skin resurfacing by facepeel and cosmetic creams by dr Philippe Chout
This young Lady benefited from a skin resurfacing by topic creams and facepeel, as described in the video
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This fact sheet is for people who are considering having Facepeel or laser facial skin resurfacing

Laser facial resurfacing is a technique that can remove the upper layers of the skin on your face using a laser. This can improve the look of your skin without having full cosmetic surgery. It can be a very effective treatment for reducing mild scarring, or the effects of sun damage, such as fine wrinkles, dark marks or other blemishes.

What is laser facial resurfacing by radiation?

A laser is a beam of light radiation, which delivers intense energy to a specific area of skin. This destroys the surface layer of skin in a carefully controlled manner, exposing the lower layer (the dermis, which is pink).

Then, at lower power, the laser heats the dermis radié, which stimulates the growth of new collagen fibres. As the wound heals, the new skin that forms is softer and less wrinkled or scarred. For deeper wrinkles, parts of the dermis can also be removed. There are several different types of laser, each with advantages for certain types of treatment. Pulses of laser light can be used to treat skin lesions such as port wine stains and spider veins. These lasers can also be used to remove the colour from tattoos and do not seriously damage the surrounding skin. Carbon dioxide or YAG lasers (YAG is the type of crystal that is used to generate the laser) are often used for resurfacing procedures. Illustration showing the three layers of skin Why have laser facial resurfacing? Laser facial resurfacing can improve the appearance of your skin and is most effective for:

• Removing superficial wrinkles
• Tightening your skin
• Evening out pigmentation (colouring)
• Smoothing rough skin
• Improving the look of shallow acne or chicken pox scars

The laser can be directed on problem areas, for example wrinkles around your eyes, mouth or nose, or the whole surface of your face can be treated. Laser facial resurfacing can cause changes in the pigmentation of your face, which means that doctors do not normally use laser techniques on dark skin. Surgery may be advised instead.

What are the Alternatives to lasers ?

Fine wrinkles and some of the milder signs of ageing skin can be improved with creams and gels. Chemicals related to vitamin A such as tretinoin (e.g. Retin A cream) and chemical peels containing alpha-hydroxy acids (e.g. glycolic and lactic acids) are commonly used for this. Laser facial resurfacing generally isn't suitable for treating the neck, or very deep wrinkles, sagging skin and extra fat. A surgical facelift is a more suitable option. For more information, please see the separate fact sheet on Facelifts. Excess skin around the eyes can be treated with cosmetic eyelid surgery. For more information, please see the separate fact sheet on Cosmetic eyelid surgery

What Happens Before Laser Facial Resurfacing by radation?

Your surgeon will discuss how to prepare for your operation. For example, you may be asked to give up smoking as this increases your risk of infection and slows the healing of wounds. Before treatment you will talk to your doctor about the procedure and you will usually be asked to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead. Your doctor can perform laser resurfacing in his or her clinic or in an operating room, depending on the amount of treatment needed and type of anaesthetic. It is often done as a day-case, which means that you can have the operation and go home the same day.

The Laser Treatment Laser facial resurfacing is usually performed under local anaesthetic, which numbs the area to be treated, but you will remain awake.

If needed, your anaesthetist can also give you an injection of a sedative, which will make you feel relaxed and possibly drowsy. If you are having your whole face treated or having another cosmetic procedure, such as eyelid surgery, done at the same time, a general anaesthetic may be preferable. This means that you will be asleep throughout the procedure and will feel no pain. Before treatment begins, your face will be cleaned thoroughly. Your surgeon will then pass a laser beam over the treatment area, with precise control over how deep the laser penetrates. The procedure lasts from a few minutes to an hour or so, depending on the size of the area being treated.
After the laser Treatment After treatment, your face is likely to be covered with antibiotic ointment. A dressing may be put on the treated area too, or it may be left uncovered. Your operation will usually be a day case and you will usually be able to go home once you have made a full recovery from the anaesthetic. If you have had a general anaesthetic, you will need to arrange for a friend or relative to drive you home and stay with you for 24 hours. Before discharge, your surgeon will give you advice about how to care for your skin as it heals.

