They Work but They Can Be Dangerous : Facial Peels to End Wrinkles Gain Acceptance
Barbara Cassebarth was a “California girl” who played tennis every day and hit the beach on weekends for hours of sun-soaking--as the lines and sunspots on her face at age 51 attested.
Worried that her face would become cancerous, the San Fernando Valley native opted last spring for a procedure commonly known as a facial peel. In one long, sometimes painful week, her wrinkles and sunspots were removed with a chemical compound.
“I had no idea how fantastic it would be,” Cassebarth said. “The change was so dramatic people literally didn’t recognize me.”
Facial peels were shunned by the medical community when they were introduced in the 1960s. And although most doctors still have not embraced the procedure, they are not as hostile as they were, said Dr. Robert L. Simons, president of the American Academy of Facial Plastic and Reconstructive Surgery.
Got Bad Press
“It is an accepted procedure,” Simons said. “Facial peels initially got a lot of bad press and rightfully so. They were done by lay people who botched a lot of faces. Now more medical doctors are around who are willing to do it.”
The increasing number of medical doctors willing to do the procedure have driven many of the lay people out of business, said Dr. Robert Kotler, who performed Cassebarth’s facial peel in his Los Angeles office.
Because doctors are able to anesthetize the patient, they can perform more thorough facial peels that result in what the patient is seeking--an unlined face covered with smooth skin, he said.
“Since the results are better now, more and more people are seeking the procedure,” said Kotler, who says that 95% of his patients are women. “This has really caught on in California and Florida. I can see it spreading to the Northeast.”
A special license is not needed to perform a facial peel, but it is a complex and possibly dangerous procedure that is best done under general anesthesia, doctors said.
The procedure, like others in medicine, seems almost ghoulish. A compound of acids and irritant oils are applied to the face to eat away a millimeter or two of skin within 24 hours, taking with it a lifetime of wrinkles and age spots.
The acids remove the entire outer epidermis and part of the supporting layer of skin cells. Within a week, a new layer of epidermis covers the face.
This new skin, thinner than the original, is as fragile as a newborn’s and often bright pink in color. But after several months patients can return to using normal make-up and going out in the sun, doctors said, if they don’t overdo it.
Just like surgery, there are some dangers associated with chemical peels and a few unwanted side effects. The new skin is often a lighter color than the old and some patients have trouble with scarring and color splotches.
Because the new skin is lighter, the procedure cannot be performed on blacks, Hispanics, Asians or some people with dark complexions, doctors said. The best candidates are fair-skinned blondes, but doctors are able to test a patch of skin on those with darker complexions to see how the new skin will turn out.
The acid applied to the face is eventually absorbed into the blood. The most frequently used acid is phenol, which the body can absorb and excrete through the urine in small amounts.
Candidates for the surgery must be screened for kidney or heart problems because the acids can damage both under the wrong conditions.
Not a Face Lift
“It’s not necessarily a greater risk than any elective surgery,” Simons said. “But it has been billed as a fast, easy alternative to surgery and that is simply not the case.”
Facial peels do not take the place of face lifts, Kotler said. Face lifts, where surgeons pull skin and muscle up from a sagging position, do not usually remove wrinkles. Chemical peels, in turn, do not lift sagging jowls.
“Many of my patients combine the two,” he said.
Recently, doctors have experimented with collagen injections as an alternative to both procedures. Collagen, a binding protein found in connective tissues, is injected into the face to fill out skin and eliminate wrinkles. But the effects don’t last more than a few years, Simons said.
