The peel is begun by applying 70% ethyl alcohol which cleanses the skin and is followed by acetone which degreases the skin. After the skin is allowed to dry, Jessner’s solution (100 mL of 95% ethanol, 14 g resorcinol, 14 g salicylic acid, and 14 mL lactic acid) is applied to act as an exfoliant and it penetrates to the basal epidermis. The 35% trichloroacetic acid (TCA) solution is then applied using 2 × 2 gauze pads (SDC 7, seevideo, Supplemental Digital Content 7, which displays chemical peel with TCA peel, http://links.lww.com/PRSGO/B92). The solution is soaked in gauze pads and light passes are made over the areas requiring treatment until a light frost develops. A pink-white hue demonstrates penetrance into the papillary dermis, whereas a uniform white frost indicates penetration in the reticular dermis. The frost can last 30–40 minutes after the peel is completed. In the posttreatment recovery period, the skin will slough over a 7- to 10-day period. Patients are instructed to wash the skin gently and apply petrolatum-based ointments or creams. Excessive moisture prevents peeling and extreme dryness delays re-epithelialization of the skin, hence a balance must be achieved. With this regimen, we have reported a very low complication rate.42 Jessner’s solution aids in penetration and evenness of the TCA peel, which helps collagen remodeling and improvement in the appearance of the skin.
Although a traditional face-lift will rejuvenate the face, it primarily addresses lateral facial skin laxity and when done alone, this procedure lacks the ability to rejuvenate and harmonize all aging regions of the face. With the advent of newer autologous fat grafting techniques and detailed knowledge of the soft tissue anatomy of the face, ancillary procedures in facial rejuvenation improve on the results of a face-lift by filling and volumizing regions of the face that have undergone fat atrophy and soft tissue deflation. In addition, ancillary procedures such as lasers and peels can improve the texture and appearance of the skin. These procedures are integral in the modern face-lift.
The authors would like to thank Dr. Paul Afrooz and Martha Aceves for their assistance in video production and video editing.
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