PATIENT CONSULTATION (PRE-PEEL)

Approximately two weeks prior to scheduling the peel procedure, a consultation with the patient is recommended to discuss Patient/Physician Expectations, Medical History, Concurrent Product/Treatment Use, Exclusions to Peels, and Side Effects. NeoStrata® also recommends that all patients sign an informed consent form.


PATIENT/PHYSICIAN EXPECTATIONS

A discussion with the patient to establish appropriate patient expectations is crucial.

 

PEEL EXPECTATIONS
CONDITIONS OBSERVABLE CHANGES
Fine lines and wrinkles Softening in appearance
Hyperpigmentation Evening of skin tone
Mild acne scars Diminution of scars
Deep acne scars Softening of the appearance of scars
Pore size Some diminution in size
Uneven/ rough texture Increased smoothness
Dull skin tone Improved natural glow/ radiance

 

It is important to clearly establish:

A.   What the patient wants to achieve:

Improvement in the appearance of fine lines due to accumulated sun damage

Improvement in skin texture

Improvement in shallow acne scars

Improvement in pigmentation irregularities

Improvement in skin brilliance or skin tone

Diminution in pore size

B. What are the areas of the face or body that the patient feels needs improvement?

C. How rapidly does the patient need/ want to see improvement(s)?

D. How does the patient want to look immediately after the peel? Are visual signs of peeling acceptable or unacceptable to the patient?

E. Has the patient seen post-peel photographs or other patients with his/her skin type (pigmentation, condition, sensitivity)?

F. The patient's history and tolerability of glycolic acid.

On the basis of information gathered in this discussion, with consideration given to the patient's age, skin type, condition, area of the face or body being treated, and historical compliance to medical treatment, the first peel procedure is scheduled.

 

MEDICAL HISTORY

Review the patient's medical history with particular regard to the following:

Skin type: Some skin types require special attention. For example, Asian skin can be more sensitive, often unable to tolerate the higher strength peels due to discomfort. Darker complected patients have an increased risk of hyper- or hypo-pigmentation following deeper peels. Short-time exposures at low concentrations, combined with a gradual treatment approach, are prudent for these populations.
Allergies: A history of allergies may indicate that the patient's skin will be very reactive to the peel procedure. In addition, a specific allergy to any of the ingredients in the Skin Rejuvenation System products should be reviewed.
History of atopic skin reactions, eczema, seborrheic dermatitis or other sensitivities could indicate that the patient has very sensitive or reactive skin.
Collagen disease/ Autoimmune disease/ Diabetes is an uncertain area, due to possible complications resulting from compromised sensory responses and healing times. Therefore, a peel procedure for patients with a history of these types of diseases is not recommended. Viral infections: Patients with a history of herpes simplex should be placed on the appropriate prophylactic antiviral medication. The peel procedure can induce an episode of herpes lesions in patients who have had them before. If the patient has warts on the targeted area, they should not be considered for the peel procedure, due to the potential of spreading the wart virus.
Prior photosensitivity: After a peel, the skin should be protected from the sun. Any prior photosensitivity could be exacerbated.
Medications used: Anticoagulant users may heal more slowly, although surface peeling should not affect coagulation response. If a deeper peel inducting epidermolysis is inadvertently performed, the risk of bleeding exists. In addition, immune suppressing agents can affect post-peel healing times and should be considered before initiating a peel. Accutane® users should not be peeled due to the potential of unpredictable peeling responses.

Use of tobacco: Smokers may heal more slowly.

Pregnancy: While glycolic acid is considered to be a very safe cosmetic ingredient, NeoStrata® has not tested its formulations on a pregnant population. For this reason, along with the potential for unpredictable responses to occur during pregnancy, it is not recommended to perform peels during pregnancy or while nursing.

 

CONCURRENT PRODUCT/TREATMENT USE

Because of the potential for some products/ treatments to increase the reactivity of the skin, patients should be questioned about the recent use of:

Electrolysis

Waxing

Depilatories

Masks/ facials

Prior peels or dermabrasions

Hair dying treatments

Permanent wave or straightening treatments

Topical retinoids, such as Retin-A® (tretinoin) and other exfoliative/ keratolytic drugs

Loofa or other types of exfoliating sponges

A sufficient period of time should pass following the use of any of these treatments/ products to allow the skin to heal before a peel is performed. Any of the above could increase the reactivity of the skin to the glycolic acid.

EXCLUSIONS TO PEELS

Specific exclusions to glycolic acid peels include:

Active herpes simplex

Warts

Accutane® (isotretinoin) use within six (6) months

Recent surgery (healing wounds)

Recent radiation treatment

Insufficient solar protection/ sunburn

History of hypertrophic or keloidal scarring

Cryotherapy/ cryosurgery within the past six (6) months

Pregnancy

Caution should be observed in patients having a history of hyper- or hypo-pigmentation.

SIDE EFFECTS OF A SUPERFICIAL PEEL

Sensations which a patient may experience during the repair/ renewal period include: redness (erythema), stinging, itching, burning, tightness, minor swelling and peeling of the superficial layer of the skin. These sensations will gradually diminish over the course of a week as the skin returns to its normal appearance.

Glycolic acid peels may also cause a peri-oral dermatitis, acne flare or herpes simplex flare (particularly if no prophylactic antiviral treatment is initiated).

Some patients may experience hyper- or hypo-pigmentation after a glycolic acid peel. If these conditions are left untreated, they usually resolve themselves with time. Hyper-pigmentation responses can often be remedied with the application of a skin lightening product such as the NeoStrata® AHA Gel for Ages Spots and Skin Lightening or the NeoStrata® NeoCeuticalsª Skin Lightening Cream. Hypo-pigmentation responses take longer to resolve and can be permanent. Peeling should not be repeated on patients having unresolved changes in pigmentation.

WARNING: If the peel goes too far or too long, potential side effects include:

Moderate to severe erythema

Epidermolysis

Post inflammatory hyper- or hypo-pigmentation

Blistering and Peeling

Scarring

Scabbing

Risk of infection

Increased likelihood of extreme skin sensitivity

Skin discomfort

Swelling

 

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