1. All content copyright 2007-08, PCA Advanced Skin Care Systems and the4 [creative network], LLC.All content copyright 2008 PCA SKIN and Physician’s Care Alliance. Images are for internal use only. chemical peel overview Presented by Lindsey Miller Licensed Aesthetician Advanced Educator, PCA SKIN ®

2. All content copyright 2008 PCA SKIN and Physician’s Care Alliance. Images are for internal use only. did you know…  According to the American Society of Aesthetic Plastic Surgery 1,048,577 chemical peels were performed in the United States in 2008.  In 2008, among the 10.4 million minimally invasive or non-surgical cosmetic procedures, the top five were:  Botox ® (5 million)  Hyaluronic acid fillers (1.1 million)  Chemical peel (1 million)  Laser hair removal (892,000)  Microdermabrasion (842,000)

3. All content copyright 2008 PCA SKIN and Physician’s Care Alliance. Images are for internal use only. topics of discussion  Function of chemical peels within the skin  Types of peeling agents  Classification of chemical peels  Variables determining depth of peel  Chemical peel fundamentals  Peel technique and contraindications  Frequency of treatment  Patient expectations  Peels with medical modalities  Pre- and post-procedure skin care

4. All content copyright 2008 PCA SKIN and Physician’s Care Alliance. Images are for internal use only. function of chemical peels within the skin

5. All content copyright 2008 PCA SKIN and Physician’s Care Alliance. Images are for internal use only. types of peeling agents  AHAs  Salicylic acid (BHA)  Jessner’s solution  TCA  Phenol  Baker-Gordon

6. All content copyright 2008 PCA SKIN and Physician’s Care Alliance. Images are for internal use only. classification of chemical peels  Superficial – very light to light (epidermal exfoliation)  AHAs  Retinoids  Salicylic Acid  Jessner’s solution  Up to 30% TCA

7. All content copyright 2008 PCA SKIN and Physician’s Care Alliance. Images are for internal use only. classification of chemical peels  Medium Depth (papillary dermal)  35-40% TCA  Jessner’s solution combined with 35% TCA  Deep (reticular dermal)  Phenol peel  Baker-Gordon  TCA in concentration > 50%  Erb:YAG/CO 2 laser resurfacing

8. All content copyright 2009 PCA SKIN and Physicians Care Alliance LLC. Images are for internal use only. classification of chemical peels Depth of Peel Penetration Cornified Layer Basal Layer Superficial Medium Depth Deep Depth AHAs Retinoids Salicylic acid Jessner’s solution Up to 30% TCA 35-40% TCA Jessner’s solution combined with 35% TCA Phenol peel Baker-Gordon TCA > 50% Erb:YAG/CO2 laser resurfacing Granular Layer Squamous Layer Papillary Dermis Reticular Dermis

9. All content copyright 2008 PCA SKIN and Physician’s Care Alliance. Images are for internal use only. variables determining depth of a peel  Peeling agent  Concentration of the peeling agent  Layers of the agent applied  Application technique  Prepping of the skin  Patient skin type  Location of the peel

10. Fitzpatrick Skin Type Skin ColorCommon Hereditary Backgrounds Visual Reaction to Sun Typical Sensitivity to Chemical Peels Common Response to UV Rays IPale WhiteNordic, Scandinavian (Swedish, Danish) Always Burns, Never Tans Very Resilient Skin Cancer & Hypopigmentation IIWhiteIrish, English, WelshUsually BurnsResilientSkin Cancer & Telangiectasia IIILight Brown, (Naturally Tan) Skin Asian, Mediterranean (Italian, Greek) Mildly Burns, Tans Relatively Well Moderately Responsive Telangiectasia IVModerate Brown Hispanic, Middle Eastern, African American, Native American Rarely Burns, Tans Well SensitiveHyperpigmentation VDark BrownHispanic, Middle Eastern, African American, Native American, South Asian Very Rarely Burns, Tans Easily Moderately Sensitive Hyperpigmentation VIBlackAfrican American, South Asian Least Likely to Burn, Tans Very Darkly Very Sensitive Hyperpigmentation Fitzpatrick’s classification of skin types and correlating sensitivity

