New York Dermatology - Board Certified Dermatologist - Dr. Gary Rothfeld - (212) 644-9494

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Chemical Peels : TCA and Phenol

Chemical peels New York City Treatment

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Chemical peels

 

Chemical peels are divided into three broad categories based on the depth of action of the chemical: superficial, medium depth, and deep. Superficial peels are used to exfoliate the skin and are aimed at the most outer layer of skin and the overlying dead skin cells. Medium depth chemical peels work well for age spots, patients with melasma, and some superficial wrinkles. For patients with significant wrinkles, deep chemical peels or resurfacing laser treatments should be undertaken.

 

Any chemical peel must be used very carefully in patients with dark skin types. Deeper peels in dark skin types can produce permanent light patches of the skin and can have disastrous results. Even more superficial peels should only be used by physicians with experience in dark skinned individuals.

 

Patients who are undergoing or have recently completed treatment with isotretinoin (Accutane®) should not undergo chemical peels. Most physicians suggest at least 6 months and probably 1 year elapse before any skin resurfacing after isotretinoin use.

 

It is imperative to have a consultation with a qualified physician before undergoing any chemical peel procedure. Some skin areas which appear to be age spots may actually be early stage skin cancers and can be masked by the chemical peel. Evaluation by a dermatologist may be necessary before any treatments are undertaken.

 

With the advent of the internet, some of the more concentrated peel solutions are available for direct consumer purchase. These should not be used at home and should only be used by trained and experienced professionals. Permanent skin scarring and color changes can occur with any chemical peel. Follow up care and application by a trained physician is essential for a positive outcome.

 

Superficial Facial Chemical Peel

 

Superficial peels are generally aimed at rejuvenation of the outer layer of skin and sloughing of any dead skin. The most commonly used compounds for superficial chemical peels are alpha hydroxyl acids. Alpha hydroxyl acids are usually naturally occurring fruit acids, including glycolic, lactic, citric, tartaric, and malic acid. The most popular form used is glycolic acid which is derived from sugar cane. AHA’s are available over the counter though the concentration is less than those used by physicians, usually 3-10%. Physician applied AHA’s may have concentrations of 50% or greater. In physician application, the compound used is applied to the skin. The length of time left on the skin determines the depth of penetration. The solution is deactivated with application of a bicarbonate solution or washing with water.

 

Superficial chemical peels can also be accomplished with Jessner’s solution. Jessner’s solution is composed of resorcinol, salicylic acid, lactic acid, and ethanol. Application of Jessner’s solution produces a light frost of the skin which identifies when the appropriate depth of penetration has been achieved.

 

After application of either solution, redness will appear and sometimes a small amount of swelling. Over the next several days the outer layer of skin will slough off and re-epithelialization will usually be complete in about a week.

 

Superficial chemical peels are often used before deeper peels to remove the dead layer of outer skin and allow the deeper peels to produce a better result. Sometimes, a physician may suggest a patient use a low concentration AHA system for several weeks before or possibly as a maintenance therapy after deeper chemical peeling or laser resurfacing treatment.

 

Medium Depth Facial Peels

 

Medium depth peels are usually performed with 20-35% trichloroacetic acid (TCA). The depth of penetration is dependent on the concentration with higher concentrations creating deeper penetration. As TCA works, a white frost is formed on the skin which identifies the end point of application. When TCA is applied, the skin will burn but this can be neutralized with topical lidocaine or fanning and resolves within about a half hour. Exfoliation occurs over several days and complete re-epithelializiation usually takes about two weeks. During this time the skin will be red and will flake.

 

Deep Facial Chemical Peel

 

Phenol is considered the chemical of choice for deep chemical peels. Phenol is mixed with various other additives to create a formula which is actually used for the peels. Common formulas include Baker-Gordon, Venner-Kellson, Maschek-Truppman, and Grade. Formulations are necessary because as the concentration of phenol increases, the depth of the peel decreases to a point. By adding other chemicals to the peel, a deep peel can be accomplished. Application of phenol peels is usually performed with some form of anesthesia, possibly even IV sedation.

