Regional(Perioral or Periorbital) Deep Phenol/Croton oil ... · Substantial generation of funds for...
Transcript of Regional(Perioral or Periorbital) Deep Phenol/Croton oil ... · Substantial generation of funds for...
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Regional(Perioral or Periorbital)
Deep Phenol/Croton oil Peeling How and Why to Do and Teach it
Association of Professors of Dermatology
Procedural Dermatology-2014
Harold J. Brody, MD
Clinical Professor of Dermatology
Emory University School of Medicine
Atlanta, Georgia
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Conflicts
Textbook:
Chemical Peeling and
Resurfacing, 3rd edition,
Emory University Press,
Amazon.com
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2012-2013
Combination Chemical Peels ASPS: 444,268
ASDS: 413,000
Within Top 5 or 6 procedures for both associations
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Why do it?? Superb method to
remove Glogau III or IV
wrinkles in one treatment
No Laser cost,
maintenance or
payments necessary
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Why do it?? Substantial generation of funds for your
department
Cost of procedure is negligible
24 procedures yearly( 2 monthly for 6 winter
months or 1 monthly) with phenol combination
would yield$1,000 or $2,000 per peel or $24,000 to
$50,000+ more per year
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14 years ago at ASDS, survey showed 1/3 of
Program Directors teaching phenol based
peels.
ASDS Visiting Professor: 6 programs in 2013.
Programs not getting didiactic peel instruction
as per RRC. Faculty and resident intense
interest. Phenol/Croton oil Demonstrations
successful
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Unlike Dermabrasion, which is rarely perfomed for wrinkles today, no blood-borne pathogens in peeling for wrinkles
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There has never been a death from a properly
performed full-face phenol peel
Pause 10 minutes between perioral and
periorbital application if doing 2 cosmetic units
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No worry of phenol
cardiotoxicity as periorbital or
perioral involves less phenol
than a phenol matrixectomy
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Oral Hydration for Phenol peels
Drink 4 cups of water(1000cc or 32 oz)
(Most patients peeling in the morning aren’t hydrated)
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Baker-Gordon Formula HALVED for ease of use
Phenol, USP, 88% 1cc
Tap water 1cc
Septisol liquid soap 3 drops
Croton oil 1 drop
As per Hetter’s work, Croton oil is the active ingredient
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Application Application causes burning for 20 seconds, then anesthesia
for 20 minutes, then throbbing pain for 6 hours.
Perform in the morning
Infraorbital and mental blocks: marcaine
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Optional occlusion Glogau IV skin
with microfoam tape
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Frosting: Light White, White, Gray
Glogau III go to White Frost
Glogau IV go to Gray frost
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No Alabaster Skin or
depigmentation if properly
performed on proper
degree of sun damage
Hypopigmentation
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Post op care In shower, dove soap and
povidone iodine or
chlorhexidine lathering skin
cleanser followed by
Aquaphor or Vaseline if
sensitive twice daily
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A great way to start
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Glogau III Brody H
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Complications of Resurfacing Pigmentation
Scarring: Less than 1% in 3 studies(Baker, Brody,Glogau)
Persistent Erythema
Infection
Regional peels imply less chance of complications since less surface area performed
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Why do it?? Substantial generation of funds for your
department
24 procedures( 2 monthly for 6 winter
months or 1 monthly) with phenol
combination would yield $24,000 to
$50,000 more per year
NO RESURFACING LASER COST OR
MAINTENANCE