Phenol-Croton Oil Peels Flashcards
How was the 1st phenol-croton oil peel created ?
- The formulas involved boiling crystals to obtain liquid phenol
- to which were added drops of the caustic acid croton oil, among other ingredients
Thomas Baker original formula
- liquid phenol, 3 drops of croton oil, water, and the surgical soap Septisol
- which acted as a surfactant to allow the aqueous & oily parts to mix
Who proved that croton
oil & not phenol was the peeling agent ?
- plastic surgeon Gregory Hetter
in Las Vegas
pros & cons of original Baker formula
- pros: highly effective in treating deep wrinkles
- cons: significant hypopigmentation, creating unnatural alabaster look, phenol’s reputation of being cardiotoxic
croton oil concentration at original Baker’s formula
2.1%
what caused the all-or-none phenomenon seen with the Baker peel ?
high croton oil concentration
advantage of modified Baker formula
- practicioner can choose different concentrations on different areas of the face depending on need & relative skin thickness
- It is feasible to peel to the desired clinical result without reaching a depth that causes hypopigmentation
main contraindication in peeling
- patient who is expected to be uncooperative in the postoperative care & may not refrain from picking
Liquid phenol concentration
- 88% or 89%
- its corrosive effect allows passage into the dermis
croton oil features
- extracted from the seeds of Croton Tiglium ,a tree indigenous to Asia
- Full-strength croton oil is highly caustic and will result in a full-thickness burn if applied to the skin
- However, when correctly diluted & appropriately applied, croton oil will yield remarkable aesthetic improvement
what is Septisol ?
- surgical soap that has been historically
used as a surfactant to allow miscibility of the aqueous & oil components - contains triclosan as a preservative, and this has become problematic as of late
- banned by FDA, allowed in Europe in low concentrations
- triclosan is inconsequential to the peel
Formulas With 35% Phenol Concentration
what is the effeft of applying dilute phenol solution to the skin ?
- dilute phenol solution (i.e.,50%) caused an initial stinging that lasted 10-15 sec after which the skin appeared insensate
anesthetic technique with phenol ?
- peeling by applying a first pass of 50% phenol to one segment of skin (such as one-half of the forehead)
- The patient would experience definite stinging for 10 to 15 seconds, after which the discomfort dissipated completely
- At this point, the skin treated with phenol is numb and can be comfortably peeled
- If the entire face is to be peeled, it is first gradually treated with 50% phenol for the anesthetic effect & then peeled
what technique can be added in order to perform a deep peel ?
- oral sedation ( 1/2 tb Xanax & 1/2 tb Stilnox, prior to treatment )
- IM pain medication, if regulations allow
- use of an apparatus that
delivers 50% oxygen and 50% nitrous oxide on demand by the patient (Pro-Nox CAREstream Medical LTD)
To significantly improve wrinkles, deep peels must reach at what skin depth ?
- upper to middle reticular dermis
how can we evaluate the degree of peel depth ?
- by constantly evaluating the degree of frost opacity
what is the significance of a thin transparent frost with pink background ?
- indicates that the peel has passed through the epidermis into the dermis
- The translucent quality of the frost reveals the dermal vessels—hence the pink color
- Depending on the circumstance & location, this may be the correct endpoint
what do we expect if more passes are applied once thin frost with pink background has been observed ?
- With more passes, the peel proceeds to the upper & middle dermis
- The frost forms a solid, opaque, even white frost
- The pink hue is lost because the acid has destroyed the intradermal vessels & the opacity hides the deeper subdermal plexus
reliable sign that the upper to mid-reticular dermis has been reached ?
- frost is gradually lost in about 15 minutes
(“defrosting”), and the skin turns into a red-brown or tan color - Further peeling after a solid white frost results in a gray-white color indicative of reaching the lower reticular dermis, which is not advisable
Another sign to evaluate depth of peeling ?
- epidermal sliding
- This occurs when the peel reaches the papillary dermis and the normal bonds between epidermis & dermis are broken and the epidermis can now slide as a thin independent sheet
- This sliding disappears when the peel reaches the reticular dermis & a solid protein block is formed
practical recommendations during peeling procedure
- always be mindful & protective of the eyes
- head of the bed is gently elevated to prevent acid running into the eye
- never using an applying sponge so wet that it can drip, and never crossing over the eye with an applying gauze in hand
- To keep the operator’s hands dry, a surgical towel can be clipped to the shoulder of the
scrub skirt and draped over the front to easily wipe the hands - Clearly labeled containers are lined up with glass
bowls and arranged in ascending strength in a consistent manner to prevent confusion
What is the specific action of the acid?
- to precipitate & coagulate the protein of the skin, forming a “frost,” of varying degrees of white appearance
- The frosting becomes progressively more dense and opaque as the peel passes through the papillary dermis into the upper & mid-reticular dermis
What is the key concept with weaker concentrations ( [croton oil] ) < 2,1%?
- main factor of the depth reached is the application technique, which is directly controlled by the surgeon
- Nuance in the technique can involve how wet the gauze is, how many passes are made, and how much pressure is applied
- The same depth can be reached using different techniques or even different concentrations
How to treat deeper wrinkles in the
lips, glabella, forehead & midface ?
postpeel care
Results of phenol-croton oil peel