Recovering From Laser Facial Resurfacing

Your will need to wash your face several times a day with a gentle cleanser, and apply antibiotic ointment or cream to aid healing. To help ensure the skin heals quickly with good cosmetic results, it is important to do the following. • Stay out of the sun. If you need to go out, apply a sunscreen with a SPF factor of at least 25, and with both ultraviolet A and B protection. You should use sunscreen for at least six months after treatment.
• Avoid making exaggerated facial movements. • Moisturise your skin frequently with a simple preparation such as aqueous cream. This will keep the skin supple and help to prevent it drying out.
• Wash your hair with a mild baby shampoo to avoid irritating your skin.


Deciding on Treatment It is important not to rush into the decision to have any cosmetic treatment. And, it is sensible to discuss the options with your GP. Laser facial resurfacing is a commonly performed and is generally a safe procedure. However, in order to give informed consent, anyone deciding whether or not to have this procedure needs to be aware of the possible side effects and the risk of complications.

Side effects are the unwanted but mostly temporary effects of a successful procedure.

For laser resurfacing, side effects include: • Discomfort of the treated area until it has healed
• Swollen skin that may ooze for the first 7-14 days after treatment
• Skin redness that may last for 6-12 weeks
• Scabs forming as part of the healing process
It can take 10 days or more for the skin to heal, and two to six months for the redness to fade completely. You can use make-up to disguise the redness. Complications are unexpected problems that can occur during or after the procedure. Most people are not affected. Specific complications of laser facial resurfacing are uncommon but can include those listed below.
• Skin infection.
• Reduction or increase of facial pigment.
• Scarring - this is rare with normal skin but the risk increases for people who have recently had radiotherapy in the same area, who are prone to keloids (overgrown scar tissue at the site of an injury) or have recently had a course of the acne medicine isotretinoin (Roaccutane).
< • Cold sores can be reactivated, but preventive medicine such as acyclovir (e.g. Zovirax) taken in tablet form can help to stop this happening. Your surgeon will advise you whether this is necessary.
You should bear in mind that although wrinkles or scars may subside after only one laser session, more sessions may be needed to complete the therapy. Also, the effect of laser resurfacing on wrinkles is not permanent, since the ageing process continues as normal after the procedure.


Chemical Face Peel One off surgical exfoliation with TCA.

Who is suitable for a face peel ? I will perform as agreed upon a TCA face peel that is to say a trichloracetic acid face peel. The face peel is a very useful mean to resurface the skin alone or done at the time of a facelift. It is indicated for acne scars (repeated face peels) or for rejuvenation resurfacing (sun damage or ageing skin, wrinkles to the upper lips). Quite often if a facelift is done, a face peel should be done as well, either at the same time or later.

What is a TCA face peel ?
The TCA peel is the equivalent of a controlled chemical superficial burning that will remove the superficial layer of epidermis.

This chemical will be applied on your face in theatre room under anaesthesia or under a sedation and you will feel a stinging sensation for a few seconds. What happen before a face peel? You must prepare your skin at home with either 1. use of Airol cream 0,025% daily for ten to thirty days or 2. use a made to measure cream (retinoic acid plus glycolic acid more or less hydroquinone) for a short period of time. The use of these creams will already exfoliate your skin and start the resurfacing process. Please read below “skin resurfacing” chapter.

What happen after a face peel ?
After the face peel you will be red and then the skin will exfoliate in five days with large brown scabs that you should not manipulate. Care after a face peel : You will just clean twice a day with DAKIN antiseptic solution, baby wipes and then apply twice a day BIAFINE cream for two weeks. I will provide you with these products. Recovering from a face peel : The skin will take two weeks to go back to normal: a new pink skin with a more uniform appearance and less fine lines and wrinkles. You can show to the public with some make –up as soon as ten days after your face peel.
The risks of a face peel: skin infections are prevented by cleaning with the antiseptic solution and avoid manipulating the skin. Sometimes antibiotics are prescribed. Dis-pigmentation is prevented by avoiding sun exposure and snubbed for three months. Face peels mst be dones by properly trained Doctors, because the depth of the face peel must be accurately controlled. If too deep this would be equivalent to a burning and could leave permanent scarring. Precautions: You must not at all be exposed to the sun, even for 10 minutes in the 3 months following a face peel.