 

Phenol peels require medical cardiac monitoring as phenol can cause arrhythmias which can be fatal. Phenol is absorbed through the skin, metabolized by the liver, and subsequently excreted by the kidneys. Patients receiving phenol treatments usually have an intravenous line started and receive significant hydration to avoid toxicity.The face must be divided in 6-8 regions and at least 20 minutes must be allowed to elapse between finishing one area and starting another.

 

At the end of the procedure, the patient will have marked redness of the skin which can take several months to completely resolve. Discomfort is usually minimal after the first 24 hours. Re-epithelialization is usually complete in about 2 weeks.

 

Care After Facial Rejuvenation

 

Chemical peels not only wound the outer layer of skin but also decrease the body’s natural defense system by wounding skin. After care is aimed at keeping a moist environment for wound healing and preventing infection. Until the skin has completely re-epithelialized, moisture (in the form of petroleum based cream or other formulas) must be applied to the skin to keep the area moist. A dry environment can lead to unsightly scarring.

 

For medium to deep chemical peels, antibiotic medications and sometimes antiviral medications are prescribed. While not causing cold sores, chemical peels can cause enough of a body shock to cause a flare up of cold sores. Antiviral medications aimed at preventing or controlling cold sores should be used especially in those people with a history of cold sores.

 

If the skin starts to slough, patients are strongly warned not to pick the face but to allow the skin to fall off on its own. Soaks with some type of antimicrobial are used shortly after the peel to keep the area clean. Some physicians use vinegar or hydrogen peroxide for this purpose.

 

Just before and immediately following treatment, patients must be very careful about sun exposure. For several months after treatment, patients must use sun precautions (sunscreens, hats, glasses) when out in the sun. Excess sun exposure can produce hyperpigmentation (dark spots) and sometimes additional scarring.

 

In the immediate post treatment period until the skin has re-epithelialized, patients must avoid application of any make-up, sunscreen, soaps, moisturizers, or any other things not specifically approved by the treating physician. Application of such compounds can cause prolonged redness, drying of the skin, unexpected reactions, and in the worst cases, scarring.

 

Patients undergoing medium to deep chemical peels require close follow up to ensure that any unexpected complications can be quickly dealt with.

 

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 Dear Friends
 
Our goal at NYC Dermatology is to be the Tiffanys of Skin
Care. I personally see every new patient who visits our office. I am not just a physician, I am a Board Certified Dermatologist. My goal is, quite simply, to provide the type of dermatologic care which I  would seek for my own family. This is a very important point, since physicans often use the phrase "Doctor's Doctor" to refer to those individuals who typically are selected by physicians themselves for personal care. I am confident that my practice fully meets that definition. This is the type of 5-star care and service that our patients expect, deserve and receive. I treat every patient the way I would want to be treated: with courtesy, dignity and respect. I carefully listen to their skin-care concerns and offer a variety of options including a treatment plan that I believe will give them the best results and the best dermatologist. We also support our patients with a very fine medical staff . Please take a moment to explore our top of the line winning website. My philosophy is simple…Experience Counts and Quality Matters. Please allow me to solve your skin problems.  After all, at NYC Dermatology , our philosophy is if you look great you will feel great with gorgeous skin.”
 
Best Regards,
 
Dr. Rothfeld
 
http://www.nycdermatologist.com/
 
 
 
 
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NYC Dermatology is a full service cosmetic dermatology practice under the direction of Dr. Rothfeld. We offer the latest, most innovative treatments for skin. All of our treatments are customized to your specific needs.

Our mission is to provide high quality skin care services with minimal downtime to our patients, and to educate our patients on properly maintaining skin health. We strive to provide education first on the skin care procedures and products we offer, allowing our patients to make informed decisions about their skin care.

