The chemical peel.

Chemical peeling of facial skin has become a valuable adjunct in the armamentarium of the facial aesthetic surgeon. Among the various techniques available, phenol solutions are the most commonly used. Peeling produces a controlled, partial-thickness chemical burn of the epidermis and the outer dermis. Several techniques are available to "fine tune" the depth of the peel. Regeneration of peeled skin results in a fresh, orderly, organized epidermis. In the dermis, a new 2- to 3-mm band of dense, compact, orderly collagen is formed between the epidermis and the underlying damaged dermis, which results in effective ablation of the fine wrinkles in the skin and a reduction of pigmentation. These clinical and histological changes are long lasting (15-20 years) and may be permanent in some patients. Because of the metabolism and systemic complications of phenol, patient selection should involve systemic evaluation of liver, renal, and cardiac function, as well as an evaluation of the skin quality and medication status of the patient. Because of potential cardiac arrhythmias, peeling must be performed in a medically supervised environment, with continuous cardiac monitoring. The local complications of peeling include pigmentation changes, scarring, milia, ectropion, infection, activation of herpes simplex, and toxic shock syndrome.