Histological case control study of peeling-induced skin changes of different peeling agents in surgically subcutaneous undermined skin flaps in facelift patients

Publication date: Available online 27 June 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): P. Gonser, S. Kaestner, P. Jaminet, K. Kaye
A histological evaluation of peeling-induced skin changes in subcutaneous undermined preauricular facial skin flaps of 9 patients was performed. There were 3 treatment groups Trichloroacetic acid (TCA) 25%, TCA 40% and phenol/croton oil; 1 group served as control. Two independent evaluators determined the epidermal and dermal thickness and the depth of necrosis (μm). The percentual tissue damage due to the peeling was calculated and a one sample t-test for statistical significance was performed. Based on the histomorphological changes, peeling depth was classified as superficial, superficial-partial, deep-partial and full thickness chemical burn. The histological results revealed a progression of wound depth for the different peeling agents without full thickness necrosis. TCA peels up to 40% can safely be applied on subcutaneous undermined facial skin flaps without impairing the vascular patency producing a predictable chemical burn whereas deep peels as phenol/croton oil peels should not be applied on subcutaneous undermined skin to not produce skin slough or necrosis by impairing vascular patency.



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