Dr. Gary Rothfeld is a board-certified dermatologist and dermatologic surgeon who specializes in aesthetic procedures. Dr. Rothfeld cares for all types of skin conditions with a special emphasis in the areas of cosmetic dermatology and laser surgery.  Dr. Rothfeld was raised in New York , and as a young man was drawn to the performing arts and creative writing. A strict academic upbringing led him into science and medicine instead. After many years of rigorous training followed by preceptorships and mentorships that added to his skill and experience, Dr. Rothfeld has found art again. Dr. Rothfeld stands on a foundation of science but is now able to express himself creatively in the world of aesthetic medicine.

Every patient is a unique palette of conditions, goals and temperament that require delicate consideration, and sometimes inventive solutions. Dr. Gary Rothfeld is able to provide the entire gamut of dermatologic services, including medical dermatology, injectables, laser treatments and surgery. This gives him a range of possibilities when evaluating a patient. Combination treatments are often tailored to provide the patient with results ranging from subtle to dramatic.

Dr. Rothfeld strives to listen and understand the patient's specific goals and concerns, and provide them with satisfying results. NYC Dermatology endeavors to make the patient's visit as comfortable and pleasant as possible, making their best effort to take the pain out of beauty. Dr. Gary Rothfeld and his staff approach their work with absolute joy and infectious enthusiasm, which is felt throughout his practice.

Trained in Dermatology, NYC Dermatology by Board Certified Dermatologist NY Dermatology Dr. Gary Rothfeld possesses the special knowledge, skills and professional capability that distinguishes him as an outstanding  Dermatologist in NYC , Manhattan , New York at NYC Dermatology by Board Certified Dermatologist. Top New York City Dermatologist, Dr. Rothfeld  in Manhattan treats the most difficult cases until the problem clears.  Dr. Rothfeld, a Board Certified Dermatologist at NYC Dermatology in Manhattan, New York is caring, detailed, and meticulous and will never give up until the problem is cleared.  Dr. Rothfeld, a board certified dermatologist in nyc who practices Dermatology in Manhattan, New York has treated many patients in the entertainment and music industry is caring, detailed and meticulous and will not give up until the condition resolves.  Dr. Rothfeld is recognized as one of the best Dermatologists in NYC by the entertainment industry.

NYC Dermatology is under the medical supervision of Dr. Gary Rothfeld, a Board Certified Dermatologist.
To enhance every aspect of your skin care, Dr. Rothfeld has personally created a superb line of cosmetic procedures..

NYC Dermatology by Board Certified  Dermatologist Dr. Gary Rothfeld  is a board certified NYC  Dermatologist with a  New York City office in Manhattan, New York  providing expert skin care, dermatology, and cosmetic dermatology services.

A board certified dermatologist in NYC specializing in dermatology and dermatologic surgery including state-of-the-art cosmetic surgical procedures, Dr. Gary Rothfeld  is known for his attention to body symmetry and his dedication to meeting patients’ personal goals. His specialties include full body liposuction using the tumescent technique, facial fat transplantation, Botulinum injection into facial lines and laser resurfacing. NYC dermatology  specializes in chemical peels, vein injections, laser, restylane, Perlane, Botox injections, JUvederm, non-surgical facelifts, collagen implantation and treatment of skin cancer.
 
