even experienced cosmetologists often experience difficulties when faced with the need to perform body peeling. This procedure is accompanied by a number of features, without which the drug may not only fail to give the desired result, but in some cases harm the patient. The skin of the body is much denser, and the surface of application is much larger than on the face, so other methods should be used. The purpose of chemical body peeling is to improve the quality of healthy skin and correct existing defects.

In the first case, weak preparations are usually used, which are applied simultaneously to a large area of ​​the skin surface, in the second - quite strong ones, selected depending on the existing problem. Improving the quality of healthy skin means, first of all, increasing its smoothness, eliminating porosity and restoring a uniform color. In addition, using peeling, you can reduce the oiliness of the skin and the number of ingrown hairs, eliminate dryness, flaking and small rashes, and get a slight anti-edematous effect. For this purpose, superficial alpha-hydroxy acid (AHA) peels are used, which require neutralization. As a rule, preparations containing acids in high concentrations and having a pH from 1.2 to 2.5 (depending on the specific correction tasks) are used, such as glycolic, glycolic-salicylic and lactic peels. Glycolic acid has an antioxidant effect, accelerates the maturation of inflammatory elements, promotes skin renewal and correction of microrelief. Lactic acid actively moisturizes the skin, stimulating the production of hyaluronic acid.

Combined hydroxy acid peels that do not require neutralization, with a significantly lower percentage of acids and a higher pH - from 3.0 to 3.7 - can also be used. They are intended for regular body skin care and are offered to clients for home use. This group of products includes the alpha-beta complex, containing 12% glycolic acid, 5% lactic acid and 2% salicylic acid, with a pH of 3.5. The peeling is recommended for daily home body care; during trips to the sea, the product can be used as an evening product that perfectly prepares the skin for morning tanning. The combination of delicate, non-traumatic and invisible exfoliation with a moisturizing effect makes this product indispensable for those who want to quickly and safely acquire a beautiful tan.

Correction of cosmetic defects

Body skin peeling is also performed in the presence of such problems and cosmetic defects as a flaccid anterior abdominal wall and atony of the inner thighs and shoulders, follicular keratosis and pityriasis versicolor, hyperkeratosis of the knees and elbows, actinic and senile hyperkeratosis, acne and post-acne, scars and striae, hyperpigmentation, idiopathic guttate hypomelanosis.

Follicular keratosis

This phenomenon is based on a violation of the keratinization process (photo 1). As a result of the blockage of the outlet openings of the sebaceous glands, rashes in the form of &quot;thorns&quot; of flesh or pinkish color are formed on the skin, which are localized, as a rule, on the outer surface of the shoulders and thighs.

<img alt="" src="https://pro.bhub.com.ua/cosmetology/upload/images/1%286%29.png" style="height:281px; width:650px" />

To eliminate this problem, as part of home care, it is recommended to regularly use keratolytic agents such as cleansing foam with proteolytic enzymes and cream with glycolic acid and retinol microcapsules. Fast and high-quality exfoliation is also provided by professional products - Jessner peeling, salicylic. Using them according to the classical scheme gives a tangible result in just one session, and after a full course of 8-10 procedures, you can observe complete elimination of this problem or get a persistent, long-lasting (up to 4-6 weeks) result. Do not forget that peels based on salicylic acid, with all their rapid action and effectiveness, act on the pathogenesis, and not on the cause of the disease. Therefore, if follicular keratosis in a given patient is torpid and tends to recur after some time, it is better to resort to the use of retinoic peeling, which in this case is used as etiotropic therapy. This is precisely what explains the significantly more lasting, prolonged effect of retinoic peels.

Follicular keratosis is caused by a disruption in the maturation of skin cells, which do not leave the skin surface by the time of physiological exfoliation, since they are well bonded to each other. The cause of this disruption is a lack of retinoids in the body, which regulate the rate of maturation of keratinocytes and the degree of keratinization of corneocytes. When retinoids are taken orally in such a situation, the necessary therapeutic concentration of retinoids is not created in the skin, the treatment becomes long-term and does not always satisfy patients. When retinoids are used externally, in the form of peeling, their targeted delivery is carried out precisely to the skin, where the necessary therapeutic concentration is created in the very first procedure, which ensures a rapid therapeutic effect.

The treatment regimen is structured as follows. First, at least 4 salicylic peeling procedures (25%) or Jessner peeling are performed, which prepare the skin for further action, and a week later, a course of retinoic peeling is performed, consisting of 3-5 procedures with intervals of 1-1.5 months.

Hyperkeratosis of the elbows and knees

This is a serious aesthetic problem associated with significant psychological discomfort for the patient (photo 2).

<img alt="" src="https://pro.bhub.com.ua/cosmetology/upload/images/2%286%29.png" style="height:281px; width:650px" />

The use of mechanical exfoliation methods with scrubs, pumice stones, files, graters, scrapers does not give the desired result. On the contrary, rough mechanical trauma destroys cells, triggering a feedback mechanism, and hyperkeratosis begins to grow with renewed vigor. An emergency remedy is salicylic peeling (25%), which is recommended to be applied in 3-4 layers, but not according to the classical method, and without washing off. In conclusion, a soothing restorative cream should be used. A significant advantage of this method compared to mechanical exfoliation is that salicylic acid acts at the micro level: dissolving desmosomes, it disrupts the connections between cells without injuring them. Such delicate exfoliation imitates the natural process of exfoliation of corneocytes, is easily and calmly perceived by the skin and is the most physiological method of exfoliation. Usually, to achieve a satisfactory result, a course of salicylic peels (25%) is carried out, consisting, depending on the severity of hyperkeratosis, of 6-12 procedures, carried out once every 10-14 days. During the peeling period, it is recommended to use a soothing restorative cream or regenerating moisturizing balm at home, which will ensure a comfortable exfoliation stage for the client.

Another drug that solves this problem, but due to slightly different mechanisms, is a peeling based on pyruvic acid (PVC 40%). Being a keratolytic, PVC has a pronounced ability to penetrate the stratum corneum, which increases several times during hyperkeratosis. In addition, pyruvic acid restores the natural level of hydration, helps to normalize metabolism in tissues. Peeling is performed with a frequency of 1 time in 7-14 days, depending on the severity of peeling, the course includes 4-8 procedures. The entire period of therapy should be accompanied by the use of a soothing restorative cream or regenerating moisturizing balm at home.

In case of relapses of hyperkeratosis of elbows and knees, 3-5 retinoic peeling procedures should be performed with an interval of 1-1.5 months. A pronounced effect in hyperkeratosis of elbows and knees is achieved by combined use of 40% PVC peeling and retinoic peeling in one procedure.

Striae and laxity of the anterior abdominal wall

To correct this aesthetic defect, such preparations as Jessner peeling, which polishes any cicatricial changes, stimulates the synthesis of collagen and elastin, promotes tissue lifting, as well as pyruvic (40%) and glycolic (70%) peelings are successfully used. The latter, deeply penetrating the skin, stimulate the mitotic activity of basal keratinocytes, due to which a gradual restoration of the epidermis occurs in areas of cicatricial changes. Retinoic peelings in the form of cream and gel, which have a unique ability to penetrate even into scar tissue, have a beneficial effect on both the epidermis and the dermis, restoring normal metabolism and regulating cell differentiation processes. However, the greatest clinical effect can be achieved by combining a medium phenol peeling (25%) and a retinoic peeling cream in one procedure (photo 3). If, when using Jessner, pyruvic (40%) and glycolic (70%) peels, a course of 20-30 procedures is necessary to achieve a noticeable result, and when using retinoic peels - 8-10, then with a combined phenol-retinoic peeling, the effect is visible after the first session, and full correction is achieved in 3-4 procedures (photo 4).

<img alt="" src="https://pro.bhub.com.ua/cosmetology/upload/images/3%284%29.png" style="height:236px; width:650px" />

Photo 3.Before peeling and 10 days after the first procedure

<img alt="" src="https://pro.bhub.com.ua/cosmetology/upload/images/4%284%29.png" style="height:237px; width:650px" />

Photo 4.Before peeling and 5 months after the second procedure

With this combined use, phenol softens scar tissue and stimulates the synthesis of new collagen and elastin. The simultaneously acting retinoic acid also stimulates the production of collagen and elastin, but this occurs due to the stimulation of nuclear cell receptors. Thus, guaranteed durable lifting and tissue retraction is ensured.

Performing the procedure

The combined peeling procedure begins with a long (4-5 minutes) treatment with a cleansing foam with proteolytic enzymes, which is essentially an enzyme-urea peeling. After washing off the preparation, the skin is degreased with a pre-peeling lotion containing isopropyl alcohol. Then, a medium phenol peeling (25%) is applied to the problem areas with a cotton swab, which causes the appearance of pronounced erythema and pastosity. Next, the peeling is re-applied, accompanied by light rubbing. The total surface area of ​​application should not exceed the area of ​​two patient&#39;s palms. 5-10 minutes after applying the second layer, excess phenol peeling is blotted with a paper napkin, and a retinoic peeling cream is applied on top. The recommended exposure of the latter is 10-12 hours, after which the preparation is removed from the skin surface with a cotton pad soaked in olive oil. Subsequently, the tactics of patient management correspond to those for simple phenol peeling, although the healing time after performing combined peeling is reduced by approximately 20%.

Editor&#39;s note:The article describes the experience of using peelings TM MedicControlPeel from the company &quot;Martinex&quot;

First published: KOSMETIK international journal, №1/2013, pp. 34-38

Chemical body peeling