The 2-Day Light Phenol Chemabrasion for Deep Wrinkles and Acne Scars: A Presentation of Face and Neck Peels

Abstract

Introduction: Most physicians associate the term phenol peel with the Baker-Gordon formula and have not kept up with the resurgence of modified, light phenol peels that were popularized by lay peelers from the 1920s through the 1990s. Deep dynamic rhytides and acne scars are typically resistant to current resurfacing techniques. The concepts of reapplying phenol on abraded skin and phenol neck peeling are neither well understood nor accepted. Materials and Methods: Seventy-eight patients were treated and followed over 3 years, with various formulations of modified light phenol formulas. High-quality before and after photographs were taken, documenting the results. Patients were separated into 3 categories: acne scars, aging, and those with both. Neck peels were done on 19 patients. Full cardiac monitoring was performed and assessed. A telephone survey and a blinded-observers evaluation of the before and after photographs was done to assess the satisfaction index, color changes, and incidence of scars. A paired comparison to evaluate the need for chemabrasion versus peel alone for the treatment of acne scars was performed. A histologic study to evaluate the depth of injury and inflammation, to compare phenol alone versus chemabrasion was done. Results: Forty-four percent of the patients had skin phototypes (SPT) II–IV. The use of epinephrine for nerve blocks during the initial 30 cases was associated with 1 case of asymptomatic premature ventricular contractions (PVCs) and 4 premature atrial contractions (PACs) during eyelid application. The last 48 patients had no epinephrine, and there were no further arrhythmias. Photographic evaluation showed that acne scars improved 80%, wrinkles improved 90%, and those with both conditions improved 86%. There were no facial scars and no cases of depigmentation over a 2-year follow-up. Four neck peels developed small scars that resolved completely with treatment. The paired comparison showed that chemabrasion was superior to peeling alone for scar correction. Histologic studies showed that both Exoderm-Lift and Stone 2 wounded equally and that the second-day reapplication of these formulas did not cause a deeper injury. All patients were 100% reepithelialized by day 8–9. Forty percent of patients had 10-minute spot touch-ups. Discussion: The 2-day light phenol chemabrasion (PCA) is a very predictable peel without the associated complications seen with Baker-Gordon peels. Premixed, stable light phenol formulas are commercially available. This avoids the variability of mixing one's own formula and facilitates the teaching of this procedure as a well-defined and reproducible resurfacing technique. The 2-day PCA has the potential of becoming the treatment of choice for deep scar and wrinkle resurfacing.