Objectives: Dr Rullan: Controversies and options in doing croton oil/ phenol peels 
Dr Landau: When and why do I use deep chemical peeling
Dr Borelli: Chemical Peeling - scientific background regarding deep peels - science and results" 
Dr Muggenthaler: “Deep Chemical Peeling and Surgical methods”
Dr Monheit: “Attenuated medium depth peel and its versatility" 
Dr Kreyden: Patient selection in chemical peeling 
Dr Gout: Positioning of Deep Peels in the world of peeling 
Dr Lederle: Perioral area: pushing the limits through pro penetration
Dr Verner: How to combine energy devices and chemical peels

Introduction: This session will explore the science of medium and deep chemical peels, including patient selection, surgical options during the peel, anesthesia and sedation options, formula options, energy device options and techniques to obtain better results

Materials / method: 9 power point presentations and session for Q&A

Results: Update the audience on the art and science of medium and deep chemical peels.
Increase audience awareness of current controversies and techniques which affect their daily practice. Learn how to set expectations from these peels and how they compare with other rejuvenating techniques such as lasers and surgery.

Conclusion: These last few years, the IPS has worked with many international congresses, in submitting scientific presentations and workshops on peels. It has also published at least 5 articles to leading journals like the JAAD. The speakers will have presented how peels help common conditions like wrinkles acne scars, melasma and actinic keratoses. Peeling is a dynamic and growing procedure that needs to be taught to physicians in practice and in training.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: Different “safety protocols”
IV or oral fluids
Monitors, I.V. line, Oxygen, Peel application time
Anesthetist/MD or Nurse
Understand Different Formulas with Croton Oil/Phenol
Understand Different application techniques
Understand Different anesthesia and sedation protocols
Explain Taped or Open technique
Explain 1 versus 2 day technique
Explain Chemabrasion on day 2
Discuss benefits of Powder mask for 7 days versus Open wound (post op)

Introduction: The International peeling Society is trying to advance the art and science of all types of chemical peels, through live workshops, seminars, peer-reviewed publications, chapters in books and building consensus. The many differences in formulas and techniques are overshadowed by the excellent technique and clinical results of board-certified Dermatologists and Plastic/Facial Plastic Surgeons around the world.

Materials / method: Power Point review of the objectives

Results: Clearly establish which controversies are relevant or not to the clinical outcome of a deep peel. Establish whether a certain formula is safer or better than another, or is the physician's own technique and experience the critical factor.Explore issues and differences that we can learn from to make peeling safer and more comfortable to our patients.

Conclusion: Deep peels with. croton oil/phenol is a very powerful rejuvenating technique that cannot be disregarded. As scientists we have to openly discuss controversies and learn from them.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: There is a plentitude of treatments to correct the different signs of facial ageing. They vary in what they aim to correct, their effectiveness and side effects. Ageing does produce specific changes of the skin in regard of it´s –pigmentation, texture, structure and mechanical properties. Loss of elasticity and volume displacement leads to some degree of sagging and significant morphological changes.
Until now there is not one technique to correct all these changes alone but we may combine different treatments in a synergistic way to obtain optimal results.

Introduction: Until now there is not one technique to correct all these changes alone but we may combine different treatments in a synergistic way to obtain optimal results.
Modern facelifts, especially when performed in a multi-layer (SMAS-) technique may restore youthful proportions and are able to correct all morphological changes due to sagging soft tissues of the face. This is formidable but often not sufficient to restore a harmonious youthful appearance since the obvious signs of superficial skin ageing are not enough or not at all addressed by surgical facelifts.

Materials / method: On the contrary peelings, especially medium peelings with TCA or deep phenol peelings have proven their potential to correct almost all signs of skin ageing. Phenol peelings result even in some kind of deep tissue tightening and may at certain locations result in lifting effects superior to surgical techniques. Very limited however are the capabilities of deep phenol peelings to correct deep tissue ageing of the neck.

Therefore it seems logical to search for combination treatments to take advantage of synergistic effects of facelifts and peelings.

