Peel

Fig. 1

The material needed for the procedure includes cleansing lotion, alcohol 70% (or acetone), cotton, gauze, and peeling solution

The peeling agent is then applied using, for example, compresses, cotton, an applicator, or a brush (Fig. 2). Reapply a new layer after 3 or 4 min. Rinse with water, removing the crystals of salicylic acid (Jacobs and Roenigk 2010; Yokomizo et al. 2013). Increasing the number of layers leads to a higher amount of product on the skin and, therefore, increasing the depth of its penetration (Bourelly and Lotsikas-Baggili 2005).

Fig. 2

The peeling application begins in the frontal region, followed by the malar regions, nasal dorsum, chin, and perioral

Depth Levels

Level I: one layer. Causes mild erythema and flaking on the surface resembling a powder that can be easily removed.
Level II: two to three layers. A more intense erythema is observed, as well as frosting in dotted thin areas. There is a mild to moderate burning sensation (Fig. 3).
Level III: three to four layers. Causes significant erythema with areas of frosting and moderate burning sensation (Jacobs and Roenigk 2010; Yokomizo et al. 2013) (Fig. 4).

Fig. 3

Depth level II: Erythema with small dots of frosting

Fig. 4

Depth level III: A more marked erythema is observed

Postprocedural Skin Care

Post-peel instructions should be given to the patient in writing. Bland emollients should be started immediately after the peel, and wetting the area should be avoided for 24 h, followed by a return to normal cleansing activities. If the patient exhibits immediate intense erythema, a topical or oral steroid can be prescribed. It’s important to apply broad-spectrum sunscreen to the treated area(s) and advise patients to avoid sun exposure (Salam et al. 2013) (Figs. 5 and 6).

Fig. 5

Pre- (a) and post- (b) Jessner’s peel (two sessions) for improvement of skin texture and photoaging in a woman with Fitzpatrick skin type III

Fig. 6

In detail, there is significant improvement of periorbital wrinkles after two sessions of Jessner’s peel

Complications and Side Effects

The risk of complications can be significantly reduced with meticulous patient selection, peel selection (volume, combination, and technique of application), patient education, adequate priming, and good intra-peel and post-peel care (Salam et al. 2013).

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