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A Chemical Peel is a treatment involving the application of chemical solution to improve the appearance of sun-damaged, unevenly pigmented, prematurely aged, and/or finely wrinkled facial skin by peeling away the skin's top layers. The new, regenerated skin is usually smoother and less wrinkled than the old skin. The new skin is also temporarily more sensitive to the sun. It is typically performed on the face, neck, hands or other parts of the body. Both the type and concentration of acid can be carefully selected to achieve the quality and depth of effect desired. It is usually a relatively brief procedure, performed in the office, and following the procedure, the patient is able to return home.

The skin is composed of 2 mutually dependent layers, outer layer the epidermis and inner layer the dermis, which rest on a fatty subcutaneous layer. The epidermis contains no blood vessels and is dependent entirely on the underlying dermis for nutrient delivery and waste disposal by diffusion through the dermoepidermal junction. The primary function of the dermis is to sustain and support the epidermis.

What Can a Chemical Peel Do?
Light peels are used to correct mild defects, medium-depth peels to correct moderate defects, and deep peels to correct severe defects. Chemical peel can improve the appearance of:

	Fine lines and wrinkles caused by sun damage, aging and hereditary factors can be reduced or eliminated.
	Pigmentation of the skin such as sun spots, age spots, liver spots.
	Epidermal Melasma. Melasma (a skin condition characterized by irregularly shaped patches of brown skin commonly found on the face and neck), usually occurs after pregnancy.
	Light freckles
	Dull skin texture and color
	Mild scarring and acne
	Treatment for the face, arms, legs, neck, chest, and hands
	Most chemical peels today are supplemented by the peeling effects of creams such as retinoic acid on a daily basis, which give a constant turnover of the top layers of the skin, further improving the results.

Chemical peel cannot improve the appearance of

	Deep wrinkles
	Sagging, hollow, or bulging fatty skin
	Deep sun damage or freckling
	Deep scarring
	Broken blood vessels on the face
	Pore size
	Cannot always totally remove hyperpigmentation in dark-skinned whites, Asians, or blacks.

Types of chemical peels
There are generally three types of peels named according to the depths of their effects as well as the duration of healing time after the procedure. Superficial, medium, and deep peel. The peel depth is determined by the agent, its concentration, the volume applied, time of contact, frequency of application, integrity of the stratum corneum, skin thickness, cleansing, oiliness and post-peel care. Remember, the deeper the peel, the longer the recovery and the better results.

	The superficial peel It is often termed a "freshening peel" or "lunchtime peel" and usually is accomplished with relatively mild agents such as glycolic acid, Jessner's solution, salicylic acid, or low strength Trichloroacetic Acid (TCA). While the concentrations of these acids may be varied, the overall goal is to produce superficial effects (primarily epidermal), with little irritation, mild redness and swelling, and little "downtime". While the results of one peel are not usually dramatic, one can achieve excellent benefit with a series of 3-6 peels at 2-4 week intervals especially when combined with a prescribed home care program. Depending on the strength and type of the peeling agent used, as well as adherence to one's home program, an occasional "booster" peel may be repeated to maintain the benefits at anywhere from 3-6 months after the initial series of peels. This procedure has only modest effects on deep facial wrinkles or scars, nor does it significantly affect telangiectases (small dilated blood vessels) in the skin. Facial peels have little or no effect on the size of facial pores. As with all cosmetic procedures, it is vital to avoid unreasonable expectations.
	Medium-Depth peels They are achieved by a variety of acids used singly or in combination to achieve a deeper effect (on both the epidermis and dermis). The most common acid combination uses a "priming solution" such as Jessner's solution followed by Trichloroacetic acid (TCA) to effect changes in fine wrinkles and pigment abnormalities in the skin. The procedure takes longer than the superficial peel noted above, is considerably more irritating, and involves significant skin redness, swelling, and "downtime" away from your normal activities from 5-10 days depending on the depth of the peel. The upper skin layer literally peels and new fresh dermal collagen is stimulated as well as a fresh new superficial (epidermal) skin layer. Healing usually occurs within a week and some mild, persistent redness can linger for a few weeks. Patients usually can wear makeup and return to work by 7-14 days after the procedure. Usually the peel is accomplished in a single treatment session, however a repeat peel may be undertaken anytime after 6 months.
	Deep peels They penetrate several layers of skin and cause second degree bum of the skin. A chemical peel called phenol is usually used . Skin regrowth begins within 10 -14 days and the skin remains extremely red and tender for up to three weeks. Complete healing takes several months.

How a chemical peel is done?

Prior to chemical peel, instructions may include the preparation of the skin with topical pre-conditioning medications or OBAGI system.
The procedure is performed at the comfort of our center only by our well experienced medical director. The proper peeling agent and type of peeling is selected based upon the type of skin damage present and your expectations.

	Superficial (light) peel Alphahydroxy acids (AHAs), Betahydroxy acids (BHAs) Light or “lunch hour” peels are the mildest of the chemical peels. These peels include glycolic, lactic, and fruit acid peels (AHA) or Salicylic Acid (BHA). Right before the peel, the skin is cleansed with an agent that removes excess oils, and the eyes and hair are protected. One or more of the chemical, peeling agents, are then applied to the skin with a small brush, sponge or cotton-tipped applicator. The chemical is left on the skin for 2-7 minutes, depending on the type of chemical used. Water is utilized to neutralize the acid and end the chemical reaction. You may feel a little burning while the chemical on the skin. No anesthesia or sedation is required.
	Medium-Depth peels For the medium peel, a similar technique is used but the chemical may be left on skin for longer period of time, different chemical is used, or higher concentration is used. Trichloroacetic acids (TCA) solution is most commonly used for medium depth peels. Full-face TCA peels take approximately 15 minutes. TCA peels are performed in the office. A sedative may be given, but TCA peels often do not require anesthesia because the solution itself has a numbing effect on the skin. At first, the patient may feel a warm or burning sensation, followed by stinging. Cold compresses and a fan may be used to reduce discomfort. Sometimes two or more TCA peel treatments, at intervals of one to two months, are necessary to achieve the desired results. OBAGI Blue Peel is a TCA peel but with certain advantages.
	Deep peels Phenol acid is the strongest chemical peel solution. Phenol peels are used to treat skin with coarse wrinkles and blotchiness. They may also be effectively used to treat patients with pre-cancerous growths. They can cause permanent lightening of the skin. For this reason, Phenol peels are not recommended for most patients with very dark skin tones. Full-face Phenol peels take approximately one to two hours. Generally, phenol peels are performed with anesthesia.

What are the side effects of chemical peels?

Light chemical peels have minimal or no side effects. While most patients get a very pleasing result, a variety of complications can result from chemical peels. In general, the deeper the peel, the greater the risk of complications. These include the following:

	Redness. Expect some redness. It can be very severe. It may fade within days to weeks or months.
	Changes in skin pigmentation (lightening or darkening).
	Crusting and scaling
	Swelling, especially around the eyes
	Scarring
	Allergic reaction to chemical
	Increased sensitivity to light
	Increased prominence of small blood vessels.
	Flare-ups of facial herpes simplex (cold sores).

What Should Be Expected After Treatment?
Depending upon the type of peel, a reaction similar to a sunburn occurs following a chemical peel.
Superficial light (AHA, BHA) peeling usually involves mild redness, followed by scaling that ends within three to seven days. Patients are usually able to engage in normal public activities same or the day after an AHA peel.
Medium-depth and deep peeling may result in swelling and the presence of water blisters that may break, crust, turn brown, and peel off over a period of seven to 14 days.
Deep peels require much longer recovery and prolonged redness for few weeks to few months and increased sensitivity of the skin. It is important to avoid overexposure to the sun after a chemical peel since the new skin is fragile and more susceptible to complications. You will need sun block SPF 15 or higher to go outside.

Who is a good candidate for chemical peel?
In general, the best candidates for chemical peels are people:

	In good physical health.
	Psychologically stable.
	Who understand the procedure
	Who do not smoke
	Wanting to look younger and more refreshed.
	Unhappy with the appearance of wrinkles or brown spots, especially around mouth or eyes.
	Free of active skin infections
	Not taking Accutane, nor have taken it for the previous 18 months.
	Free from unusual scar formations or keloids
	Have realistic expectations.
	Willing to accept the limitations involved in the healing process and possible down time with deep peels.

The above is only a partial list of the criteria that we will consider in determining whether or not this procedure is appropriate for you.

OBAGI BLUE PEEL^®

The Vein & Laser Center is an official site for the distribution of OBAGI Products.
Dr. Taha has special training and is experienced with this highly effective Peel.

What is unique about the Obagi Blue Peel^®?

Unlike alpha- hydroxy peels or other superficial procedures, the Obagi Blue Peel allows the doctor to control the depth of the peel and the number of coats appliedin order to tailor the process to your skin’s specific needs. The Obagi peel can be performed on the face, neck, hands, chest and legs.

