Chemical Peels
Chemical Peel
If You're Considering Chemical Peel...
Chemical peel uses a chemical solution to improve and smooth the texture of the facial skin by removing its damaged outer layers. It is helpful for those individuals with facial blemishes, wrinkles and uneven skin pigmentation. Phenol, trichloroacetic acid (TCA) and alphahydroxy acids (AHAs) are used for this purpose. The precise formula used may be adjusted to meet each patient's needs. Although chemical peel may be performed in conjunction with a facelift, it is not a substitute for such surgery, nor will it prevent or slow the aging process. This brochure provides basic information about certain types of chemical peel treatments and the results you might expect. It won't answer all your questions, since a lot depends on your individual circumstances. Once you and your plastic surgeon have decided on a specific peel program, be sure to ask about any details that you do not understand.
Deciding if chemical peel is right for you Chemical peel is most commonly performed for cosmetic reasons -- to enhance your appearance and your self confidence. Chemical peel may also remove pre-cancerous skin growths, soften acne facial scars and even control acne. In certain cases, health insurance may cover the peel procedure. Be sure to check your policy and contact your insurance company before the procedure is performed.
Alphahydroxy acids (AHAs), such as glycolic, lactic, or fruit acids are the mildest of the peel formulas and produce light peels. These types of peels can provide smoother, brighter-looking skin for people who can't spare the time to recover from a phenol or TCA peel. AHA peels may be used to treat fine wrinkling, areas of dryness, uneven pigmentation and acne. Various concentrations of an AHA may be applied weekly or at longer intervals to obtain the best result. Your doctor will make this decision during your consultation and as the treatment proceeds. An alphahydroxy acid, such as glycolic acid, can also be mixed with a facial wash or cream in lesser concentrations as part of a daily skin-care regimen to improve the skin's texture.
Trichloroacetic acid (TCA) can be used in many concentrations, but it is most commonly used for medium-depth peeling. Fine surface wrinkles, superficial blemishes and pigment problems are commonly treated with TCA. The results of TCA peel are usually less dramatic than and not as long-lasting as those of a phenol peel. In fact, more than one TCA peel may be needed to achieve the desired result. The recovery from a TCA peel is usually shorter than with a phenol peel.
Phenol is the strongest of the chemical solutions and produces a deep peel. It is used mainly to treat patients with coarse facial wrinkles, areas of blotchy or damaged skin caused by sun exposure, or pre-cancerous growths. Since phenol sometimes lightens the treated areas, your skin pigmentation may be a determining factor as to whether or not this is an appropriate treatment for you. Phenol is primarily used on the face; scarring may result if it's applied to the neck or other body areas.
All chemical peels carry some uncertainty and risk. Chemical peel is normally a safe procedure when it is performed by a qualified, experienced plastic surgeon. However, some unpredictability and risks such as infection and scarring, while infrequent, are possible.
AHA peels may cause stinging, redness, irritation and crusting. However, as the skin adjusts to the treatment regimen, these problems will subside.
With a TCA peel, your healed skin will be able to produce pigment as always; the peel will not bleach the skin. However, TCA-peel patients are advised to avoid sun exposure for several months after treatment to protect the newly formed layers of skin. Even though TCA is milder than phenol, it may also produce some unintended color changes in the skin.
With a phenol peel, the new skin frequently loses its ability to make pigment (that is, tan). This means that not only will the skin be lighter in color, but you'll always have to protect it from the sun. Phenol may pose a special risk for patients with a history of heart disease. It's important that you make your surgeon aware of any heart problems when your medical history is taken.
It is also possible that phenol will cause some undesired cosmetic results, such as uneven pigment changes. Certain modified phenol peels are gentler and may be preferred in some circumstances.
Find out more >>Acne
Acne
Acne scarring management requires a dermatologist's "reservoir" of treatment options, which need to be "taylorized" to the individual's needs. A specialist dermatologic surgeon is the most suitable individual to assess your needs, and recommend what treatment might be appropriate for you.
Treatment of acne scarring cannot begin until all active acne has been treated and observed for at least six months following initial total clearance. Your acne scarred skin will never be restored to totally normal appearance, but with a combination of treatments specific to your requirements, significant improvement can definitely be achieved at the Skin Specialist Centre clinic.
Types of Acne Scars
There are a number of different-looking scars caused by acne:
- Ice-pick scars (deep pits). Ice-pick scars are narrow, sharp scars that make the skin appear as if it has been punctured with an ice-pick. They are narrow and less than 2mm and extend into the deep dermal subcutaneous layer. They respond well to TCA technique (see below); and surgical removal.
- Box car scars - these are angular scars that usually occur on the temples and the cheeks and can be either superficial or deep and are similar to chickenpox scars. They are oval depressions that have sharp, vertical edges. Unlike ice-pick scars, they do not taper. They are usually 0.1 - 0.5mm in depth and can be treated with conventional skin resurfacing techniques.
