CHEMICAL FACE PEELING
Chemical face peeling, a technique that involves applying a chemical mixture to the face for superficial destruction of the epi-dermis and the upper layers of the dermis, treats fine wrinkles, keratoses, and pigment problems. It is especially useful for wrin-kles at the upper and lower lip, forehead, and periorbital areas.
Pretreatment may consist of cleansing the face and hair for several days before the procedure with a hexachlorophene deter-gent. Pretreatment medication (ie, analgesic and tranquilizer for moderate sedation) may be prescribed to alleviate apprehension and control pain. This permits the patient to be sedated but con-scious during the procedure, although some patients request gen-eral anesthesia.
The type of chemical used depends on the planned depth of the peel. A phenol-based chemical in an oil–water emulsion is commonly used because it produces a controlled, predictable chemical burn. The chemical is applied systematically to the face with cotton-tipped applicators. The conscious patient feels a burning sensation at this time. A mask of waterproof adhesive may then be applied directly to the skin and molded closely to the contours of the face, thereby acting as an occlusive dressing that increases the chemical penetration and action. Some surgeons be-lieve that equally good results can be obtained with occlusive tape. After the tape mask is applied, the burning sensation con-tinues, and the tape mask remains in place for 12 to 24 hours. Frequent small doses of analgesics and tranquilizers are prescribed to keep the patient comfortable.
Complications may arise when control of the chemically induced burn cannot be sustained. Complications include pigment changes, infection, milia (ie, small inclusion cysts that disappear after several months), scarring, atrophy, sensitivity changes, and long-term (4 to 5 months) erythema or pruritus.
Because chemical face peeling is performed in the physician’s of-fice or in an outpatient surgical department, most care takes place in the home. After 6 to 8 hours, the face becomes edematous and the eyelids usually swell shut. The patient should be reassured that this reaction is expected and normal. The patient is cautioned to move the mouth as little as possible so that the tape continues to adhere to the skin. The head of the bed is elevated, and liquids are administered through a straw. Most of the burning sensation and discomfort subside after the first 12 to 24 hours.
By the second day, the patient may feel moisture under the dressings as serous exudate seeps from the chemically exfoliated skin. Dressings are usually removed 24 to 48 hours after treat-ment, exposing skin resembling a second-degree burn. The pa-tient may be alarmed by the appearance of the skin and should be reassured. After the tape mask is removed, some surgeons dust the treated skin surface with thymol-iodine powder for its drying and bacteriostatic effects. Application of triple-antibiotic ointment may be substituted in some cases. The skin surface is left uncovered to dry. The patient may be permitted to wash the face with luke-warm water or advised to shower several times daily to help removeany remaining facial crusting. An ointment is prescribed to cover the face and soften and loosen the crust between washings.
The nurse reinforces the physician’s explanation that the red-ness of the skin will gradually subside over the next 4 to 12 weeks. Although a line between treated and untreated skin may be seen, makeup is usually permitted after the first few weeks. The patient is cautioned to avoid exposure to direct or reflected sunlight, be-cause the treatment reduces the natural protection of the skin from sun. The skin will probably never tan evenly again. Blotchy pigmentation can occur with exposure to the sun.
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