San Benito Surgery

A chemical peel can restore a more youthful appearance to wrinkled, unevenly pigmented,
sun-damaged, or blotchy skin. However, a peel cannot reverse the aging process or completely
remove deep scars. Wrinkled skin that is loose and sagging may also require a face-lift, laser
resurfacing treatment, or combination of procedures for best results.

How is a chemical peel performed?
All chemical peels involve applying a chemical solution to remove the outer layers of skin
so that a smoother, more evenly pigmented, glowing layer of skin can appear. There are three
basic categories of chemical peels. Each type works differently, and produces different results.
Your doctor may choose from the following three types of chemical peel, or he/she may tailor the treatment to the needs of your skin. In general, the stronger the chemical, the deeper the peel,
and the more impressive the results. However, the deeper the peel, the more pain you’re likely to experience and the longer the recovery
time will be.

Light peels: 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). They burn off
only the outer layers of the skin to smooth out fine wrinkles
and/or rough, dry skin. AHA and Beta lift peels may also be
used to improve the texture of sun-damaged skin, balance
out skin pigmentation, or diminish some types of acne
scars. These peels are often repeated to achieve the
desired results.

The application of AHA and Beta lift peels are relatively fast
and simple. These peels are generally performed in the
doctor’s office. No sedation or anesthesia is required, since
the patient only experiences a slight stinging when the
solution is applied. The treatment usually takes about 10 to
15 minutes, but the doctor may vary the concentration
of the chemical solution or the length of time of the treatment.

Dr. Wittenbergy will begin by thoroughly cleansing the area to be treated. Next, he/she will
apply the AHA solution, wait up to 15 minutes, and then remove it. After the procedure, no
ointments or salves will be necessary to cover the treated area. Monthly or weekly repetition
is common.

Medium peels: Trichloroacetic acids (TCA) A TCA solution is used for medium depth peels.
This is generally used to treat skin with moderate sun damage, surface wrinkles, and/or uneven
tone or pigment abnormalities. Full-face TCA peels take approximately 15 minutes. Generally,
TCA peels are performed in the doctor’s office or in a surgery center as an outpatient procedure.

Before applying the chemical solution, the doctor will thoroughly cleanse the area to be treated.
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. Sometimes two or more TCA peel treatments, at intervals of one to two
months, are necessary to achieve the desired results. The TCA peels can be used in varying concentrations, the higher concentrations may require oral or liquid anesthesia medication.

Deep peels: Phenol acid Phenol acid is the strongest chemical peel solution, and it is used
for the deepest possible chemical peel. 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.

Phenol peels should be used with caution because 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, but small-area phenol peels
(such as on the upper lip) may take about 10 - 15 minutes. Generally, phenol peels are
performed in the doctor’s office or in a surgery center as an outpatient procedure with anesthesia.

After completing the procedure, Dr. Wittenberg may apply petroleum jelly or a waterproof
dressing tape to the treated area. This covering will be left on for a day or two. Unlike AHA
and TCA peels, Phenol peels are only used once and create dramatic results.

How long does it take?

AHA and TCA peels for the full face generally take 10 - 15 minutes. Full-face Phenol peels
may take between one and two hours. Phenol peels for small portions of the face, such as the
upper lip, may take only 10 to 15 minutes.

How much pain is there?
During the procedure, most people feel a brief burning sensation, followed by a feeling of
numbness or stinging. The sensation will vary depending on the type of peel as well as the
possible of pain medications in the case of deep peels. The AHA, BHA and TCA peeks are
uncomfortable only during treatment. The phenol peel may have discomfort after the procedure.

What can I expect afterward?
After the procedure, most people experience some facial swelling and reddening. Your doctor
may advise you to keep your head elevated.

After a Phenol peel, the eyes often swell shut. Following a Phenol peel, a petroleum jelly or
waterproof dressing may be applied to the treated area. This covering is left on for a day or two.
After Phenol and deep TCA peels, you’ll need to arrange for someone to drive you home. Ride arrangements do not need to be made after having an AHA or a light TCA peel.

The recovery period is different for each type of peel.