What is OBAGI Chemical Peel^®?
The Obagi Blue Peel is an in-office procedure designed to significantly improve the appearance and health of your skin. Using a low concentration of the chemical Trichloroacetic acid (TCA) mixed with a special blue base to slow penetration, the Obagi Blue Peel allows us to monitor the appropriate depth to effectively remove the thin surface layers of aged and damaged skin from the face or other parts of the body. These dead skin cells are replaced by healthier ones, allowing the skin's own clarity and tightness to resurface. The procedure is performed by our medical director, who has specialized training and experience with this highly effective peel.

What does the procedure consist of?
The Obagi Blue Peel is a quick, relativelysimple and highly tolerable that in most cases, does not require sedation.
Application of the Obagi Blue Peel takes about 20 minutes, depending on the number of coats that has been determined are necessary to achieve your goals. You will experience a burning sensation that lasts two to three minutes (An electric fan is used to minimize this sensation). Immediately after the procedure, a bluish tint remains on your skin, which will usually wash off in 12 to 24 hours.

How long is the recovery period?
After the procedure, you will experience light swelling, and your skin will begin to peel within 2 to 3 days. This peeling will continue over the next several days and should be healed in an average of 7 to 10 days. If you are having a lighter, exfoliative Obagi Blue Peel, healing is completed in 3 to 6 days. In either case, this peeling should not disrupt your regular lifestyle for long, although you may want to limit your normal activity.

Can I apply makeup after an Obagi Blue Peel?
To best aid in the recovery process, makeup should only be applied after the skin is completely healed.

How will my skin look after recovery?
When your skin has completely finished peeling, you will immediately notice the dramatic results of your newly improved complexion. Your skin's appearance will continue to improve for the next 4 to 6 weeks, becoming firmer, clearer, smoother, healthier and more youthful looking.

Can the Obagi peel combined with other procedures?
Yes. This can be very effective in achieving even more dramatic results in the same time period. Talk to us about the possible combination that may be best for your skin.

Can the Obagi Blue Peel be repeated?
At your first visit, we will tell you how many peels are necessary to give you the desired result. In most cases, one to three Obagi Blue Peels can achieve dramatic improvements in many skin problems. The peels can be performed in 6 to 8 week intervals until your desired goals are reached.

How can I maintain the benefits of chemical peel?
Keeping your skin's new healthy glow and youthful appearance is an ongoing process. The Obagi Nu-Derm® System is a prescription system that utilizes a specific sequence of dosage and frequency to help skin look and act younger and healthier. The Obagi Nu-Derm System is formulated to work safely and effectively in conjunction with the Obagi Blue Peel. Ask our staff for more information on the Obagi Nu-Derm System.

After Chemical Peel Instructions

Immediately following peel, take extra precaution to guard against exposure to sun. Sun protection is critical. You should NOT have any sun exposure; wear a broad spectrum sunscreen with a minimum of SPF 30. This includes driving to work. Never leave the house without applying sun screen

Avoid harsh cleansers, scrubs (any other scrubbing brushes), washcloths, Retin-A, AHAs, or Benzoyl Peroxide for 5 - 7 days. DO wash twice a day with water, pat skin dry / do not rub, and liberally apply a bland moisturizer after cleansing and throughout the day as needed to prevent dryness and formation of crust (Aquaphor, Cetaphil, CeraVe, Neutrogena moisturizer)

DO NOT PICK OR PULL THE SKIN, as scarring and hyperpigmentation (brown spots) can occur.

It is safe to wear makeup the same day depending on the level of peel. Aggressive peels, avoid makeup for 3 days.

Avoid strenuous exercise (i.e.: Hot Yoga) with aggressive peels, as sweat gets trapped under the skin leaving little water bubbles.

Do not have any other facial treatments/procedures for at least one week after peel or until flaking stops.

DO wait 7 days before resuming the use of Retin-a (tretinoin), Renova, Differin, Tazorac, Ziana, glycolic acids or any other exfoliating agents such as a Clarisonic Brush.

AVOID swimming, sauna, or whirlpool use for at least 7 days after the peel.

The procedure may cause swelling, redness, crusting, dryness, skin sensitivity, itching, and peeling of the site which could last for 1-2 weeks. In the days after the peel, the skin may feel and look tight, with parchment-paper like changes or darkening. These are expected reactions.

If you are unclear about your post treatment instructions, or are concerned about your reactions, contact the office (201-795-9007). Do not wait for your next appointment.

Take the opportunity to discuss the OBAGI BLUE PEEL® with us.
Call the Vein & Laser Center for a private consultation at 201-795-9007