SKIN RESURFACING by Daily exfoliation with pharmaceutical creams +/- face peels.

This range of topical medical treatments aimed at improving the skin’s appearance by exfoliation either alone or followed by a series of face peels. Though not an actual peel, but rather an appropriate preparation to be used before and after a TCA face peel, these treatments are prepared using chemicals that will sometimes create the final result of a face peel (peeling) without necessarily going through the inconvenience of a proper face peel, which is usually total social disappearance for 10 days. These treatments should not be mistaken for a cosmetic treatment. Consisting of the gathering of specific to skin pharmaceutical medication, these treatments, which are available as a cream, ointment or gel, are not available without a prescription or medical delivery and because of their side effects require medical supervision. A detailed breakdown of the medical components in the treatment can be found on the MEDLINE website (Kligman’s trio) Their aim, according to the formula, is to visibly improve the skin

· Resurfacing for facial Rejuvenation
· Resurfacing of acne scarring
· Clearing of blemishes excessive pigmentation or even the skin tone
· Easing/toning down/reducing fresh stretch marks
· Moisturizing and protection of facial skin surface for some
The price per tube of cream is £90. ( =100 euro)

Release Procedure of skin resurfacing creams

This product is a medical product and is released exclusively by a pharmacy and should only be taken under strict medical supervision. Because your skin will react and may over react it is important to read the information leaflet thoroughly and to keep it for future reference. Your file will contain an additional copy stating your specific treatment and relevant information, both of which are necessary to receive the products. In addition, photos may be taken of the affected area.
This treatment is not cosmetic it is a pharmaceutical drug with some side effects and inconveniences such as swelling redness and exfoliation. It is a medical treatment, which differs from cosmetic in that it penetrates the dermis where cosmetics cannot reach. Without reaching the under layers of the dermis no visible or lasting changes will occur. Our treatment is made up of a complex pharmaceutical preparation released by a small number of pharmacies whose doctors have been trained in its creation. As they are a select group, they address themselves to a select few; to those who are educated, attentive, motivated and have a comfortable financial situation. If you are not serious about undertaking a serious and prolonged treatment, coping with its risks or sides effects or cannot afford to renew the prescription it is recommended that you choose a different treatment better suited to your situation.
These creams are not magic creams at all. Patients who are seeking painless automatic and fast results are not suitable. The aim of the program is to improve the appearance of the skin. You should not expect to see fast, automatic and simple results but should consider this an attempt at reaching the desired result that may face some difficulties. Thus no guarantee is given. You should also experience some inconvenience and delay so it is your commitment to plan your public non–appearance. There is always a trial period at the beginning in order to establish the right formula and type of application for each person. Owing to different types of skin tolerance and sensitivity, you may have to buy a new tube of stronger or weaker concentration a few weeks after commencing treatment.

Precautions and Instructions for use of resurfacing creams

Sun exposure and sun beds must be totally avoided. Facials and masks as well as depilation lasers or IPL must be totally avoided. Often the treatment will start with AIROL only, and later the pharmaceutical preparation associating Acidic A vitamin (retinoic acid) with ascorbic acid, and hydroquinone and others such as diluted glycolic acid or cortico steroids. Start the treatment by one application every other day if you have sensitive skin. After fifteen days you may start a daily application. Wash skin with a mild soap or an astringent and use sterilized wipes (baby wipes). Rinse and blot dry without rubbing. Apply the night cream over the entire face, which should be free of all makeup, from the hairline down to the neck, avoiding the upper eyelids, and wipe away any surplus from the nose and lips. If you can avoid using a day moisturizer, the therapeutic effects of the creams will be visible sooner. If you can apply the product at night and also by daytime then the results will show even faster, but the side effects will be greater. Therefore this treatment is adjustable, for careful and smart patients. It is possible to resume your regular makeup routine after the tenth day of treatment after first applying the hydrating and soothing day cream. A weekly, extra-soft exfoliation is recommended.