Light peels: Alphahydroxy acids (AHAs) AHA peels generally cause some flaking, redness
and dryness, or skin irritation. These side effects diminish over time. Once the body heals itself naturally, the outer layer of skin will fall away. Patients are usually able to engage in normal
public activities the day after an AHA peel.

Medium peels: Trichloroacetic acids (TCA) TCA peels may cause significant swelling,
depending on the potency of the chemical solution that was used. Swelling should diminish
after the first week. The skin will heal sufficiently to resume normal activities in approximately
7-10 days.

After TCA peels, some patients also have outbreaks of small whiteheads, called milia, which
are formed in obstructed facial glands. Generally, these disappear with washing.

Deep peels: Phenol acid After a Phenol peel, your doctor may prescribe a mild pain medication
to relieve any discomfort. If a waterproof adhesive is applied to the treated area, it will be
removed in 1-2 days, and you’ll be instructed to cover the area with antiseptic powder several
times a day. A scab
will form and, within 7-10 days, new skin will form. While the skin will be red at first, the color will
lighten over a few weeks to a few months.

After any peel, it is critically important that the skin be protected from the sun. Ask your doctor
to recommend a sun block with both UVA and UVB protection, and apply it daily.

After the procedure, the doctor may recommend that the patient stop smoking for at least a
week. Smoking decreases circulation of the blood in the skin, which can slow your recovery.

Ideal candidate:

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, including most kinds of acne.
Informed about the appropriate skin tone for the type of peel used.
Not taking Accutane, nor have taken it for the previous 18 months.
Free from large or unusual scar formations, such as keloids.
Realistic in their expectations.
Willing to accept the limitations involved in the healing process.

Other important information:

Partial-face chemical peels are frequently combined with a face-lift, because face-lifts
can correct loose and sagging skin, while chemical peels improve the texture of the skin.
Aging skin may require both kinds of corrections in order to achieve a healthier, more
youthful appearance. Alternative procedures include dermabrasion, laser resurfacing,
and injectable fillers. In addition, Retin-A (a prescription medication derived from Vitamin
A) is often used to pre-treat the skin by thinning the skin’s outer layer. This pre-treatment
allows for deeper penetration of the chemical solution. The pre-treatment period may
take up to a month before the chemical peel is actually performed.

Risks and limitations:
Significant complications with chemical peels are infrequent, but potential complications
include:
Scarring
Infection
Temporary or permanent changes in skin tone or uneven tone
(especially with Phenol peels). These include
Hyperpigmentation (a darkening of the skin, treatable in most cases with
current bleaching techniques)
Hypopigmentation (a lightening of the skin, more difficult to treat)
Cold sore breakouts in patients who have a history of recurring blisters
and cold sores, like herpes and shingles. (An anti-viral medication before the
procedure can help prevent this.)
Risks for those with a family history of heart disease (Phenol peel only).

You can help minimize certain risks by following the advice and instructions of your
doctor, both before and after the chemical peel. Pre-existing conditions may also put you
at risk. If you have a history of heart disease or herpes, or you have a tendency to form
large or unusual scars, be sure to discuss this with your doctor before you have a
chemical peel. Also tell your doctor if you have undergone considerable amounts of
radiation or facial x-rays.

For more information schedule your free consultation with Dr. Wittenberg to
discuss this procedure in full. Our experienced and professional office staff members
are here to help you with all your questions. Call our offices at (831) 636-9808.

890 Sunset Drive, Suite B-1A
Hollister, California 95023

Telephone: (831) 636-9808
Facsimile: (831) 636-9843

NOTICE TO WEB SITE BROWSERS
This website is provided for informational and educational purposes only. No doctor/patient relationship is established by your use of this site. No diagnosis or treatment is being provided. The information contained herein should be used in consultation with an oral and maxillofacial surgeon or other physician of your choice. No guarantees or warrantees are made or implied regarding any of the information contained within this website. This website is not intended to offer specific medical, dental or surgical advice to anyone. Drs. McBride and Wittenberg are licensed to practice medicine in the state of California, this website is not intended to solicit patients from other states. Further, this website and Drs. McBride and Wittenberg take no responsibility for websites hyperlinked to this site and such hyperlinking does not imply any relationships or endorsements of the linked sites.

Site Designed by: