Chemical peels to improve the quality of skin in the periorbital area

Yana Kotova, cosmetologist, certified trainer of the Premium Aesthetic Service company

The main goal of aesthetic medicine is the correction and prevention of various skin problems, and in the modern world, thanks to the possibility of using various techniques that affect certain pathogenetic mechanisms, we can get the desired results without resorting to aggressive and radical methods of influence.

Currently, chemical peels are becoming most common among dermatologists and cosmetologists as a method of solving various aesthetic problems. This popularity is due to the wide range of drugs required for the procedure, ease of use, safety of use, smoothed rehabilitation period and, most importantly, the ability to solve several aesthetic problems simultaneously even in the most delicate areas.

Many of us very often face the question of the safety and effectiveness of chemical peels in the periorbital area. Most of the popular anti-aging procedures cannot be performed here due to the high risk of eye injury, swelling and hematomas. In addition, the skin in this area has a very low ability to regenerate.

What is chemical exfoliation based on organic acids?

The chemical peeling procedure is the removal of the top layer of keratinized particles, where organic acid is used as an exfoliant, the effect of which is carried out through controlled damage to the skin and, accordingly, negative stimulation of the dermis for the production of collagen fibers and hyaluronic acid, which ensures the manifestation of pronounced reparative processes and an increase in local immunity.

Peels are divided into several types according to the depth of penetration of the active agents:

• Very superficial - acts within the stratum corneum of the dermis. An exfoliant is abrasive particles that instantly exfoliate the upper keratinized cells. There is no recovery period or side effects.
• Superficial – peeling, in which organic alpha-hydroxy acids act as an exfoliant, acting in the upper layers of the epidermis and not descending below the papillary layer of the dermis. Causes fine-plate peeling, which disappears by the 7th day after the procedure.
• Medium – more aggressive peeling, in which, as a rule, the exfoliant is TCA (trichloroacetic acid); causes a controlled chemical burn with subsequent detachment of the epidermis and dermis to the upper part of the reticular layer. Immediately after the procedure, we see pronounced hyperemia; in the post-procedure period, large-plate peeling is observed, and crust formation is possible. The period of complete rehabilitation lasts from 14 to 21 days.
• Deep - performed with a concentrated solution of phenol or a solution of trichloroacetic acid (TCA) at a concentration of 50% or more. The procedure is carried out in a hospital setting, where the early period of rehabilitation takes place - this is due to the high level of trauma to the epidermis and dermis up to the middle of the mesh layer.

The effect of any organic acid on the skin occurs in two phases : catabolic (destruction) and anabolic (synthesis). First, the connections between corneocytes (cells of the stratum corneum) are destroyed, which, in turn, is accompanied by desquamation of epidermal keratinocytes and cells of the stratum corneum from the surface of the skin. After this, the second phase begins, anabolic, during which a new layer of cells is formed, replaced by new epidermal cells and fibrous structures of the skin.

Indications for the chemical peeling procedure:

• photo- and chronoaging;
• hyperpigmentation (melasma, lentigo, post-inflammatory);
• actinic keratosis;
• dull complexion;
• atrophic and normotrophic scars;
• decreased skin tone.

Acids used for chemoexfoliation in the periorbital area

As mentioned earlier, chemical peeling can correct several aesthetic defects at once. Therefore, taking into account the characteristics of the periorbital area, acids should be carefully selected to minimize the rehabilitation period and the number of procedures required per course.

The most relevant in our time is the use of trichloroacetic (TCA) acid in low concentration and lactic acid.