Exposure to the sun is strongly discouraged. In the case of even brief or indirect sun exposure, Total Photoderm Max 60 (total sunblock) should be applied and a hat should be worn. Complications are rare: allergies, irritation, cold sores, redness, hyper sensibility and in extreme cases burning, unwanted reappearance of the pigmentation, permanent dyschromy and dyspigmentation. Regular consultations must follow initial treatment process to assess tolerance and results. No claim would be receivable if you have missed the monthly consultations following the start of the treatment. This treatment is to be totally avoided during pregnancy and breast-feeding. Laser treatments, IPL and sun beds should be avoided due to the risk of burning. The practitioner will not be held responsible for the improper use of this product, by disregard for the safety precautions or too long of a delay between the appearance of symptoms and the medical consultation. If you experience abnormal symptoms you have to consult your doctor within five days Products and visits are non-refundable regardless of the final outcome.
The cost of each 30ml tube is £90. The estimated budget for such treatment is £360. There are no perfumes or artificial colours. Do not swallow. Keep out of reach of children. This product is not to be used on any other person aside from the person to whom it is prescribed. Save the products permanently in the refrigerator at 2° to 5 ° C. To be refrigerated up to 4 months. Do not store or use after four months.

Usual side effects of skin resurfacing creams DELAYED IMPROVEMENT :After several weeks of use the effect will be that of a micro peeling. It is normal that the skin become dry and pink or red and for it to sting and tighten. Crackling stinging and burning sensation vary according to the degree of sensitivity, but also to are side effects showing the efficacy in providing anti-ageing benefits. Unusual side effects would be important swelling, redness, large scabs, and burns and infection. If the later occur you must consult your doctor. If the first side effects become too noticeable, treatment should be stopped for a few weeks and then resumed with one application every 3 days for the first two weeks and then every other 2 days for two weeks then again daily. When stopping the treatment you can south the skin with BIAFINE moisturizing and repair cream for a week. After a week in normal use the skin will start to renew itself and peel or flake slightly pink and dry. You should therefore take this into consideration when planning your public appearances.
INITIAL WORSENING is USUAL : At the start of the night repair treatment wrinkles and blemishes will become more noticeable but will disappear after the first few days the appearance of the skin usually worsen at the start. This aggravation and side effects within the first ten days of treatment are quite common. These side effects are harmless and are proof of the efficiency of the product. This is only a temporary condition occurring while the skin becomes accustomed to the treatment and will subside after the skin adjusts to the treatment. As make up cannot be easily applied during the first two weeks, because of the skin flaking condition, it should be avoided during the first two weeks. Remember that the final goal is for you to have such a nicer skin that you could show it without make-up at all. No hydrating day cream (in the best case our Day repair and moisturizing TLC) should be applied the first three weeks, because they reduce the night cream’s effects (and side effects as well. If the effects of the night cream become too intense however, use should be interrupted or lessened in favour of the hydrating day cream. The patient however does have the option of modifying the effect of the treatment by spacing out the applications and counter acting its effects with the hydrating day cream. Unusual side effects: large exfoliation with redness swelling and stinging can be related to an allergy or at least an over reaction (sensibility) to the association or a too fast introduction. Then the treatment must be stopped and later re-introduced gradually.
STRENGHT SCALE : § 0= BIAFINE : moisturizing and repair cream : no or exceptional side effects
§ 2= AVIBON : Very mild peel effect
§ 4 to 6= AIROL : moderate strength peel effect. Dryness possible scabs pinkness and swelling
§ 6 to 7= ASSOCIATION 5-5-5-5 (retinoic acid, glycolic acid, ascorbic acid, Mequinone) : strong: dryness, crackling, scabs, crust redness stinging and swelling sometimes allergy with burning sensation
§ 8 to 9 = Association 5-5-5-10 : the strongest “home peel” cream only for certain skin type after successful use of 5-5-5-5. strong: dryness, crackling, scabs, redness stinging and swelling sometimes allergy with burning sensation, superficial non-permanent burn like.
§ 20 to 40= ACTUAL FACE PEEL with TCA: Trichloracetic acid face peel done in the consultation room or in theatre: is far stronger than the above mentioned. The TCA peel solution is applied on the face for a few minutes: the depth and strength of the peel depends on the length of its application. The face peel actually removes the superficial layers of the epidermis. Following a face peel you should expect a massive exfoliation with large brown crust and scabs and intense redness equivalent to a burn and the need to hide from public eyes during eight days at least. superficial non-permanent burn like. Daily care with BIAFINE twice ad ay must be done for ten days. Dr Chout doesn’t do deep and strong TCA face peel, but only mild face peels.
§ 40 to 60 = Phenol peel : Dr Chout doesn’t do phenol peel at all.


