Cosmetic Surgery - Chemosurgery

Chemosurgery consists of the application of an acid to the skin. The acids that are used today are a 50 percent solution of phenol, one of the chloracetic acids for a lesser exfoliation (the phenol peel), or one of the fruit acids, such as glycolic acid, which can be used by the patient at home.

The phenol peel is probably the treatment of choice for wrinkles around the mouth. Anatomical segments may be peeled, or the entire face may be treated. At one time, there were reports of some cardiac irregularity during the procedure. Since then, the EKG monitor has been used and no further reports have been made. The face is carefully cleansed and the patient is heavily sedated.

As the surgeon applies the phenol solution with an applicator, the patient experiences a stinging sensation. A waterproof adhesive tape mask is applied in overlying strips and left in place for 24 to 48 hours. The patient has marked pain during the first 16 hours. Following removal of the tape, thymol iodide powder is applied to dry the weeping surface. Today, many physicians prefer to use Vaseline in place of adhesive tape and Neosporin powder in place of thymol iodide. After removal of the mask, there is intense redness, which my take as long as six months to subside.

Complications following this procedure are similar to those following dermabrasion and are more apt to occur. The patient must protect her face from the sun as long as the redness persists. Keloids (thick red raised scars) may result, which have to be treated with prolonged injections of cortisone. Perhaps these complications can best be avoided by following the advice of dermatologist surgeon Harold J. Brody, chairman of the American Academy of Dermatology's Task Force for Chemical Peeling Guidelines. In a January 1995 Vogue magazine interview, Dr. Brody advises those interested in a chemical peel to be sure to seek out an ethical, board-certified physician through the American Academy of Dermatologists because "dermatologists and dermatological surgeons are the only ones specifically trained during their residency for this procedure.

Scars are permanent in nature, but in some instances they can be made less conspicuous by redesign of tissue. Procedures such as Z-plasty or W-plasty are used to change the direction of the scar and also lengthen the scar so that there is no contracture. Keloids may be improved by the injection of cortisone or the application of pressure by paper taping or elastic pressure. These techniques may be used singly or in combination.

The length of time the improvement will last varies with the individual factors mentioned with regard to immediate recovery and also the amount of stress experienced; general health; maintenance of a constant weight; avoidance of excess exposure to the sun and overindulgence in alcohol, smoking and drugs. There may be some relaxation at the end of six months that may be improved by minor surgery. If they are not undertaken too frequently, repeat procedures of chemosurgery will produce equally satisfactory results.