Trichloroacetic acid (TCA) acts on the dermal layers of the skin, actively stimulating fibroblasts, and also has a pronounced keratolytic effect and inhibits melanogenesis, thus being ideal for solving the problems we are considering. The procedure using TCA is indicated for the correction of signs of pronounced photo- and chronoaging, scars. After this procedure, we can observe the following histological changes in the skin: immediately after trichloroacetic acid comes into contact with the skin, inflammatory processes begin, immediately followed by coagulation necrosis of the epidermis and papillary layer of the dermis, pronounced hyperemia, swelling and destruction of collagen fibers to a homogeneous mass are observed. Around the 3rd–4th day, vascularization in the dermis increases, we observe a significant increase in the number of fibroblasts, and signs of regeneration appear in the epidermis. By the 7th day, the re-epithelialization processes are coming to an end. In the dermis, there is a significant decrease in swelling and smoothness of the papillary layer, a significant increase in the number and thickness of collagen fibers and, as before, a large number of fibroblasts. In subsequent regenerative processes, new collagen and elastin fibers are located horizontally, parallel to the surface of the skin, which, in turn, leads to an increase in skin density and tension, as a result of which we see a pronounced smoothing effect.

Lactic acid is part of the lipid mantle of the skin and is one of the main components of the natural moisturizing factor. In high concentrations, this acid has a pronounced ability to stimulate the activity of fibroblasts, thereby increasing the production of the main components of the intercellular matrix. Lactic acid ensures uniform distribution of melanin granules in the epidermis and inhibits the processes of melanogenesis even after its neutralization, which determines its depigmenting effect. In addition, lactic acid provides a significant increase in skin turgor and smoothing of microrelief by increasing the level of hydration and viscoelastic properties of the dermis.

Peeling, which contains trichloroacetic acid in a low concentration (3.75%) in combination with 15% lactic acid, provides lightening of hyperpigmented areas of the skin, smoothing out fine wrinkles and lifts the upper eyelid after the first procedure. Instead of exfoliated keratinized epidermal cells, we note the appearance of physiologically active young cells. With each subsequent procedure their number increases, the skin in the periorbital area becomes more elastic and smooth. Due to the destruction of melanocytes, which synthesize pigment in excess, and the formation of new, normally functioning cells in their place, dark circles under the eyes disappear. Thus, we get excellent results in a short (four procedures) course, a minimal rehabilitation period and do not worry about the safety of using this formula.

Photo 1. Before and after one procedure of a chemical peel based on TCA and lactic acid

Innovations and features of peelings for the periorbital area

Aesthetic medicine does not stand still, and modern upgrades are constantly appearing aimed at increasing the comfort and safety of the procedure. One of the most important points in the chemical peel procedure is the controllability of skin damage from organic acid. In my work, I use the Enerpeel line of peelings from General Topics (Italy), created based on the patented “carrier molecule” and “sleeping proton” technology. The "carrier molecule" technology ensures uniform absorption of acid to polar and non-polar skin structures, and the "sleeping proton" technology, in turn, activates protons in various layers of protein and cellular structures, thus guaranteeing controlled and effective physiological, chemical and biological effects with minimal skin trauma. The mobility of protons is reduced and increases when they penetrate the skin and interact with water molecules, which are present in varying quantities in all layers of the skin.

Currently, there are many “tricks” for comfortable chemoexfoliation in the periorbital area. The peeling texture in the form of a monophasic gel significantly improves the quality of the procedure and reduces the risk of eye injury. Packaging in the form of a pencil with a nylon applicator head and dispenser simplifies use, ensuring more accurate and uniform application of the monophasic gel, making the procedure as safe as possible.

Features of reducing the risk of complications in the post-procedure period:

• careful collection of anamnesis to identify standard contraindications to the chemoexfoliation procedure;
• it is necessary to avoid a combination of chemical peeling and taking drugs that increase photosensitivity;
• mandatory pre-peeling preparation;
• compliance with recommended intervals between procedures and courses of chemical peeling;
• correct post-peeling care.

Modern chemical peels are able to control the depth of penetration of agents and the spread of particles, due to which, with the correct selection of the peeling solution, adequate management of the pre-, intra- and post-procedural period, we minimize the likelihood of unwanted side effects while maintaining high effectiveness of therapy and can recommend procedures to socially active people thanks to a short and smooth rehabilitation period. And we also don’t have to worry about the safety of the procedure due to innovative technologies used in aesthetic medicine.

First published: KOSMETIK international journal, No. 4 (58) / 2014