- Rolling scars (scars that give the skin a wave-like appearance). These occur as a result of tethering of otherwise normal appearing skin to the subcutaneous tissue below. Conventional skin resurfacing techniques do not work on rolling scars and they must be corrected by breaking up the subcutaneous fibrous bands.
- Hypertrophic scars - these are thickened scars.
- Macular scarring - this is characterized by flat areas of decreased and increased pigmentation as a result of acne. No indentations are associated with this.
Treatment of Acne Scarring
The treatments listed below (either alone or in combination) should achieve significant improvement in your acne scarring, but will be dependent on the individual:-
1. Fraxel Laser System
This newly introduced technology stimulates collagen regeneration. Usually five treatments with the Fraxel laser at four weekly intervals are required for this. This laser significantly helps to smooth all acne scars.
2. Subcision
Subcision is used to break up fibrous bands that cause rolling scars. This technique is performed under local anaesthesia by inserting a needle under the skin that is parallel to the skin surface. It is essential that a dermatologic surgeon performs this procedure as the needle must stay in the plane between the dermis and subcutaneous tissue. The needle is gently advanced or retracted in a piston-like motion, cutting the tethering bands. The procedure causes bruising which fades within seven days. This approach, where appropriate, achieves significant improvement, usually within two to three sessions. Rolling acne scars respond particularly well to this technique.
3. TCA Cross
With this procedure, high-strength trichloroacetic acid is placed into the ice-pick scar area, resulting in the production of new collagen and re-modelling of existing collagen to fill the scar. The treatment is localized to the ice-pick scar only and not the unaffected skin.
4. Dermal Filler Injections
Dermal fillers such as Restylane can be injected into acne scars to raise the surface of the skin and give a smoother look. The injection of such materials does not permanently correct acne scars, so further injections are necessary. This would need to be repeated regularly every six to twelve months depending on the site of the lesions. Consideration can also be given to fat transfer into the areas. Rolling acne scars respond well to dermal fillers.
5. Punch Excision
This can be used for deep scars, such as ice-pick or deep box-car scars. A punch biopsy is used, which is like a cookie cutter tool that has varying diameters from 1.5 - 4mm. The size of the punch biopsy is matched to the size of the scar to include the walls of the scar. Following local anaesthesia, the scar is excised with the punch and the skin is sutured together. If it is noticeable following this procedure, the area can be treated by various resurfacing techniques.
6. Punch Excision with Skin Graft Replacement
With this approach the scar is excised with the punch biopsy instrument as above. Instead of suturing the skin edges together, a punch graft is usually taken from behind the ear and placed in the resulting punched out defect.
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Botox Treatment
Botox Treatment
About
Botox is a natural, purified protein that relaxes wrinkle-causing muscles, creating a rejuvenated appearance.
- Eyebrow lift
- Reduces frown lines between the brows (glabella)
- Reduces crows feet (lines at the lateral corners of the eye)
- Reduces forehead wrinkles
- Reduces lip lines
- Reduces gummy smile
- Reduces nasal flaring
- Reduces muscle bulkiness at the angle of the jaw (masseter muscle)
- Reduces chin wrinkling
- Reduces neck rhytids
- Reduces turned down corners of the mouth
- Reduces excessive sweating of the underarms and palms
- No downtime
- Minimal risk
Alternatives
Dermal fillers, fat transfer, skin rejuvenation
How Does it Work?
Dynamic wrinkles (smile lines) are caused by contractions of underlying facial muscles as you laugh or smile. Botox blocks impulses from the nerve to the muscles that cause these lines, so that the muscles do not contract. Consequently as the muscles are unable to contract, the areas appear relaxed, creating a softer, more youthful appearance. The nerve endings which have been blocked usually grow new connections to the muscles in about three to five months, and muscle movement and activity returns. Therefore, treatment must be repeated at least twice a year.
Who is a Candidate?
All skin types can have Botox, but patients who are pregnant or have neuro-muscular disorders such as myasthenia gravis should not undergo this procedure. The key to successful Botox treatment is precise injection into the muscles. This depends on the skill of the injector.
What Can I Expect?
Reduction or complete elimination of wrinkles and excessive sweating. The full effects may not be seen until 5 - 10 days, and the results vary depending upon the amount of botox and the site.
Safety and Side-Effects
Botox has a very safe track record and has become one of the most popular procedures performed in New Zealand. While infrequent, mild, temporary bruising is the commonest side-effect. Very rarely there can be drooping of an eyelid or asymmetry of facial expression. Such risks depend upon the muscles injected.
Recovery Time
Nil. Patients can return to work the same day and resume most of their regular activities.
Does it Hurt?
We use a 33 gauge insulin syringe and also bacteriostatic saline for dilution, which minimises discomfort at the time of injection.
Before Treatment Instructions
Avoid blood thinners such as Aspirin and anti-inflammatory pills for two weeks prior to treatment.
After Treatment Instructions
Patients are encouraged to frown as much as possible for three hours after injection of Botox into the frown lines.
Who Performs the Treatment?
Dr McKerrow
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