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Aesthetics Journal
Aesthetics
Delving beneath
the surface of
peels and lasers
Skin resurfacing using chemical peels and lasers of different modalities are
popular and effective methods of rejuvenating skin, as well as treating some
skin complaints. Allie Anderson speaks to practitioners about how they
should be used in aesthetic clinics
They say youth is wasted on the young, and this is
perhaps particularly true in relation to the skin. Until
the age of around 30, most people are relatively
carefree when it comes to looking after their skin,
since, to a great extent, the skin appears to look after
itself. The process of skin cell renewal is reliable and
consistent, and crucially its relatively rapid.1 With age
and poor treatment of the skin, however be it sun
exposure, smoking, or lack of an adequate skincare
regime successful skin cell renewal becomes more
challenging.1
SKIN REJUVENATION
During skin cell renewal, firstly, the outermost layers of
the epidermis (the stratum corneum) are shed naturally
through a process called desquamation.
New cells are then formed beneath that gradually
make their way towards the surface, in a process called
keratinisation,1 meaning that damaged skin is renewed
regularly. Second, fibroblasts in the dermis deposit wellstructured and plentiful collagen fibres, which keep the
skin plump and elastic.2 As a result, the face retains the
characteristics of youthful skin, despite behaviours that
will, in time, degrade its health. As we age, however,
these youth-prolonging mechanisms become less
effective. The matrix that holds the stratum corneum
together becomes denser, enabling the cells to build
up, and consequently making desquamation more
difficult and keratinisation slower.1 Moreover, collagen
synthesis begins to decline during our 20s and 30s,
and the collagen that is produced is increasingly
fragmented and degraded thereafter, causing the skin
to weaken and lose elasticity.2 Although taking care of
the skin from a young age will go some way to staving
off the tell-tale signs of facial ageing, they are inevitable.
But for those wishing to turn back the clock, an effective
method of rejuvenation is skin resurfacing, the goal of
which is to bring new skin to the surface by mechanical
or chemical removal of the topmost layer. Perhaps
paradoxically, resurfacing entails controlled injury to the skin in order to improve its
appearance. This can be performed by peeling or the application of lasers: a third
option dermabrasion is not discussed herein.
PEELS
In a peeling treatment, chemicals are applied to the skin so that the epidermis peels
away, revealing fresh skin beneath. As well as proving effective in combatting and
reversing visible signs of skin ageing such as fine lines and wrinkles; dull, rough
skin; enlarged pores; uneven tone; and areas of pigmentation peels can be used
to treat acne and resulting scarring, rosacea and pigmentation disorders such as
melasma and chloasma.3 Peel solutions are categorised in part by how deeply they
penetrate into the skin, ranging from superficial (or micro/light), medium and deep
peels, with results typically improving as penetration depth increases.4
Superficial peels these commonly contain either alpha-hydroxy acid (AHA),
such as glycolic acid; or beta-hydroxy acid (BHA), such as salycilic acid, at
various concentrations.5
Glycolic acid the preferred treatment at James Willis Faces is a glycolic acid
solution, supported by a robust homecare regime both in preparation for and
following the peel itself. We have a mandatory two-week home preparation period
that comprises a simple but effective five-step procedure, one of which involves
a little bit of glycolic acid, explains managing director and therapist Alison Procter.
That routine is maintained for around six months after treatment as well. For the peel
itself, we provide a series of six glycolic peels of increasing strength, one a week for
six weeks, and the effects are very impressive. The first peel is normally 40% glycolic
acid concentration, and based on a number of factors such as the patients age, skin
type, the severity of the complaint and the desired result as well as how the patient
reacts to the mildest solution subsequent peels will contain an added exfoliant
(proteolytic enzymes), a higher concentration (70%) of glycolic acid, or both.
Salycilic acid this formulation is often favoured when treating patients with
skin of colour. Dermatologist Dr Marina Landau says, For a superficial peel I
might use the BHA salycilic acid, which is less inflammatory and can therefore be
used relatively safely on darker phenotypes. Published evidence suggests that
such superficial peels are the best and sometimes the only option for Fitzpatrick
skin types IV and above.6 This is because deeper peels carry an increased risk
of post-inflammatory hyperpigmentation, to which darker skin types are more
susceptible.7 Salycilic acid has been shown to elicit more marked long-term
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PEEL DEPTH
SUPERFICIAL
Scarring (rare)
Post-inflammatory Hyperpigmentation
(PIH) (rare)
Infection (rare)
Pigmentary changes
Infection
Allergic reactions
Images courtesy of Dr Marina Landau
MEDIUM AND
DEEP PEELS
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Before
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After
Results following treatment with the Lumenis Ultrapulse CO2 laser. Images
courtesy of Joseph Niamtu II DMD
RF energy to the deep, middle and upper level dermis and the
epidermal layer. This creates controlled thermal damage that
generates a tightening effect, and triggers a healing response in
the dermis to boost collagen production.
APPLICATION OF LASERS
Machines typically either have a rolling motion, whereby the head is
rolled over the skin in a number of passes; a stamping motion, where
the hand-piece is moved up and down between adjacent areas of
skin to be treated; or a scanning-type mode. The skin is numbed with
a topical solution for around 45 minutes: for full resurfacing, which
is more painful and requires greater downtime, local anaesthetic is
injected. Next, the skin is thoroughly cleansed and when goggles are
in place to protect the patients eyes, the treatment is applied. The skin
is lasered one area at a time based on the lasers spot size, although,
according to Dr Al-Niaimi, best results are achieved by treating the
entire face to avoid visible demarcation. The face is divided into
so-called sub-units. At a minimum, you would treat an entire sub-unit
the whole nose or the whole mouth unit or, for optimum results,
you treat the entire face, but you use a blending technique, he
explains. This involves applying a milder form of laser to the rest of the
face, feathering the borders with low-pulse energy and density.22 As
with peels, post-laser aftercare centres on sun protection. In addition,
regular cleansing and moisturising is essential using occlusive
ointments following ablative procedures and lighter moisturisers
for non-ablative. A good antiseptic is the key component of good
aftercare to prevent infection, explains Dr Al-Niaimi. Patients are able
to return to work the day after a RF resurfacing treatment, adds Xu.
COMPLICATIONS
Types of complications include:
Erythema
PIH
Infection
Scarring
Swelling
Severe itching
Acne
The severity of each complication can be classified as minor,
intermediate or major and will vary depending on the type of patient
and concern treated, as well as the strength of the laser used.22,23
Eective
Pigmentation
Resolution
Thats kind on skin
EXCELLENT CLINICAL
EFFICACY
74% reduction
in the area and severity of melasma
as measured by clinicians.1
www.aestheticare.co.uk
email: info@aestheticare.co.uk
or call FREE: 0800 0195 322
Ferndale Pharmaceuticals Ltd 2015.
1
Truchuelo M et al, Journal of Cosmetic Dermatology, 2014. 2Cameli N et al, Dermatological Experiences, 2012.
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