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Objectives: There are special group of patients that are beyond the regular standard of care regarding chemical peeling . We intend to give some simple advice in order to simplify the procedures in these patients.

Introduction: Chemical peelings are regarded simple procedures but require well trained providers especially when their age, gender, prototype, personal history etc raise limitations to our therapeutic plan

Materials / method: The individuals that are under isotretinoin medication, small children , pregnant women , skin of color or men , are you going to peel them or not ? What about during summer ? Do we stop chemical peeling ?

Results: Using safe parameters and with respect to the pre and post care steps the risk of complications is minimized and all these patients can eventually benefit from the chemical peeling unique properties.

Conclusion: Certain groups of patients need a different approach as far as chemical peeling is concerned but knowing how to handle them will give us excellent results through safe procedures.

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Objectives: Acne scar patients are some of our most grateful cosmetic patients as the scars become their major focus. To determine the type of scar and location allows the physician to use the proper modality. Macular and shallow hypo or hyper pigmented scars respond to correction with repetitive light or medium depth chemical peels. Ice pick scars are best treated with repetitive 90 to 100% TCA using the CROSS (Chemical reconstruction of skin scars) technique. Other contour scars can be corrected with scar revision, punch grafts, subcision, dermabrasion and lasers. These are then blended with medium depth chemical peels.

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Objectives: Important factors of pretreatment, the treatment itself and the posttreatment phases are identified and explained in detail. This includes the description of the goal of skin pretreatment before a phenol peel and how this can be achieved, the
premedication and type of anesthesia to perform phenol peels safely and the application of a bismuth-gallate mask after the peeling and furthermore the use of different agents to promote healing and reduce redness.

Introduction: Phenol peels have been proven to be one of the oldest and most effective methods of facial rejuvenation and wrinkle correction. Nevertheless, they are relatively rarely performed. One important reason is certainly the severe trauma immediately triggered by them, especially in the first phase of wound healing. In addition there is no general agreed consent how to pretreat the skin in the weeks before a peeling and under which kind of premedication and anesthesia the peeling should be performed. These open questions leave “beginners” in a lot of uncertainty.

Materials / method: We present our protocol of skin pretreatment which mainly consists of a combination of intense cleansing, antioxidants, bleaching agents and retinoids. In addition we have developed a procedure that greatly simplifies post-treatment, making it more comfortable and suitable for both patients and physicians, and probably also reducing healing time and improving treatment outcomes. It consists of applying a mask mixed with bismuth gallate and blood plasma immediately after the exfoliation or after an initial tape dressing treatment. This procedure clearly represents a relief of the wound care.

Results: We have found that the use of the powder/plasma mixture has significantly improved patient acceptance. In addition we have the impression that the extent and length of skin redness after peelings has significantly decreased and the effectiveness of the treatment in correcting wrinkles has also increased. These effects may be explained as a result of the wound healing-promoting components of blood plasma.

Conclusion: With the application of a blood plasma bismuth gallate mask, we have developed a procedure which considerably simplifies the after-treatment and probably also contributes to an improvement of the treatment results.

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Objectives: You learn a new method in combining non ablative IPL threatment in the same session with superficial TCA Peeling in order to enhance the effect with limitation of side effects.

Introduction: EBD like ablative and non-ablative lasers are widely accepted tools for skin quality improvement. Superficial peelings, a little bit forgotten in the last years, however have their place in structural skin treament. On the other side both lasers and superficial peelings have their limits in effect or are connected with sometime darmatic side effects depending on the strength of the therapy.

Materials / method: Lasers and superficial peelings often lead to unpleasant downtime when using for superficial skin rejuvenation. However sometimes the effect weeks after treatment could be better, why the treatment has to repeted with the burden of accepting the dwntime again

Results: Photo-Peel, a combination of IPL treatment followed by superficial TCA peeling in the same session shows significantly better results without increasing the downtime as both IPL an Peeling can be performed in low dosage (IPL) and low concentration (TCA) respectively.

Conclusion: Photo-Peel is a new technique whith better effect due to the synergistic effect of the combination of two mostly effectful treatmeant modalities

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