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Male voice: Hi. Today we're going to do a phenol chemical peel on a patient's face with acne scars. I'll demonstrate it with some of the close up shots, some of the acne scars which are basically the typical pit type acne scars. There's various types of scars that we can have, but she's got the pit type acne scars.

About 12 years ago or so, she had a CO2 laser or Erbium laser [inaudible 00:00:23] laser, it was at a different surgical center. And while there was lots of crusting and peeling, the results were not that impressive. A little while ago, I think about a year ago or so, we did some dermabrasion.

Now, the way I like to start this is I like to prep the face. In the hospital, in the OR, I use acetone. It's a clinical-grade acetone to prep the [inaudible 00:00:50] prepping, essentially it's degreasing; taking any grease off, make-up, any kind of oils on the face, just so the chemical peel can have a deep penetration and a uniform penetration.

In the office, acetone is a little bit too toxic, and it just creates a bad smell for the patient's, and it can burn their nose and eyes. So what I just do is use alcohol. You can use regular alcohol wipes, but a little bit of alcohol, rubbing alcohol and a sponge gets a better penetration. So I just clean the areas that we are going to do the chemical peel to.

Now you'll notice that there is some patchy white [inaudible 00:01:30] to the cheeks and there's a few little bruises that you see. These are essentially from the numbing shots. A little while ago, about 10 minutes ago, I did an upper/lower dental blocks, numbing her inferior alveolar nerve as well as her mental nerve, and then going and numbing some of this zygomatic branches of the facial nerve as well, and then doing some local injections underneath the skin as well. This is to make sure we're completely numb for this procedure, because as I said, a phenol peel is extremely deep and you have to have numbing. Topical numbing by itself like a numbing cream is not going to be deep enough or strong enough for this type of a peel.

She has had a little bit of Valium which makes her more comfortable. She's also listening to some music on her Ipod or... Now the cheeks are fairly swollen from about 20 cc's of numbing agent that I put basically in the face.

The phenol is mixed by your local pharmacy. Again, this is a causative substance and you should be careful like any poison or dangerous substance; they should not be left alone. How are you doing?

Female voice: I'm okay. It's not too bad. [inaudible 00:02:56] alcohol.

Male voice: Yeah. Keep your eyes closed. [inaudible 00:02:59] the fume. You can kind of see what's happening. You see a little bit of a frost reaction there. On the frost is a protein denaturing. Now all these areas have been numbed. What you'll notice is that it's definitely a deep frost.

Now, sometimes using a little fan, and go very slow so there's not a lot of fumes coming off. The other thing with Phenol is that it is cardio-toxic in high doses. So when we do certain areas, if we're doing the cheeks, if we're doing the entire sub-unit, we want to split the face into five parts and do the five parts over about an hour period. We also tell the patients to be well-hydrated, making sure that they're not dehydrated the night before doing this procedure. And let it sit in a little bit, and we're going to do this zone. We're going to give it about 10 minutes, and then we're going to repeat it on the other side of the face.

Now the way I care for this is essentially once we're done, I'm going to have her get in the shower twice a day and wash her face another four times a day on top of this. And what she's going to do is make sure that nothing crusts or scabs; that everything pretty much stays nice and clean as it heals. No crusting, no scabbing. How are you doing?

Female voice: [inaudible 00:04:37]

Male voice: Okay. So we'll give this about 10 minutes, then we'll go to the other side. So we've let this other side sit. Let me have you turn your head a little bit this way. You can start seeing the frost is wearing down a little bit. There's a zone of erythemal redness around it, but the frost is shrinking. In a few hours this frost is basically just going to be red. In a couple of days, it will turn brown, it starts peeling and she should start her routine at home. Now, and after giving it about 10 to 15 minutes, we're going to come and do the other side. Again, 88% Phenol, a nice wet pad. This zone is numb; you can see some of the puncture holes from the numbing shot, and she's definitely swollen from the numbing. You'll start seeing the frost immediately. Again, this is 88% Phenol, it gives you an immediate frost. The only other substance is the Baker-Gordon peel which is based on the 88% Phenol, and it does a similar type of frost.

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Chemical Peels Provide a Deep Solution to Acne Scarring

An 88 percent phenol chemical peel is administered by Dr. Shervin Naderi for a patient with deep acne scars.

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