Preprocedure Rejuvenation Regiment

Retinoic acid, hydroquinone, glycolic acid, or lactic acid and sunscreens are among the products used in the pre- and posttreatment phase of medium-depth chemical peels. Their effects on corneocyte adhesion, the stratum corneum and melanin production help ensure even absorption of the peel and reduce postoperative hyperpigmentation. In addition, the use of oral prophylaxis for herpes simplex before the peel and throughout the period of re-epithelialization has become the standard, even in patients without a known history of herpetic infection. Although some degree of variation in clinical management between cosmetic surgeons exists, the basic treatment protocol is similar. Patients are instructed to avoid excessive sun exposure and wear sunscreen 3 or more months in advance of their first peel. Retinoic acid 0.5–1.0% and hydroquinone 2–8% are usually applied daily to the area to be peeled starting from 2 to 12 weeks prior to the procedure. As a keratolytic agent, retinoic acid thins the stratum corneum, increasing the depth of the peel and allowing for more uniform absorption. As mentioned earlier, retinoic acid also speeds epidermal healing and independently has a pronounced effect on collagenesis [49]. Because hydroquinone interferes with tyrosinase, the enzyme responsible for the conversion of tyrosine to L-dopa (a melanin precursor) [52], the end result is stabilizing melanin production. The end effect is limiting the amount of postinflammation pigment from the chemical peel’s dermal inflammatory reaction. This is particularly important in darker skin types (Fitzpatrick III and higher) but also in lighter skin with dyschromia.

The day of the peel, most patients are advised to start antiviral prophylaxis (some are instructed to start 2 days before the peel) and continue for 7–10 days. In some cases, the patient is also given a prescription for an antibiotic (i.e.,Cephalexin) and advised to start taking whole-food supplements [52]. Patients are to avoid any procedure that may alter the penetration of the peeling agent, such as waxing, microdermabrasion, electrolysis, or laser hair removal, for 2 weeks prior to the peel. The wait following isotretinoin therapy can be anywhere from 12 to 24 months.