Phenol Croton Oil Peels At A Glance
- Best Results2-4 months
- Treatment Recovery14+ days
- Procedure Time1 hour
- Skin SpecialistDermatologist
- Duration of Results3-10+ years
- Back to Work2 weeks
- Cost$$- $$$$
Phenol Croton Oil Peels
Deep chemical peels, including high strength TCA & phenol croton oil peels have had a resurgence in the past decade. Peels can treat wrinkles, pigmentation, sun damage & acne scars. The type and concentration of the peel will depend on your clinical presentation, skin type and downtime.
FactsFacts on Phenol Peels - deep chemical peels
- Phenol peels have been used in dermatology for over 4 decades
- The most common type of deep peel is the phenol croton oil peel
- This deep peel concentration is best for deep acne scars or very deep wrinkles
- The concentration of the peel will depend on the dermatological condition
- Downtime following deep peels ranges from 7 to 18 days
What conditions can be treated with phenol chemical peels?
Deep peels such as phenol and TCA are best reserved for deeper dermal conditions including deep acne scars, elastosis, sun damage and wrinkles. The clinical presentation will dictate both treatment and formulations.
How many sessions will I require for treatment of acne scars?
This depends on both the DEPTH of scars and one’s skin type. Majority of patients require 2-4 sessions over a period of 3-8 months. I do think that depth of scars play a more important role than skin type, as PIH is transient. The logic of using chemical peels in the treatment of acne scars is to raise the deepest scar up, prior to consideration of laser resurfacing (if required). The rate limiting scar is the deepest scar.
Does phenol peeling hurt?
Yes and no. If I am performing phenol croton oil spot peels, the answer is no. Numbing cream is used 60 minutes pre-procedure making this super comfortable. For larger areas of peeling, blocks & sedation is used.
What is the downtime following phenol chemical peels?
In the context of acne scar revision, the downtime following spot phenol & TCA peel is very similar- 5-8 days depending on the concentration, application and surface area. Post peel care is different depending on the peel, namely bismuth powder vs emollients. My team will guide you regarding post-op instructions. For females the use of Lycogel makeup on day 2 or longer can hide recovery ‘spots’.
In the context of TCA and phenol spot peels your skin will be ‘raw’, namely no epidermis for around a week. What you look like really depends on the EXTENT (how many scars I treat) and the surface area of each scar. Some patients may have 4-6 spots, whilst others will have over 300! It comes back to the appropriate acne scar type that you have.
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What is better: Phenol Peels vs TCA Peels?
There are recent papers comparing the efficacy of TCA vs Phenol peels (namely CROSS, Drip or Paint) for the treatment of deeper acne scars. To date, in my hands I marginally prefer the TCA technique over phenol. This is based upon split face studies using BOTH chemicals. Papers suggest a much higher rate of post inflammatory HYPO (white) pigmentation with TCA cf. phenol, however an audit of my cases since 2007 have shown only one case of prolonged post inflammatory hypopigmentation. Additionally my results with TCA are better than with Phenol. On this basis my standard is TCA in either anhydrous formulation or ETOH.
What is better: laser resurfacing vs chemical peels?
Peels (focal) can be likened to a smart ‘bomb’, namely targeting the specific scar with little or no collateral damage to the surrounding skin. Lasers on the other hand can be likened to carpet bombing the skin; namely lots of collateral damage to normal skin. On this basis I prefer peels for DEEP FOCAL scars, whilst lasers are used to treat multiple, shallow broad areas of scarring.
What are the side effects of chemical peels?
The most frequent side effect is PIH or post inflammatory hyperpigmentation. In fact it can be argued that PIH is NOT a side effect as it is universally expected in patients of colour. For darker skin types (Asian, Indian Sri Lankan), expect PIH for up to 3 months. In these skin types, if I don’t give a tiny bit of PIH I can not successfully treat your scars. Rare side effects include infection, hypopigmentation (white areas) and scar widening. Idiosyncratic widening is more frequently seen in midline scars (eg nose), or in scars with ill defined edges.
How do I approach acne scarring (regardless of peel type)?
The algorithm for the management of acne scars can be complex. The most important factor is to understand the type of scars. Most patients will have a mixture of boxcar acne scars, pick, ice pick, rolling, atrophic and tethered scars. These scars can be further classified as shallow, medium or deep, narrow, medium or broad. Scars that are DEEP and narrow do best with peels (exceptions include broad sharp bordered acne scars). In the majority of patients I use many different methods to revise scars including peels, lasers, RFM, subcision, saline – HA fillers, injection techniques, & surgery. Each patient is different, and hence bespoke treatments are indicated.
How do I know if I am suited for chemical peels?
Assessment is complex as only some patients are suited to deep peels. The first step is a real time consultation with myself. During this consultation I will examine your pathology taking into consideration your skin type, scar type or pathology, as well as your previous treatment history and downtime. If you are suited to phenol peels, I will then formulate a peel percentage, taking into account the concentration of the croton oil. This dictates the depth of peeling.
Davin’s viewpoint on deep chemical peels | phenol-croton oil peels
Deep peels are still very relevant in the age of lasers and energy based devices such as HIFU and radiofrequency. Recent papers published in an American journal confirms the efficacy of phenol croton oil peels for the treatment of acne scars and wrinkles. The rate limiting factor for these peels is the need for cardiac monitoring if large surface areas are treated; namely the face-neck area. For focal deep peels; such as in the management of acne scarring, cardiac monitoring is not required. Chemical peels are still relevant in the day & age of lasers.
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