Dr Chout’s face peel strategy is to try to give the best results with the less invasive treatment. Instead of doing deep TCA peels or Phenol peels that are risky procedures and may leave permanent scars like burns, Dr Chout give the priority to more “gentle” home exfoliation with cream. The use of AIROL alone or in combination with an association like 5-5-5-5 quite often provides patients after three months of use with a long lasting skin improvement equivalent to a light TCA peel. If this is enough then fine. If not, a TCA peel is necessary and whished by the patient, then anyway the use of AIROL alone or combined with 5-5-5-5 association cream prepares the skin for the TCA peel during one or two months. Three weeks after the TCA peel the use of these creams improve the final result of a TCA peel as well.

INGREDIENTS Retinoic and vitamin A

The core ingredient of all creams used is vitamin A in its different strength. The vitamin A is a molecule formed with covalent bonds between carbon and hydrogen, is linked to a family of similarly shaped molecules, the retinoids, which complete the remainder of the vitamin sequence. Its important part is the retinyl group, which can be found in several forms. The major form of vitamin A is an ester primarily retinyl palmitate which is converted to an alcohol (retinol = Avibon) in the small intestine. Vitamin A can also exist as an aldehyde (retinal) or as an acid (retinoic acid =Airol). Vitamin A appears to be essential in maintaining normal skin health youth and function. The mechanisms behind retinoid's therapeutic agents in the treatment of dermatological diseases are being researched. For the treatment of acne, the most effective drug is 13-cis retinoic acid (isotretinoin). This is also a powerful agent of resurfacing the elderly skin. Although its mechanism of action remains against acne is unknown, it is the only retinoid that dramatically reduces the size and secretion of the sebaceous glands involved in acne. Isotretinoin reduces fine lines and epidermis most superficial layer while thickening its deeper living layers and reducing bacterial numbers in both the ducts and skin surface. This is thought to be a result of the reduction in sebum, a nutrient source for the bacteria. Isotretinoin reduces inflammation via inhibition of chemotatic responses of monocytes and neutrophils. Isotretinoin is a teratogen its use is confined to medical supervision. It is not compatible with pregnancy. The use of retinoic acid in trio or larger association like 5-5-5-5 are based on Kligmans formula. Doctor Chout’s formula is an amended version of kligman’s formula.

Hydroquinone is now avoided and replaced by other bleaching agent such as arbutin. Mequinone is a skin bleaching or skin lightening ingredient that may be used anywhere on the face or body to lighten areas of darkened or hyper pigmented skin such as freckles, chloasma (skin darkening caused by hormones), melasma (general face’s skin darkening) and age spots (sometimes referred to as solar lentigenes). it works by decreasing the production and increasing the breakdown of melanosomes (melanin pigment granules) in the skin's pigment cells (melanocytes). Melanin and melanocytes are responsible for skin colouring. IT does this by inhibiting the activity of tyrosinase, the enzyme needed to make melanin. Hydoquinone Works better in association when added benefit of retinol or glycolic acid, an exfoliant that helps to increase the efficacy of MEQUIONONE by gently removing dead skin cells on the skin surface. In most cases, some skin lightening will be apparent after 4 weeks of treatment. Though it may take longer to see complete results, generally within 8 to 12 weeks.

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