As an expert in the field of dermatology and cosmetic dermatologic surgery, Dr. Rothfeld is has appeared on national television shows. Dr. Rothfeld has also been quoted in many high profile national magazines.
Our goal at the manhattan office of Board Certified  Derrmatologist , Dr. Gary Rothfeld is to create an atmosphere of professionalism, trust and complete patient satisfaction at the NYC Dermatology and Cosmetic Surgery Center in Manhattan, New York.  Dr. Rothfeld, Dermatology Director of NYC Dermatolgy is a Board Certified  Dermatologist at NYC Dermatology who has treated many patients in the  entertainment industry.
   Schedule an appointment at our office which provides top of the line  expert skin care, dermatology, cosmetic dermatology services, and advanced dermatology laser treatments for cosmetic needs and medical skin conditions. We offer a full range of services including surgery for skin cancer, laser hair removal, Botox®, the Fractionated Resurfacing laser, Titan laser, and acne photodynamic treatments. Our main goal is to provide you with the most effective and advanced treatment. Join the NYC Laser Center NYC Dermatology Mailing List Our periodic newsletters include exclusive offers, educational articles, as well as free treatment & product drawings! Email: nycdermatologist@aol.com in our Media  office and   including different offers and many more. We offer a variety of services from Botox® to Liposuction . Please contact us with any questions you may have or schedule an appointment online or by phone for a consultation.   Beauty Is Forever!  and Dr. Rothfeld  at NYC Dermatologist has over 20 years of experience with his beauty tips. 
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During your office consultation  and examination you will be provided with a detailed plan of the treatments that will benefit you most.  NYC Laser Center NYC Dermatology top laser dermatology center offering skin care, dermatolgy,cosmetic dermatology services, and laser treatments for sun damaged skin, acne, acne scars, rosacea, pigmentation, laser hair removal, broken blood vessels, as well as superficial and deep wrinkles. We offer patients in Manhattan,  services including general dermatology, wrinkle fillers such as Restylane®, Captique,  Perlane,Cosmoderm and Cosmoplast, Radiance® (radiesse) and Sculptra. We also offer Botox®, Cosmelan, Velasmooth, Fotofacial, Titan laser, Refirme, and the Fractionated Resurfacing laser. in the treatment of acne, rosacea, skin cancer and  surgery.  Dr. Rothfeld has taught numerous other physicians on the proper use of Botox®, medical hair transplants, and lasers in  the country.   Acne Photodynamic Treatment - Botox® - Botox® for Hyperhidrosis - Cellulite - Cool Laser  - Cosmelan Depigmentation Treatment - Glycolic Acid Peel - Fat Transfer - Fotofacial / IPL Fractionated Resurfacing Laser - Hair Loss - Laser Hair Removal - Liposuction -  - Surgery - Minimal Scar Technique -  Photodynamic Rejuvenation Radiance® - Restylane® - Sclerotherapy - Sculptra - Smoothbeam - Stretch Marks - SunFX - TCA Peel - Tattoo Removal - Titan Laser Facelift - V-beam Laser Treatments - Velasmooth Our cosmetic surgeon includes Dermatologist  Dr. Gary Rothfeld Board Certified Dermatologist  at NYC Dermatology.  Our NYC dermatologist offers advanced dermatology laser treatments for cosmetic needs and medical skin conditions. We offer our services to Manhattan , Brooklyn, Bronx, Queens locations through our Manhattan office in NYC

 

Sun Protection

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Ultraviolet radiation is the major cause of skin cancer, including melanoma. It is important for everyone to be aware of its damaging effects and take measures to avoid overexposure.

Although many people enjoy the appearance of tanned skin and think it looks "healthy," tanned skin is damaged skin. The ultraviolet radiation in sunlight penetrates the deepest layers of the skin where it harms the cells. The body responds by making more pigment (melanin) to try to protect itself, but the damage has already happened and may be permanent. The more exposure you have to the sun, the more likely you are to develop skin problems later in life.

Ultraviolet Radiation

The damaging part of sunlight is called ultraviolet radiation, or UV rays. It is categorized into three types:

  • UVC rays (wavelengths = 200 nm to 290 nm) are the shortest and most powerful of the UV rays. UVC is the most likely to cause cancer if it reaches skin. Fortunately, most of it is absorbed by the ozone layer in our atmosphere. However, there is concern that a thinning of the ozone layer may be causing more UVC to reach the earth's surface.
  • UVB rays (wavelengths = 290 nm to 320 nm) are less damaging than UVC, but more of it penetrates to the earth's surface. It is the most common cause of sunburn and skin cancer. UVB is particularly strong at the equator, at high elevations, and during the summer.
  • UVA rays (wavelengths = 320 nm to 400 nm) are the least powerful of the UV rays, but they are present all year and can penetrate windows and clouds.

