Are phenol peels still a thing or are there better procedures for under eye wrinkles? (photos)

Question

Searching for the best possible treatment for under eye wrinkles. I'm 35 and they're pretty bad for my age. I'm open to anything - even blepharoplasty.

Luis Villar, MD, FACS · Answer

Phenol/Croton oil Peel is still the best treatment for deep etched wrinkles of the face.  No other treatment can match it.  However, for small wrinkles around the eyes, it is over kill because it changes the color, texture, and tightness of the skin.  if only the eyelids are treated, you will likely have a line of demarcation along the borders of treatment.  At the Boston Meeting of ASPS, a show of hands revealed only a third of those present knew how to perform a Phenol Peel.  Younger surgeons are being trained in less effective non invasive techniques which we old timers have found very disappointing.We have had some success with erbium laser.  No success with ultherapy.  Botox improves the wrinkles when you animate but leaves you with whatever etched lines or redundant skin you have at rest.  Fillers under the thin skin can leave bumps and lumps.  Fractionated ablative lasers may offer some hope and lighter peels might help without changing color too much.  Every patient is different and treatments have to be customized to each individual and each eyelid (your left is worse than your right).  We are now researching the use of nanofat to change the architecture of the skin, but this is a slow process.I wound not recommend the standard strength Phenol/ Croton Peel in cases like yours.

Raffy Karamanoukian, MD, FACS · Answer

Fractional CO2 laser is an excellent tool for skin rejuvenation in our center in Santa Monica. We use the fractional multi-depth ablative approach to help resurface the skin, recontour acne scars, improve incisional plastic surgery scars, and reduce surface irregularities from skin tone to dark pigmentation. Our approach utilizes a multi-depth approach that targets melanocytes in the epidermis and collagen fibroblasts in the dermis. This approach can be combined with a TCA Peel in a process known as a sapphire peel. Fractional laser is excellent for acne scars and contour scars in the skin. Patients are advised to undergo skin protocols with Melarase creams before and after treatment to help reduce pigmentation. Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. After the laser, we expect redness for a few weeks as the skin improves. PRP and Hydrafacial enzyme facials can further improve skin quality after fractional co2.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best,
Dr. Karamanoukian 
Realself100 Surgeon

Jason Emer, MD · Answer

A combination approach would give the most improvement. Deep wrinkles and smile lines can be improved with a combination of Botox and/or fillers for the lines themselves and to build anatomical support with Sculptra for collagen building. Ultherapy is a great skin tightening device, but works best in combination with other treatments like J Plasma, RF treatments, lasers, microneedling/PRP, salt facials, Cosmelan for skin tightening and improve skin tone. I recommend getting a formal evaluation with an expert. Best, Dr. Emer

Anthony J. Wilson, MD · Answer

Phenol peels are still excellent treatments and there is really no comparison. However they are high risk with the potential for the best result. Patients need to see a surgeon who performs these regularly and can prep your skin appropriately to avoid the most common complication (hyperpigmentation). Best of luck!

Richard H. Bensimon, MD (retired) · Answer

Dear Noonnie,I am very glad you asked this question because Phenol peels (more correctly called Phenol/Croton Oil peels) are great for smoothing out lower lid wrinkles and crepey skin. Changes in the skin of the lower lid are often the first signs of aging, especially in the thinner skin of women. This is a great annoyance to patients and all of the over the counter eye creams do nothing! Worse is to make the mistake of operating on the lids when there is no real excess of skin rather than address the quality of the skin.
Phenol/Croton oil peels literally change the anatomy of the skin by depositing thick, stable collagen and elastin (the springy cells of the skin) resulting in younger, smoother skin. This remarkable process is like ironing the skin!
I have been peeling for 20 years and have found that peeling the eyes alone is an excellent choice for younger patients. It can easily be done as a simple office procedure without formal anesthesia. The results are long lasting, and if in the future there is a loss of effect, the peel can be repeated, effectively keeping up with aging!
I think this is the procedure of choice for eyelids like yours. Good Luck!

Are phenol peels still a thing or are there better procedures for under eye wrinkles? (photos)

Answers (5)

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