11. All content copyright 2008 PCA SKIN and Physician’s Care Alliance. Images are for internal use only. chemical peel fundamentals  Do not peel a red/traumatized face  Have antidote for heat on hand  Use the sensitivity scale of one to ten  Other visual factors  Excessive erythema  Frosting  Blanching

12. All content copyright 2008 PCA SKIN and Physician’s Care Alliance. Images are for internal use only.  Frosting chemical peel fundamentals

13. All content copyright 2008 PCA SKIN and Physician’s Care Alliance. Images are for internal use only. chemical peel fundamentals  Blanching © 1995, J.B.Lippincott

14. All content copyright 2008 PCA SKIN and Physician’s Care Alliance. Images are for internal use only. peel technique  Cleanse the skin and remove excess sebum and cell debris  Degrease the skin with an alcohol-free toner (do not use acetone); patch test for sensitivity  Apply appropriate number of layers of peel  Customize the treatment with advanced serums and moisturizers  Occlude the treatment and protect from UV exposure with a combination of anti-inflammatory and broad-spectrum SPF moisturizers

15. All content copyright 2008 PCA SKIN and Physician’s Care Alliance. Images are for internal use only. contraindications to peels  Pregnancy  Lactation  Active herpetic lesions  Allergies to ingredients found in peels  Trentinoin/Retin-A ® /Renova ® /Differin ® /Tazorac ® /Avage ® / EpiDuo™/Ziana ® : Discontinue use 5 days before and after treatment

16. All content copyright 2009 PCA SKIN and Physicians Care Alliance LLC. Images are for internal use only. frequency of treatment Day of treatment Week 1Week 2Week 3Week 4 Normal/Maintenance (once a month) XX Pigment/Melasma (every three weeks to begin, then once a month) XX Acne/Blemishes (every two weeks to begin, then once a month) XXX Rosacea (once a month) XX Aging Skin (every three weeks, then once a month) X X

17. All content copyright 2008 PCA SKIN and Physician’s Care Alliance. Images are for internal use only. what to expect immediately following a peel  Mild to moderate erythema (redness)  Periorbital edema (puffy eyes)  Tightness/dryness

18. All content copyright 2009 PCA SKIN and Physicians Care Alliance LLC. Images are for internal use only. immediately following treatment day of treatmentfollowing morning day 2day 3 - 5day 5+ skin appearance and feeling ▪ tight ▪ moist and dewy appearance ▪ mild to moderate edema and erythema ▪ tight ▪ dry ▪ mild to moderate edema and erythema ▪ skin may begin to peel ▪ heaviest peeling ▪ typically peeling is complete precautions ▪ apply products in an appropriate post- procedure solution ▪ keep cool ▪ reapply products in an appropriate post- procedure solution ▪ keep cool ▪ do not pick at loose skin ▪ reapply products in an appropriate post- procedure solution ▪ avoid direct sun exposure ▪ restart recommended daily care regimen

19. All content copyright 2008 PCA SKIN and Physician’s Care Alliance. Images are for internal use only. peels with medical modalities  Enhance results by combining chemical peels with:  Microdermabrasion  Ultrasound  IPL  LED  Non-ablative and fractionated laser  Erb:YAG and CO 2 laser resurfacing

20. All content copyright 2008 PCA SKIN and Physician’s Care Alliance. Images are for internal use only. the importance of daily care  Pre-treatment  Minimize complications  Accelerate results  Pre-condition the skin  Customized systems  Hyperpigmentation  Acne  Rosacea  Age control

21. All content copyright 2008 PCA SKIN and Physician’s Care Alliance. Images are for internal use only.  Post-treatment  Minimize complications  Heal and soothe the skin  Post-procedure recommendations  Post-procedure products the importance of daily care