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Author: Oksana Didur,leading dermatocosmetologist at the Gialual Institute (Ukraine, Kyiv)

Source: KOSMETIK international journal, No. 4/2013, pp. 32-33

______________________________________________________________________

When starting a chemical peeling, it is very important to see not only the procedure protocol, but also the specific patient: clearly assess the initial condition of the skin, the expected result, the possibilities of a particular peeling, masterfully mastering and operating all the subtleties of various solutions, their concentration and pH.

Classification of peels by depth of skin damage:

<ol>
	<li>Very superficial: damage within the stratum corneum, down to the granular layer of the epidermis, living cells are not damaged.</li>
	<li>Superficial: damage the epidermis down to the basement membrane.</li>
	<li>Medium-deep: damage the basement membrane down to the papillary dermis.</li>
	<li>Deep: complete destruction of the epidermis, coagulative necrosis up to the middle of the reticular layer of the dermis.</li>
</ol>

When offering a peeling to a patient, we paint a rosy picture of the skin&#39;s condition after the recovery stage: &quot;You will have renewed, smooth, pink, healthy skin.&quot; This is true, and in most cases we achieve such results. But there is a small percentage of patients whose skin recovery process was less successful. And it is not only due to the incorrect prescription of peeling solutions (we are not even talking about poorly trained specialists). In fact, the main reason lies in the impossibility, the inability of the patients&#39; skin to recover after a minimally invasive, but still quite aggressive procedure.

Controlled damage

What is peeling?

Chemical peeling is a controlled damaging factor of certain layers of the epidermis and/or dermis of the skin, which we use to solve important cosmetology problems, in particular to reduce hyperkeratosis, pigmentation, scars and post-acne spots, to rejuvenate the skin, significantly narrow the pores, and smooth out fine wrinkles. In response to damage, a huge amount of anti-inflammatory mediators, growth factors, and biologically active substances are released, which leads to the activation of protective regenerative mechanisms, increased metabolic and mitotic activity of basal keratinocytes and fibroblasts. The expected effects of the chemical peeling procedure are: improved skin appearance: its color, smoothing of the skin profile, improvement of micro- and macrorelief, activation of reparative processes, increased synthesis of epidermal lipids and extracellular structures of the dermal matrix. The effect depends to a greater extent on the depth of skin damage and to a lesser extent on the chemical preparation. The stimulating effect of chemical peeling is indirect. This is the skin&#39;s reaction to inflammation that develops as a result of skin damage.

The main task of peeling at the dermal level is to stimulate fibroblasts. It is necessary to remember that only two physiological processes occurring in tissues lead to the transition of fibroblasts to their active form - this is natural plastic metabolism and a wound. We use a dosed application of peeling solution to create a wound surface.

An effective combination

Unfortunately, as many years of experience as a dermatologist show, for many patients the peeling procedure does not end with rejuvenation at all, but with a reason to contact a dermatologist with a far from aesthetic problem: we get a patient with a chemical burn, traumatic couperose and rosacea. However, such situations can be predicted and prevented.

For this purpose, it is very effective to combine the chemical peeling procedure with redermalization.

Redermalization is an innovative injection procedure aimed at skin rejuvenation through its restoration. Redermalization affects three main pathogenetic mechanisms of skin aging:

<ul>
	<li>metabolic process disorder;</li>
	<li>accumulation of free radicals;</li>
	<li>water imbalance disorder.</li>
</ul>

We use the drug &quot;Gialual&quot; 1.1 or 1.8%, which:

<ul>
	<li>regulates and restores biochemical and physiological processes in cells;</li>
	<li>actively blocks free radicals (as a result of tissue and cell destruction during peeling, a large number of free radicals are formed);</li>
	<li>restores lost water balance.</li>
</ul>

When planning a superficial peeling, we perform:

<ul>
	<li>one redermalization procedure;</li>
	<li>2-week break;</li>
	<li>superficial peeling;</li>
	<li>2-week break;</li>
	<li>redermalization procedure.</li>
</ul>

And so on until the result is achieved. Usually it is 2-3 peelings and 4-5 redermalization procedures.

If we are planning a superficial-medium or medium peeling, we proceed as follows:

<ul>
	<li>2 redermalization procedures with an interval of 2 weeks;</li>
	<li>peeling;</li>
	<li>skin recovery period for 2-3 weeks;</li>
	<li>2 redermalization procedures.</li>
</ul>

We always carry out pre-peeling preparation.

The presented figures demonstrate injection schemes for the redermalization procedure in various zones (Fig. 1&ndash;6).

<img alt="" src="https://pro.bhub.com.ua/cosmetology/upload/images/1%287%29.png" style="height:800px; width:650px" />

As our own experience and the experience of colleagues who work according to our recommendations shows, the recovery period for patients is much better, we get brighter results and in a shorter period of time.

What happens at the tissue level in this case?

Sodium succinate (a substance involved in the Krebs cycle) and hyaluronic acid, which are part of the redermalization preparation, optimize the work of fibroblasts, increasing their morphological, proliferative and productive activity. Consequently, the skin and, in particular, fibroblasts, meet the dosed aggression in the form of peeling prepared, having the strength and resources for rapid tissue restoration.

Every patient is an individual. Love and cherish your patients, and then there will be no room for seasonal depression in their hearts and souls.

Combination of redermalization with chemical peels