Sun Protection

The first and more effective way to avoid sun damage is to stay out of tthe sun as much as possible.

If you cannot avoid being exposed to sunlight, there are five basic defenses that you should keep in mind when you go outdoors:

  • Avoid peak hours of sunlight
  • Sunscreen
  • Clothing
  • Sunglasses
  • Shade

Avoid Peak Hours of Sunlight (UV Index)

In general, UV rays are the greatest between 10 a.m. and 4 p.m. It is best to avoid the outdoors during these hours without protection, particularly during summer, in tropical regions, or at altitude. During this time, you should pay close attention to the appropriate use of sunscreen, clothing, sunglasses, and shade.

You can obtain an accurate measure of the amount of UV rays in your area by looking up the Ultraviolet (UV) Index. The UV Index is like a weather forecast. It provides a report on the amount of damaging UV rays that are expected to affect a region on a particular day. The UV Index changes day to day according to time of year, cloud cover, atmospheric ozone, and other factors.

The following table is a breakdown of the UV Index. A high UV Index number means that you are at greater risk of being exposed to ultraviolet radiation. You should take special care to avoid outdoor exposure to sunlight when the UV Index is moderate or greater.

  • 0 to 2 = Minimal
  • 3 to 4 = Low
  • 5 to 6 = Moderate
  • 7 to 9 = High
  • 10 or more = Very high

The UV Index can be found on our Website or in local papers, usually in the weather section.

Sunscreen

There are several factors to consider when selecting the right sunscreen. (See the Sunscreens handout for more information.)

Sun protection actor (SPF) - Sunscreens are rated by the amount of protection they provide from UVB, measured as the "sun protection factor" or SPF. Sunscreens with higher SPF provide greater protection from the sun. It is best to use sunscreens that offer a minimum SPF of 15.

Broad-spectrum sunscreens - It is best to use a sunscreen that can protect you from both UVA and UVB rays. These are called "broad-spectrum" sunscreens.
Most of the original sunscreens blocked only UVB, but increased awareness of the damage caused by UVA has lead to the development of ingredients that protect against UVA too. Broad-spectrum sunscreens combine ingredients to provide a product with greater protection.

Common sunscreen ingredients that  provide protection from UVB rays:

  • Cinnamates
  • Octocrylene
  • PABA (para-aminobenzoic acid)
  • Padimate O and Padimate A (Octyl Dimethyl PABA)
  • Salicylates

Common sunscreen ingredients that  provide protection from UVA rays:

  • Avobenzone (Parsol 1789)
  • Benzophenones (oxybenzone, dioxybenzone, sulisobenzone)

Sunblocks - "Physical" sunscreen ingredients lie on top of the skin and work by reflecting or scattering UV radiation. They are particularly useful for people who are sensitive to the ingredients found in other sunscreens. Sunblocks often contain one or more of these ingredients:

  • Zinc oxide
  • Titanium dioxide
  • Iron oxide

Although past formulations were unsightly (often leaving a white film on the skin), newer "microfine" formulations are invisible after being applied. Microfine titanium dioxide is effective at protecting from both UVA and UVB rays.

Water resistance - Sunscreens are classified as "water-resistant" if they maintain their protection after two 20-minute immersions in water. They are classified as "waterproof" if they maintain their protection after four 20-minute immersions. You should seek a water-resistant or waterproof sunscreen if you will be participating in water sports, such as swimming or water skiing, or will be actively sweating.

However, independent testing has shown many products do not perform well in the real world. So it remains a good idea to apply sunscreen every time you leave the water, or frequently if you are actively sweating.

Using a Sunscreen

Sunscreen should be applied evenly and liberally on all sun-exposed skin within 30 minutes before going outside to give sunscreen time to take effect. (Sunblocks are effective immediately after being applied.) Sunscreens should be reapplied every two hours or following swimming or sweating. Apply sunscreen generously and reapply frequently at least every two hours.


