MedEsthetics magazines offers business education and in-depth coverage of the latest noninvasive cosmetic procedures for physicians and practice managers working in the medical aesthetics industry.
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photodamage. "I use chemical peels a lot," says Dr. Reichel. "They're really great in a younger population or in an older popula- tion as a maintenance treatment." When used as maintenance between ablative laser resurfacing procedures, she has patients wait at least three months before begin- ning the peels. "It will keep the skin looking fresh, and it's a nice way to maintain the rejuvenation you receive from the bigger guns," she says. The variety of peeling agents and com- bination peels available today make them a popular and effective choice for a wide range of patients, notes Marc Edward Weiner, licensed esthetician and owner of Marc Ed- ward Skincare in West Hollywood, Califor- nia. "Chemical peels are going to be effective for pigmentation, pores and acne, and they will reduce fi ne lines," he says. "There are even some chemical peels that will help reduce redness and, because rosacea can be caused by Demodex mites, chemical peels can reduce the mites in the follicles, which can reduce the redness of rosacea." Two concerns that cannot be addressed by superfi cial peels are acne scarring and broken capillaries. "I have never seen a peel improve capillaries—that's going to be a laser treat- ment," says Weiner. "And lasers are much more effective for deep acne scarring." Dr. Katz also fi nds superfi cial peels helpful for off-the-face indications. "Some women begin to develop fi ne lines in the cleavage area, we do light chemical peels there, though I still think fractional resurfacing works better," he says. "But some people prefer a chemical peel. Particularly here in the East during the winter, people begin to look sallow, so they come in for a few superfi cial chemi- cal peels to liven up their skin and make them look more fl ushed and glowing. It's a nice little pick-me-up. It's also a nice pampering experience." Chemical peels, particularly glycolic and salicylic acid peels, are effective treatments for active acne. Dr. Katz fi nds that, in ad- dition to helping reduce acne outbreaks, these peels can also reduce hyperpigmen- tation. "Acne patients typically get post- infl ammatory hyperpigmentation—or dark spots—from the acne, particularly patients with darker skin," he says. "These superfi cial peels will help not only the acne but also the discoloration. So superfi cial peels do have a role in acne as well." Though you want to provide the most effective treatments to your patients, the high cost of lasers and the relatively modest cost of chemical peels must be considered as well. "TCA peels are fantastic. I tell people, 'Before you get an expensive laser treatment, try doing some low or medium chemical exfoliation—you can get great results and that may be enough,'" says Weiner. Dr. Reichel also considers her patients' budgets and tolerance for downtime when discussing treatment options. "The bigger the procedure, the more costly it is. I have done multiple chemical peels on patients over a two- to three-year period of time when, if they could have afforded it, I probably would have chosen a series of nonablative fractional treatments. But the cost was so discrepant," she says. "So I may change my recommen- dation based on factors outside of 'This is what's perfect for your concerns.' Namely, budget and tolerance for downtime." Crystal Resurfacing A third resurfacing option for medical aesthetic patients is microdermabrasion. The typically gentle treatment exfoliates the top layers of the epidermis and also helps to stimulate circulation. "We fi nd that micro- dermabrasion is quite helpful in improving the texture of the skin," says Dr. Katz. "A lot of women will have a very nice glow after microdermabrasion. We also fi nd it helpful for comedonal acne, where the person has a lot of blackheads and whiteheads." Weiner notes that microdermabrasion is a popular procedure for minor concerns, since it has relatively no downtime. He also consid- ers it a valuable adjunct to chemical peels and laser treatments, where a very light microdermabrasion performed before a chemical peel or laser treatment helps to im- prove the penetration of the peeling agent or the light. "A very light microderm, whether it's crystal or crystal-free, can be very effective in enhancing the results of both chemical peels and laser treatments," he says. Fairman uses microdermabrasion prior to chemical peels as well, but with some cautions. "I would not use microderm on anyone who has signifi cant acne because you can spread the bacteria," she says. "If the patient has signifi cant signs of rosacea in the skin, I would not choose microderm because of the risk of fl are up. If the patient states that their level of discomfort is high and they show signs of redness as soon as you start the microdermabrasion, that's a very good indication that this patient is not going to tolerate a peel on top of a microderm. You're better off choosing a lighter lactic acid peel, seeing how they do and then having them return for a more aggressive peel." She also performs microdermabrasion as a standalone procedure to fi ne-tune the skin. "Microdermabrasion alone can be satisfactory for people who want to get a little brighter, as long as they have strong capillaries and don't have any visible vessels," says Fairman. Inga Hansen is the executive editor of MedEsthetics. © GETTY IMAGES OFF WITH THE OLD 32 MARCH 2015 | Med Esthetics "Chemical peels are going to be effective for pigmentation, pores and acne, and they will reduce fi ne lines."