Chemical Peels for Acne and Pigmentation

A COMPREHENSIVE REVIEW ON CHEMICAL PEELS AND ENERPEEL

 

 

 

 

The history of chemical peels dates back to the time of Ancient Egyptians and Romans; where women used  sour milk and fermented grape juice to rejuvenate the skin. Thankfully, chemical peels have evolved to become more  palatable  and safer to patients today. Although eclipsed in popularity by the wide variety of skin resurfacing lasers, chemical peels still remain a safe and efficacious way of lightening pigmentation such  as melasma, erase fine wrinkles and control acne outbreaks.

What is chemical peel

Chemical peel, or chemoexfoliation, is a non invasive clinic based treatment that is suitable for for individuals with pigmentation, wrinkles, uneven skin tone and acne. By removing damaged skin and promoting collagen rejuvenation, skin looks younger and smoother.  this "younger" skin also tends to be more radiant and receptive to skincare because there are no more damaged and dead skin cells to impede penetration.

There is a wide array of chemical peels available and the selection of the agent will depend on your skin condition and your expectations. Hence, treatment can be personalised for each patient.

The treatment involves the doctor applying the selected solution to your skin and monitoring your progress.  When the endpoint is reached, the solution is neutralised.  The objective of the treatment is to achieve removal of damaged skin to allow skin rejunvation.

How does a chem peel work

Essentially, chemical peels remove the top layer of damaged skin gradually, thereby promoting collagen production and skin regeneration.  This layer of new skin is usually smoother and less wrinkled. Chemical peels have been used to treat conditions such as acne scars, melasma, uneven skin tone and fine wrinkles.

The  mechanism of chemical peels can be classified according to the depth of their action-superficial depth, medium depth and deep peels.

Superficial chemical peels extend to the level of the epidermis and are most well tolerated by patients. A superficial chemical peel can be used to lighten certain types of pigmentation, achieve more even skin tone, lighten scars and improve acne scars.

Medium depth peels extend to the upper reticular dermis and can be used to treat the same conditions as superficial chemical peel. Understandably, the downtime and discomfort may be longer than superficial chemical peels.

Deep peels extend to the  mid reticular dermis and usually require analgesia prior to performing the procedure. Deep peels are useful in treating severe wrinkles and intense pigmentations. These peels are also associated with a higher risk of complications.

What conditions can be treated by chem peel

·         uneven skin colour/ skin discolouration

·         pigmentation (e.g. freckles, melasma, lentigenes, post inflammatory hyperpigmentation)

·         fine lines and wrinkles

·         exfoliation and acne control

·         soften acne scars

·         control oil and sebum secretion

Am I a candidate

Patients with skin discolouration, pigmentation, aged skin and acne are ideal candidates for chemical peels.  By lightening pigmentation, removing dead skin and promoting collagen rejuvenation, skin appearance and texture can be improved.

What can i expect/experience during the peel

After a thorough evaluation and discussion with our doctor; the choice of chemical peel is selected. your face is thoroughly cleansed to remove dirt, sweat and oil. Using an applicator, our doctor then applies the chemical peel to your skin. You may experience a temporary tingly sensation,  itchiness or warmth which will resolve when the peel is complete. Please inform your doctor if you find the sensation to be unbearable.

When the chemical peel has reached its endpoint the chemical peel is neutralised. this is followed by cleaning of the skin. Cooling measures may be employed if necessary.  An antibiotic cream is usually prescribed to prevent skin infections

What to expect after

There is no immediate downtime for chemical peels and the procedure can even be performed during lunch time! Depending on the chemical peel used, you may experience facial redness for 1-2 days followed by flaking or exfoliation for up to 1 week.

The skin flakiness may be fine or slightly larger depending on the type of peel used. It is safe to wear makeup to conceal the flakiness if you choose to do so. you may experience skin dryness and this is easily correctable with a moisturiser. During this phase, it is also important to have adequate sun protection and to be gentle when cleansing your face.

How to care for the skin after

·         Be gentle with your skin- please do not peel off any flaking skin

·         moisturise well

·         strict sun protection and sun avoidance for 2 weeks.

Protocol- how often, combination treatment, how many peels/duration

The number of sessions and treatment programme is depend on your skin condition and our doctors' assessment. Generally, deeper and more stubborn lesions will require more sessions.