The chemicals may lose effectiveness over time, so it is important to throw away sunscreen that is past its expiration date or is over two years old.


No sunscreen is 100% effective; take additional measures to avoid the damaging effects of the sun's rays.

Clothing

Clothing can provide excellent protection from the sun. However, not all clothing is protective. A thin, wet, white t-shirt will provide almost no protection from UV rays. When selecting clothes for sun protection, consider the following:

  • Cover your head, shoulders, arms, legs, and feet.
  • Use a hat that is broad-brimmed (brim should be at least four inches wide).
  • Wear fabrics that are thicker or with a tight weave; these allow less sunlight to penetrate the skin.
  • Wear darker-colored clothes that absorb more UV rays.
  • Wear clothing made from nylon or Dacron because it is more protective than cotton.
  • Avoid remaining in wet clothes because wet fabric may allow more UV rays to penetrate the skin.
  • Wash clothing with chemical absorbers to increase their protectiveness.
  • Some clothing comes with a UPF rating that stands for "Ultraviolet Protection Factor." This measures the ability of the fabric to block UV radiation from penetrating to the skin. A fabric with a UPF 15 allows only 1/15th (6.66%) of the UV radiation to penetrate your skin as compared to uncovered skin.

Garments fall into 3 categories:

  • Good protection: UPF = 15 to 24
  • Very good protection: UPF = 25 to 39
  • Excellent protection: UPF = 40 to 50+

Choose clothing with a UPF rating of at least 15. Keep in mind that the UPF of a garment will decrease over time as the fabric wears.

Sunglasses

Overexposure to sunlight can cause cataracts and macular degeneration, a major cause of blindness. Sunglasses can provide protection. However, not all sunglasses are of value. A darker lens itself does not guarantee protection. Look at the label to ensure that the glasses provide UV protection. Sunglasses should be large enough to shield your eyes from many angles. Look for sunglasses that are described as blocking 99% or 100% of UVA and UVB. The glasses may also be described as providing UV absorption up to 400 nm.

Shade

If possible, remain in the shade when outdoors. Keep in mind that shade does not provide full protection from the sun because UV rays can bounce off reflective surfaces, such as sand, snow, water, concrete, or even porch decks. In addition, some fabrics used as shade devices, such as parasols or umbrellas, may not provide sufficient protection. If you seek shade under a cloth, look for a fabric that is thick, tightly woven, and dark-colored.

Clear window glass provides protection from UVC and UVB, but not UVA rays. If you are frequently exposed to sunlight while driving, the plastic interleaf of your windshield (which prevents it from shattering) can help block the light, but side windows have no such protection. Non-drivers can make use of additional window shade devices. Drivers in some states may be able to use darkly-tinted glass in the side windows, but this is illegal in some states.

Summary

  • Avoid the sun when its UV rays are strongest, between 10 a.m. and 4 p.m.
  • Use a broad-spectrum sunscreen with SPF 15 or greater. Apply it 30 minutes prior to being exposed to the sun and reapply every two hours. Consider using a water-resistant sunscreen if you will be active (sweating) or in the water.
  • Use a sunblock on your lips.
  • Wear a broad-brimmed hat when outdoors.
  • Wear sunglasses.
  • Wear tightly woven, dark clothing to cover your arms, legs, and feet.
  • Stay in the shade when possible.
  • Avoid reflective surfaces, such as water or snow.
  • Avoid sunbathing.
  • Don't be fooled by cloudy days since damaging rays can penetrate clouds.

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NYC Dermatology - Manhattan Dermatology - Skin Institute of New York - Skin Cancer Doctor- NYC Cosmetic Dermatology-  Cosmetic Dermatological Surgery - New York City - Board Certified Dermatologist

Manhattan Office 

 Dr. Gary Rothfeld
NYC Dermatology - Board Certified Dermatologist - New York, NY
30 E. 60th St. Ste. 805
Manhattan, New York 10022
212.644.9494
1.800.BLEMISH
  


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