Chemabrasion (Chemical Peels)

 Definition

  • Chemical peeling refers to the application of a cauterant to the skin for the purpose of causing a superficial destruction of the epidermis and upper layer of dermis. After healing, the treated area has a new epithelium and a somewhat more youthful appearance.
  • Several agents can be used toperform the chemical peel, including phenol and trichloroacetic acid and may be used in a combination formula, depending on the preference of the surgeon.
Discusssion
  • The cauterant acts in a way similar to surgical dermabrasions; it destroys the entire epidermis and upper portion of the dermis by chemical coagulation rather than by mechanical removal, with dermal regeneration occurring in 2 to 3 weeks postoperatively.
  • If corrective surgery on the eyelids and face is planned, the surgical procedure should be performed; at that time, only one area of the face should be treated by chemical application such as forehead and perioral region, with the remainder of the face and eyelids treated after an interval of atleast 8 to 12 weeks.
  • Chemical peeling is not a substitute for corrective surgery, but it is considered an excellent supplement for a finished look.
  • Contraindications for this procedure generally include:
    1. Areas devoid or deficient of epithelial elements.
    2. Dark skinned individuals.
    3. Patients with poor nutritional status.
    4. Diabetics
Positioning
  • Supine, with arms tucked in at the side.
Supplies/ Equipment
  • Chemosolution
  • Syringes
  • Impervious (waterproof) tape.
Procedure Overview
  1. The face or selected area is painted with the chemosolution, which burns and erodes the area to which it is applied.
  2. Small strips of impervious tape are precut and applied to the area, and allowed to dry.
  3. A light dressing may be applied.
Perioperative Nursing Considerations
  1. Heavy conscious intravenous sedation is usually used for the procedure, constant physiologic monitoring is required.
  2. A P.C.A. pump may be used for postoperative pain management.
  3. The surgeon will usually formulate the solution. A table containing the solutions and syringes should be created according to preferences.
  4. The procedure may or may not require a sterile set-up depending on the surgeon’s preference.
  5. The skin preparation solution is only used to decrease the skin.
  6. The circulator will cut the tape as directed by the surgeon; the tape usually stays on approximately 48 hours.
  7. The patient should be cautioned to avoid any excessive talking, which could adversely affect the aesthetic results of the procedure.