 

Chemical peels can be combined together with other medical treatments such as lasers to accelerate result. A recommended programme would comprise of a chemical peel every 4-6 weeks.

Complications

Complications are rare when chemical peels are performed by trained doctors, patients are closely monitored and evaluated and when the appropriate chemical peel is selected.  Some of the complications that have been quoted with chemical peels include hyperpigmentation, skin infection, milia seeds, acneiform dermatitis, persistant wrinkles and scarring

Why enerpeel

As one of the leading aesthetic clinics in Singapore, The Clifford Clinic is committed to performing safe and efficacious treatments. traditional chemical peels have been dependent on skin redness and frosting on the surface of the skin as indicators of skin reactivity to the chemical peel. A more ideal peel would allow less visible skin redness and frosting while achieving deeper skin remodelling and rejuvenation.

 

Enerpeel (R) employs a breakthrough patented carrier solution which controls the acids' activity until it is absorbed.  bB using desmosome disruption- or more simply, by controlling the acid and then releasing it to penetrate between skin cells, the uptake of the acid is more uniform and enhanced. additionally, the uptake of the acid is increased by 2-3 fold without having to increase the strength of the acid. Talk about achieving better results with greater safety! What our patients can expect from Enerpeel(R) are: faster resolution of skin redness and enhanced skin renewal! 

Nose thread lift - Ultra V Hiko Nose Threads

Traditionally, nose augmentation or improving the nose profile has been limited to rhinoplasty (commonly referred to as "surgical nose job") and nose fillers

The recent trend for nose augmentation is starting to see a shift away from fillers and instead moving towards nose threadlifts due to the improved safety profile. Nose threadlifts are also known as Hiko nose threadlifts.  This procedure was first introduced in Korea 15 years ago. 'Hi' means high and 'Ko" means nose in the Korean language.

Here's a comprehensive FAQ that I've written for nose threadlifts. Enjoy!

What is the Ultra V Hiko nose threadlift / thread lift?

Hiko nose threadlift is also commonly referred to the "lunch time nose job" because my patients have been able to leave my clinic within 30 minutes and resume their daily activities. The nose threadlift are performed by placing very fine threads in the supraperichondrial and supraperiosteal plane of the nose without requiring any incision or surgery, thereby lifting the nose bridge and tip immediately!

Essentially, the hiko nose threadlift is a cross between nose dermal fillers and surgical rhinoplasty. It combines the benefits of dermal fillers (e.g. no incision, no downtime...etc.) and surgical rhinoplasty (e.g. longer lasting results).

What are the improvements seen with a nose threadlift?

1. Higher nose bridge
2. Sharper and better defined nose bridge
3. Straighter nose bridge
4. Sharper nose tip
5. Correction of bulbous nose
6. Shrinkage of nostrils

 

How is the Hiko nose threadlift performed?

Let's go through a detailed step by step analysis on how a nose thread lift is done
We can go through a patient who has kindly agreed for the use of her pictures

  

Step 1
After removing makeup and dirt from the face, the face is sterilised with Iodine and Chlorhexine. Next, localanaesthesia is placed at the tip of the nose, nose bridge and along the nasal septum to the philtrum. These are the locations for which the threads will be inserted, both to build up the nose bridge height as well as the nose tip.

Step 2

Once the nose is numb, the threads are introduced using a blunt cannula which is then removed. Nose threads are placed horizontally through the nose tip in the supraperichondrial and supraperiosteal plane. This improves the height and definition of the nose bridge.

Step 3

It is the same process for the nose tip. The threads are then placed vertically through the nasal tip along the columella.

 

What are these threads made of?
The threads are made up of a material called Polydioxanone (PDO). PDO is commonly used in surgeries as sutures to stitch up wounds. PDO is absorbable and is dissolved in 6 to 12 months time.

Fortunately, before the PDO threads are completely absorbed, the threads stimulate your nose to produce its own collagen and connective tissue along where the PDO threads were placed. This collagen and connective tissue produced by your body accounts for the long lasting results of nose threads. Also, the results of the nose threads continue to improve over time even as the PDO threads dissolve away. Patients can expect to see a continued gradual improvement of their nose bridge and nose tip over time.


How long can the threads last?
The results of these nose threads last 1-2 years but with the new collagen and connective tissue produced by your own body, there will some permanent results. However, in patients such as smokers, the results can be shorter lasting.

The Hiko nose threadlifts can be repeated if necessary. This can be done either at the 1 month follow up, or even after 6 months after the initial thread lift.

Is there any pain from the procedure?
Pain level from nose threads are actually surprisingly similar or even less than fillers. Some anaesthesia is used to numb the entry point for the threads. After that, the threads can be inserted with ease into the nose, with minimal pain and hardly any discomfort.

Is there any downtime? Do I need to avoid anything?
There is hardly any downtime. There is very mild swelling and bruising that usually results from the local anaesthesia and this disappears in a few hours. Patients are able to return to work and wear makeup after the Hiko nose threadlift.

You can resume your daily activities and sports too after the Hiko nose threadlift. The nose threads are very stable and secure and will not migrate or change in shape.

In terms of diet, there is no food that you need to avoid too.

I have done fillers before, am I still suitable?
Yes, these threads were particularly designed for those who have gone through fillers previously and are intending to find a more permanent solution but yet are not ready to undergo a rhinoplasty.

For patients unsatisfied with the problems and risks of fillers, the Hiko nose threadlift is a good option.

Rhinoplasty vs Threads
Threads are a great alternative to rhinoplasty for many reasons. First with surgery there is a risk of the implant shifting. Secondly, revision surgery may be necessary if you happen to be unhappy with the result from the surgery. The nose may be not straight, too round, not tall enough etc etc. Third, threads do not leave scars unlike a rhinoplasty that does leave a well hidden scar beneath the columella.

What are the risk of threads then?
As with all procedures, some minor bruising and swelling is expected.  Swelling is usually due to the local anaesthesia and disappears within a few hours as the local anaesthesia wears off.  Ice packs for cold compression can be used to hasten the recovery. Full recovery can be expected in 2-3 days.

There is a small risk of infection (e.g. cellulitis and abscesses) but unlike an implant where a repeat surgery is required to remove the foreign body, threads are easier to remove and the risk of infection is low. In my clinic, the Hiko nose threadlift is performed using sterile techniques and patients are started on antibiotics and this helps to minimize any skin infection. Keeping your face clean at home also helps to reduce the chances o infection.

The nose thread lift has no chance of displacement or shifting. This is because the thread lift thread is placed within the soft tissue. The threads then dissolve within 6 months and natural collagen stimulated. This new collagen is formed by your own body and this gives the long term lasting results for the height increase.

Are threads safer than fillers?
Threads are much safer than fillers for many reasons. Nose fillers have long been plagued with complications like blindness and skin necrosis, due to the inadvertent puncture of fine vessels around the nose and injection of the filler into these vessels, hence limiting blood flow to the eye or the skin resulting in these complications. Although the risk of this happening is extremely low, the risk is still there and the consequences are devastating.

Threads however have no risk of occluding these vessels. The puncture or damage to these vessels do not cause problems, but it is when a filler or gel is injected into these vessels and it tracks into the more narrow vessels that causes these unfortunate events. Although the risk is low, but there has already been 2 blindness cases reported in Singapore till date!!

Secondly, dermal fillers in the nose are known to migrate and can cause broadening of the nose bridge. This unsightly problem does not occur with nose threadlifts as the threads are very stable and can hardly migrate.

Bilateral blindness after filler injection. Published by Dr Kim from Korea.
Plast Reconstr Surg. 2013 Feb;131(2):298e-299e.
https://www.ncbi.nlm.nih.gov/pubmed/23358039

Avoiding and Treating Blindness From Fillers: A Review of the World Literature. Published by Dr Beleznay K
Dermatol Surg. 2015 Oct;41(10):1097-117.
https://www.ncbi.nlm.nih.gov/pubmed/26356847

No doubt I have performed countless number of nose fillers over the years with excellent results, but safety is still of paramount importance to my patients. Hence I would much prefer decreasing the use of these fillers for nose augmentation.

Which type of nose threads do you use?
Ultra V Hiko Nose threads improve the height of the nose and give the sharpest profile.

Some doctors claim using those with cog threads are able to grip better to lift the sagging skin. However from my experience, the results do not differ much from normal Ultra V Hiko threads. In fact these threads may even cause unnecessary tension on the skin and result in scarring or uneven texture on the surface.

How many threads do you use?
It all depends on the height and the baseline we are starting from. It is usual for one to need about 6-8 threads for the bridge and about 4 for the columella. 2-3 threads can be used for the nasion as well.