Results: We describe an algorithm to select effective and safe combinations of facelifts and peelings taking into consideration the degree and extent of facial ageing and the limitations of both techniques.

Conclusion: The effects of medium and deep peelings may be combined in a synergistic and highly effective way with surgical facelifts. This combination may provide a maximal hormonious restoration of a youthful appearance of the face and the neck.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: 1: Because in aesthetic dermatology patients turn into a client, physician has to be skilled not only in technical concerns but also in psychological empathy
2: Right indication for deep chemical peel is essential
3: Correct performance is indispensable when dealing with deep chemical peels
4: Daily Controls after deep chemical Peel help the patient to cope with the reaction after peeling, increases the quality of the peeling and brings experience to the treating physician (Learning of the own cases)

Introduction: Results after deep Chemical Peeling can be extraordinary, when performed correctly. However, the post interventional reaction is dramatic and the down time is a challenge both for the patient and the doctor the same. Therefore, Deep Peel is not good for everybody and the patients have to be selected very carefully.

Materials / method: In Aesthetic Dermatology we deal with a client and not with a patient like in Classic Dermatology. The aesthetic treating physician is faced with a healthy individual who has a particular demand. Therefore, the doctor’s position turns from the active sender (the doctor performs what is needed) to a passive acceptor (the doctor has to perform the clients wish). The disfiguring condition after deep chemical peeling implies the need not only of excellent psychological skills but also superbly technical skills and experience in performing deep chemical peels.

Results: With the dramatic side effects of Deep Peeling a unmistakable indication has to be demanded indispensably. Patient’s information of all details before, during and after treatment shows competence of the physician and helps to build up a bond of trust. To achieve skills and experience beginners should start with superficial (15% TCA) or middle deep (25% TCA) peelings before performing deep peeling (TCA 35% and Phenol). Daily controls after the peel are indispensable for a good outcome and for improvement of the own skills respectively (Learning of the own cases).

Conclusion: Deep peels are associated with a dramatic down time as well as an outstanding result after complete healing. There are good or even excellent indications, but there are also no-goes. The treating doctor has to be aware of the faultless patient selection and the right indication. If trained correctly and with the right indication deep peels are more effective than any other treatment in aesthetics including facelifts. However, we have to respect the limits and we have to be trained better than good to perform a deep peel.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Objectives: Numerus aesthetical treatments can be used in the peri oral area; Each patient is a special case. Patient wishes and practitionner experience must be considered as well as the acceptable down time and the complications that may occur. Peelings, although they have been used for years, remain a treatment of choice in this specific location. Unfortunately, practitionners attracted by newer technologies are less and less trained for peelings and do not tend to use them.

Introduction: AHA peels are very superficial, and remain in the epidermis. These won't play a major role in this location and will be of use only in patients with darker skin who are at risk with stronger peels. On this area, medium to deep peels, alone or in association with other techniques will be a better option. 25 to 35% TCA peels: mecanism of action is related to acidity, leading to protein coagulation and cell death. The higher the concentration, the deeper the penetration untill total neutralisation.

Materials / method: Propenetration: The skin is often very thick and very damaged in this location. 35% Phenol peels with high croton concentration (1.2 to 1.6%) for a better penetration in this location. Croton oil has a keratolytic action that will enhance the action of phenol which has a toxic effect leading to cell death.
An abrasion (electrodissection as well as sandpaper abrasion removing the superficial layer of the skin, microporation with Fractionnal CO2 laser) prior to the application will allow a deeper penetration and therefore a better result will be obtained.

Results: Follow up, complications and results: Dark skins must not be treated. Downtime period can last up to 2 weeks and redness up to 2 month. Major side effect is HPPI, which happens frequently and can last up to 6 month. Results are often spectacular.

Conclusion: Peri oral area is a very resistant location. Medium to deep peels remain the treatment of choice, especially when an abrasive technique is performed prior to the application when the skin is very damaged..

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability