Vera Delfina, dr

Product Manager_Peacock
Jl. Paseban Raya No. 21
Jakarta Pusat 10440
Telp. 021-3162421 Fax. 021-3162417

Chemical Peeling
 Definition

A chemical peel is a therapy to reduce or improve wrinkles, blemishes, pigment

spots, and sun-damaged areas of the skin. Using a chemical solution of phenol,
trichloroacetic acid, or alpha hydroxy fruit acid, the top skin layers are peeled
away, allowing new, smoother skin with tighter cells to occupy the surface.
**Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier.

A chemical peel is a skin-resurfacing procedure in which a chemical

solution is applied to skin to peel away the top layers.
**Mayo Staff Clinic from www.mayoclinic.org
Mainstay in the cosmetic practitioners’s because :

- Treatment some skin disorder

- Provide aesthetic benefit
- Combined with other resurfacing & rejuvenations
procedure
- Providing synergic treatment
- Flexibility in tailoring treatment to specific patient
need & condition
Chemical peels Create an injury of specific
skin depth:

– New skin growth

– Improving surface structure
– Evenly distributed melanin
– Stimulate collagen

**Rendon, Berson, Cohen, etc. Evidence & Considerations in The

Application of Chemical Peels in Skin Disorders & Aesthetic
Resurfacing. The Journal of Clinical & Aesthetic Dermatology. July
2010
Classification & Application of Peels
Skin Histology
 Classification & Application of Peels
Level Histology Solution Clinical Practice
Superficial Target on Very Light: • Acne
Peel (SP) epidermis & - TCA 10 – 20 %
- Low potency AHA • PIH
dermal- - Beta-hydroxy acid • Mild dyschromia
epidermal - Tretinoid
interface - LHA 10%  New • Photodamage
• Actinic keratoses
Light:
- TCA 20 – 30 % • Skin radiance &
- Jessner solution luminosity
- 70% AHA
Medium Penetrating to - TCA 35% • Dyschromias
Depth Peel the papillary • Multiple keratoses
(MDP) dermis. Combination Peels: Superficial scar
•
• Monheit’s  Jessner with TCA • Pigmentary disorder
• Coleman’s  GA 70% with TCA • Textural changes
• Brody’s  CO2 Solid with TCA
Deep Pell (DP) Penetrating to Baker - Gordon Phenol peel • Severe photoaging
reticular • Deep or coarse wrinkle
dermis. • Scars
• Precancer skin lessions

**Rendon, Berson, Cohen, etc. Evidence & Considerations in The Application of Chemical Peels in
Skin Disorders & Aesthetic Resurfacing. The Journal of Clinical & Aesthetic Dermatology. July
2010
Superficial peels:

• Can be used in nearly all skin types

• Safe & tolerated
• Mild discomfort
• Scarring & infection are rare

Medium - depth peels:

• Full epithelialization  1 week

• Risk of line of demarcation
 Deep Peel
• Maximizes the generation of new
collagen
• Epithelialization occurs in 5 – 10 days
• Require significant healing time  2
months or more
• Potentiating cardiotoxicity 
arrhytmias
• Complications  hypopigmentation,
hyperpigmentation, scarring, keloid
• Not recommended for dark skin
 Contra Indication

• Active herpes simplex infection

• Patient at risk : PIH, keloid formation, heavy

occupational sun exposure

• A history of intolerability to sunscreen

• Uncooperative patients
Approach Before & After Peeling

Anamnesis:
- Patient expectation
- Oral isotretinoin  waiting 6 months after stop
oral isotretinoin therapy
 Approach Before & After Peeling
Pretreatment:

- Enhance outcomes
- Started 2-4 weeks prior to the peel and discontinued 3-5 days
before the procedure.
- Pretreatment agent : topical tretinoids, GA 10% crem, prepeel
solutions

Postpeel:

- Sunscreen
- Facial Cleanser
- Moisturizer
 AHA

• AHA weaken the corneocytes cohesion.

Sunscreen
 REFERENSI PENDUKUNG

KESIMPULAN :

Aplikasi topikal HA terbukti mampu memperbaiki

kelembaban dan elastisitas kulit.
Aplikasi Low Molecule Weight-HA yang paling baik
mengurangi kedalaman wrinkle,
karena kemampuan penetrasi ke dalam dermis.
HYALUMOIST_CROSS-LINKED POLYMER

 Stabil terhadap hyaluronidase

 Action Mechanism

Ѵ Healing
properties
Protect skin from UV &
γ radiation
Anti
inflammatory
Ѵ

Moisturizer & anti aging

Immune system Moisturizer
effect & anti
aging effect

Laxative effect Anti viral & anti tumor Antiseptic

 Approach Before & After Peeling
Maintenance:
- Edema, erythema, desquamation occurs 1-3
days for superficial peels & 5 – 10 days for
medium to deep peels
- Avoid peeling or scratching the face
- Schedule :
- Peeling / months  6 months
- Peeling / 3 months  depending on the skin
problem & condition
GA Peeling Procedure
 GA Peeling Procedure
1. During the 2 weeks using one of the AHA cream
lotion or gel, in order to give the skin time to adjust
to pH below normal and assist the initial
desquamation.

2. Clean the face with a pre-peel cleanser to remove

cellular debris and grease.

3. Applying petroleum jelly around eyes, lips and nose.

 GA Peeling Procedure
4 . Use glycolic acid peels with a particular concentration
begins with a low concentration of 20% for 2 minutes.

5. Applying GA solution outwards, make sure the flat

and only a single coat.

6. Check End Point.

7. Minutes vary (average 10-20 minutes). When 20

minutes not react (no erythema) stop.
 GA Peeling Procedure

8. Termination peeling procedure to neutralize the acid

reaction using peel neutralizer containing sodium
bicarbonate

9. Use post peel soothing & nutrition cream until

conditions return to normal skin

10. Continue the use of AHA cream, lotion or gel.

 End Point (score 0-4)
Score Clinics Process
0 No erythema Denaturation protein
1 Red ± 50% stratum corneum impact
2 Red Grey All stratum corneum impact
3 Grey Basal membrane impact
4 White Papilla dermis impact
 Profile GlikoDerm Sol

GlikoDerm Solution
Composition Glycolic Acid
Indication Improve aging signs
Preparation Bottle, 30 ml, available concentration 20%, 35%,
50% and 70%
Storage Store in cool temperature and avoid from light.
• Available complete concentration

• Equipped with a pipette scale

• Legal with BPOM registration

• Peel Neutralizer is equipped with a sprayer

 Colloidal Gold
• Gold Nanoparticle :
– Memperkuat farmakokinetik & biodistribusi 
meningkatkan kelarutan & efektifitas, menekan efek yang
tidak diinginkan.
 Keunggulan Topikal Gold Colloidal
• Konjugasi sintetik peptida - nano gold particle memperkuat
penetrasi sampai ke dermis sesuai dengan target kerjanya di
fibroblast.
Setelah diserap di layer dermis, ikatan covalent bond (charge
positif negatif) akan terlepas. Peptide akan bekerja di
fibroblast dan particle gold-nya akan bertahan di bagian atas
kulit.

• Seiring dengan proses regenerasi kulit, maka partikel gold

yang ada di lapisan kulit akan turut terlepas bersama sel
kulit mati.
Jadi tidak akan membentuk build up.
THANK YOU