After Chemical Peels
WHAT CAN I EXPECT AFTER SURGERY?
There will be a mild to moderate amount of discomfort associated with the procedure. This should be easily controlled with oral medications. Tylenol with codeine (or equivalent if allergy to codeine exists) is generally always sufficient for pain control. Occasionally, using a medication to help you sleep may be useful for the first 7 to 10 days after the peel. After the peeling surgery pain should really not be a major problem for you. The skin often feels like it has been sunburned.
After the initial application of the peel solution you will feel a stinging pain for a few minutes. Within several hours expect the pain to reoccur and last for 6 to 8 hours. Swelling will also begin to develop in earnest around this time. Ice wrapped in a dry cloth may be applied to the peeled areas for relief of some of the pain. The ice should only be used for the first 24 hours after the procedure.
The discomfort should begin to significantly decrease after 24 hours. A significant increase in pain after this period should prompt you to call the office. Severe pain is rare; if you experience this, please contact us immediately.
Bruising and swelling are to be expected after the peeling surgery. These symptoms will peak within the first 36 to 48 hours after surgery, and will gradually subside over the next 7 to 10 days. To minimize the swelling, you should sleep with your head elevated for 3 weeks after the surgery.
Within 24 hours, the top layer of the skin will blister and peel. The peeled areas will resemble a deep sunburn. It is not unusual to have some slight drainage for the first few days after surgery. This will most often significantly improve or disappear by the end of the first week.
Prior to surgery most patients should be on Retin-A, a Glycolic acid skin regimen and a Vitamin C skin preparation for a minimum of 4 to 6 weeks. This treatment plan is important in optimally preparing the skin prior to surgery, in order to provide you with the best result possible. In addition, dark haired, dark eyed patients may also be placed on a pigment gel to help redistribute and stabilize the pigment cells of the skin. These medications may all be purchased at the office. Information, as to how and at what times to use the different preparations, will be provided to you.
It is of utmost importance to tell Dr. Ducic ahead of time if you have ever been on Accutane, received radiation therapy to the head and neck, taken steroids or immunosuppressive agents. Immunosuppressed patients (HIV positive, chemotherapy, AIDS etc.) and patients with certain autoimmune disorders are not good candidates for this procedure as the risks of poor healing and infection leading to permanent scarring are much higher. It is mandatory that you inform Dr. Ducic if you have any of these conditions before any peeling surgery.
CALL THE OFFICE PROMPTLY IF YOU NOTICE ANY OF THE FOLLOWING:
- development of a temperature elevation exceeding 100.0 degrees.
- significant pain which is not easily relieved by taking your prescribed medication.
- development of cold sores, or small blisters on the resurfaced skin.
If any of the above should occur after regular office hours, do not hesitate to reach us through the answering service. For whatever reason, if you notice one of the above changes and cannot reach us at our office or through the answering service, present yourself to the emergency department for evaluation.
HOW DO I CARE FOR MYSELF AFTER SURGERY?
Make arrangements to have someone drive you to, and from, your surgery. Having someone stay with you on at least the first night after your surgery is highly recommended. Be sure to fill your prescriptions before your surgery since you have to start taking some of the medications prior to the procedure. You will receive an antibiotic, pain pills and hydrocortisone cream. You may also receive an antiviral medication. If you wish to have a few sleeping pills, as well, you should ask Dr. Ducic to give you a prescription.
You should also purchase the following supplies prior to surgery:
- a fresh 2 liter bottle of hydrogen peroxide. a generous supply of gauze sponges from the local drug store.
- Benadryl tablets (25 mg). These are available without a prescription.
- a large container of vaseline.
Arrive for your surgery in loose comfortable clothing. Your top should button or zip rather than pull over your head. Use the medications only as prescribed by the office. Start taking the antiviral (if prescribed) and antibiotic on the night before your surgery. After the surgery try to avoid taking the pills on an empty stomach or at the same time, in order to avoid stomach upset. Do not take any aspirin or any anti-inflammatory compounds for 2 weeks before and 2 weeks after your surgery unless you first discuss it with your surgeon. If you have only mild discomfort, you may use plain Tylenol (acetaminophen). Otherwise, you may use the pain pills that were prescribed for you. If you are a smoker, you should not smoke for at least 2 weeks prior to surgery and 3 weeks after surgery. Smoking and chewing tobacco inhibit your circulation and can significantly compromise your surgical outcome. You should thoroughly wash your hair with an antibacterial shampoo or soap (available in drug stores) the night before surgery. After the peeling surgery, the treated areas will blister and peel (usually takes 24 hours). Once the upper layers of the skin have peeled away, you need to begin using soaks and applying ointment as described below. It is critically important to keep the treated areas moist at all times (after the upper layers have peeled off). They should never be allowed to dry and form crusts.
It is thus usually not necessary to start soaks until after the first 24 hours have elapsed. Now, using the gauze sponges, soak the treated areas with a solution of 4 tablespoons of hydrogen peroxide mixed with 1 cup of clean, cool water. Do the soaks for 20 to 30 minutes at a time. You should find the soaks to be soothing. If the solution is irritating for some reason, the hydrogen peroxide may be diluted by half (2 tablespoons of hydrogen peroxide to one cup of water). The soaks should be repeated 6 times per day, until the skin is fully epithelialized. This will generally take 7 to 10 days.
After each soak, either vaseline or other prescribed ointment, should be liberally applied to the treated areas. Do not pick or otherwise remove crusted areas. Do not allow the treated areas to dry out or scab over.
It is not uncommon to experience some itching as the treated skin heals. This commonly occurs between 5 to 7 days. Hydrocortisone cream may be applied to the itchy areas before applying the ointment. You may also use benadryl to ease the itch (follow product instructions). Note that benadryl will cause sedation. It should generally not be used at the same time as sleeping pills or pain pills. If in doubt, ask your pharmacist. It is not unusual for patients to get itchy at night while they are sleeping. This can cause scratch marks on the healing skin that will slow healing. Wearing bulky mittens (with no finger pockets) to bed may decrease this problem.
Sleep with the head elevated for 3 weeks after surgery.
Between 2 weeks and 2 months after the surgery, it is not uncommon to note the presence of what look like white heads on the treated areas. These are, in fact, milia. They represent areas where fresh epithelium has overgrown the underlying glands. They may be gently scrubbed and removed. If you are having trouble removing them, we will be happy to help you in the office.
You should do no vigorous exercise and should avoid any significant physical exertion, lifting or straining for a minimum of 2 weeks after your surgery, as this activity could disrupt your wound healing. Plan on taking it easy.
Do not rub or massage your face until after you are examined and told it is all right to do so. Likewise, do not wear make-up until your surgeon says that it is all right to do so. Generally you will be able to cover the treated areas with make-up within 10 to 14 days. At this time the skin will be fully resurfaced (no weeping, blistering or breaks in the skin) and soaks will no longer be necessary. You will find that make-up is somewhat more difficult to apply to the treated areas. They are, in fact, so smooth, that the make-up will often almost slide off. We will suggest certain products if you are having this problem.
Contact lenses should not be worn for the first 10 to 14 days after peeling surgery to the eye area, as placing them into your eye may put some strain on your healing face. You should avoid the sun and use a sunscreen with at least SPF 15 for six months after peeling surgery. Sun exposure may lead to hyperpigmentation or excess darkening of the treated areas. Although, this is generally treatable with pigment gels, they may take a while to work. Therefore, avoid the sun. If at all possible. Broad rimmed hats are also quite useful in this regard.
Your skin will be bright red after the procedure. This is to be expected. The redness will gradually fade and begin to return to a more normal color around the third week after surgery. However, some residual pink or light red color will persist for 6 to 12 weeks. The length of time it will take for a complete return to normal coloration is variable. Generally, persons with red hair or freckles will be red for somewhat longer periods of time than other people.
Retin-A, glycolics and vitamin C preparations should not be used after the surgery until you are told by Dr. Ducic that it is all right to do so. Generally, you should start back on this regimen 4 to 6 weeks after the surgery. This should be a gradual process. The Retin-A should be started first and used alone for 2 weeks. Then, the glycolics should be added 2 weeks later. Finally, the vitamin C preparation is added a further 2 weeks after that. Using this skin care regimen will enhance your surgical results and help restore damaged skin.
You will notice that the treated skin looks smoother and generally more youthful at 2 to 3 weeks after the surgery. It will look even better in a few months as the effects of the peel act to slowly tighten the skin’s collagen.
Approximate recovery after chemical face peeling is as follows:
DAY 1 Return home. Treated areas will begin to swell and burn more at around 6 to 8 hours after the peel. Treated areas are bright red.
DAY 2 Maximum bruising and swelling. Start soaks with peroxide once upper layers of skin have peeled off. Apply ointment after soaks. Repeat 6 times per day.
DAYS 5-7 Swelling and bruising starting to go away. Skin is being resurfaced. Discomfort much less. May start to itch (use hydrocortisone cream and benadryl).
DAYS 10-14 Usually the skin is fully resurfaced by now. May stop using soaks, and may start using make-up (once told by Dr. Ducic).
WEKS 6-12 Redness usually faded by now.
3 MONTHS Enjoy your result and avoid the sun. You should be back on Retin-A, gylcolic acid and the vitamin c preparation.
REMEMBER: If you have any concerns or questions, please contact our office any time. Our office should be a source of information and reassurance throughout this entire experience, from the time of your first consultation and continuing after your surgery.