Peeling II

BEAUTY may be defined as a subjective sensory state of pleasant fulfillment !

VANITY is but the folly of our pursuits !

It is conceit about ones attainment or appearance, with a lot of Narcissism thrown in good measure ! Most vain people are dissatisfied, worried about what people think and have unrealistic expectations from Dermatologists or aesthetique experts. It is our duty as a Dermatologist to help people to look better but not at any cost ! A little bit of counselling, is a must .

Why do I say Dermatologist and not a plastic surgeon ? Dermatology has today far progressed beyond a magnifying glass & skin diseases. It is imperative for us, younger dermatologists to be trained in a variety of cosmetic treatments within the range of our capabilities. I also find it necessary to keep up with the latest cosmetics available in the market and their efficacies to be able to guide patients better. Its simpler because as we dont have to sell anything personally we can have a clear & objective view of even a daily care regimen for patients.

Be it for men or women, skin care has gone way beyond soap, water & cream. Going by the numerous products that flood the market daily it is easy to discern that todays men & women do consider their appearance to be important & dont mind spending for it. The Downside is that they also tend to get carried away by numerous advertisements & sales personnel. In 24hrs how many products can you slather on your face, just THINK !

Pharmacies have entered the fray by launching COSMECEUTICALS which combine pharmaceutical standards & todays cosmetic demands. They have a slight edge over pure cosmetics in that the prices are competitive & active ingredients used can be done so in higher concentrations thus showing more acceptable results. Where COSMETIC companies score is in their advertisements, marketting, easy availibility & sales personnel.

Today I get more & more patients consulting me for cosmetic problems. It has become imperative now that I have added a lot of cosmetic procedures to my treatment armamentarium. I thank my stars that I was always interested in cosmetology, which allowed me to combine my scientific knowledge of the skin & its appendages with cosmetics, cosmetic procedures and their uses. I still am of the belief that without proper training one must not step on a plastic surgeons toes ! Each of our specialities are different & their limits should be respected !

I will now enumerate the Dermatocosmetic procedures carried out routinely in our clinics.

PEELING…..What is it ?
Chemical peeling is basically an accelerated form of exfoliation induced by a Chemical cauterant or an escharotic 9 scar forming) agent.

Peeling is divided into
…..Superficial ( Epidermis to papillary dermis)
…..Medium depth (upto upper dermis)
…..Deep peels ( upto mid papillary dermis).

Peels can be done for all skin types, Albeit the type of peel & depth differs. Deep peels are best avoided in dark skin people as far as possible, becuse of the unpredictability of post peel pigmentation.

The acids used are:
……for superficial peels – Glycolic acids 50 to 70 %, TCA 10 to 30 %, Resorcinol 40 to 50 %
……for medium depth peels – We use 30 to 50 % TCA ( Trichloro acetic acid)
……for Deep peels – Phenol upto 88% is used
….. LASER PEELS – using Carbon or Er YaG lasers is also in fashion but are to be done by only highly trained doctors and skin colour is a restriction !

Another form of superficial resurfacing I use is Cryoslush, i.e use of dry ice ( Carbon). It is superficial, safe & leaves no pigmentation. What are peels done for ? Peels are used to reduce or rid of skin changes of aging, fine wrinkles, pigmentations, acne & acne scars. They also have a beneficial effect on other small scars and as rejuvenating or freshening up the appearance of the skin. A point to note……results grow more dramatic and risks more perilous the deeper you go. Superficial & medium peels lift away mild wrinkling, unclog pores, lift pigments etc The DOWNSIDE is does not have dramatic results…….repeated sessions are necessary & patience is called for ! Deeper peels can literally mop up the pigment cells and can cause a permanent bleaching effect in lighter skins and post peel pigmentation in dark skins.

Pre peel counselling is a must and the patient must be told what to expect. Unrealistic expectations need to be doused & cost factor should also be worked out. LASER for hair Removal………the latest craze especially since invention of laser for dark skins! Hair removal Lasers are not new in the western world. The Ruby Laser has been around for along time but becuse of the dangers of using it in Asian skins it had not made its mark in our regions. With latest technology in Alexandrite & Diode Lasers for dark skins suddenly lasers are become the ‘In Thing’.

Remember they are safe interms of any long term internal effects but they are not purely cosmetic by any standard. A thorough understanding of the skin, hair cycles, hormones & hair types is very important. Also the handling of the Machine. It looks very simple but believe me when I say that experience and training is a must, because do it for an unindicated case & you have opened up a can of Worms !
DOWNSIDE…………Costly, needs multiple sittings & needs a lot of pre laser consultations because unrealistic expectations abound !

IONTOPHORESIS………..a very old treatment though neglected,…….. for treatment of excessive sweating of armpits, hands and feet. Also useful to control body odours from these areas. I used to get a lot of patients who complained of smelly armpits inspite of using Deo’s. This got me thinking nad I revisited my books and sought out this simple and safe office procedure of controlling sweating. it utilises Tap water & involves least discomfort to the patient. Downside………it takes atleast 20 mins per treatment and upto 3 or 4 treatments may be required . ELECTROCAUTERY & CRYOCAUTERY……….are actually medical treatments to remove warts, skin tags moles etc but need to be done with a lot of care so as to leave behind no blemish.

Age spots, freckles & age related benign growths are also well treated with the same. DOWNSIDE………..with electrocautery local anaesthesia is necessary making it difficult to treat children easily whereas with a cryo the lesion is not removed on the spot but is just allowed to sort of self destruct after treatment thus leaving it in place for a few days !

Other well known cosmetic procedures are FILLERS & BOTOX injections which are used mainly to smoothen out Furrows, wrinkles & frown lines. These are combined with Laser resurfacing for better results.

What is BOTOX ? It is an injection of diluted Botulinum Toxin. It was previously used to treat Facial & eye tics & twitches. How does it act ? It acts as an DENERVATION agent……..i.e it disrupts the connection of the nerve and muscle thus effecting the muscle paralysed .This automatically smoothens out the lines especially Brow lines & frown lines which are caused due to muscle expressions ! It is great not to have any wrinkles say most look conscious people.
DOWNSIDE………are many…….Painful, leaves behind red pinpricks for a while, temporary so needs a repeat 4 mnths down the line & the greatest problem is that requires a highly trained doctor because one slip up in injecting it can spread to involve other muscles leaving the patient with a temporary droop of eyelid or Ptosis Also as it paralyses the muscles it resticts your expressions and you can get a mask like effect.

Newer advances and a lot of research has come up with better techniques of injections and avoidance of side effects at large. FILLERS…….Collagen, Fat, Hyaluronic acid and Silicon………cause plumping up of skin. Used for uplifting of scars, filling in deep furrows & wrinkles, thus smoothig them out. Costly, again require qualified operators and need refilling at regular intervals. Use of Fat & Hyaluronic Acid have brought down the incidence of allergic reactions, long term effects on the immune system as opposed to collagen . But all these techniques need strict sterilisation to avoid infections & it is a meticulous process. Slicon is permanent but has its own complications. reports of carcinogenesis with silicon implnats has also been reported.

HAIR AND NAILS…….A word about these skin appendages.
Cosmetics to improve these are not far behind. Better shamoos, conditioners, softer colours, perms are all part of cosmetic hair treatments. so also is usage of certain stimulants bt dermatologists for hair growth. These range from medicines, vitamins to Therapeutic light treatments ! Nail cometics are now gaining ground too. These still fall into the Beauty categories rather than dermatologists, becuse we can treat nail disorders whereas the beauticinas can camouflage them well if they are ireversible.

The idea of this article is to get real…..okay clear, healthy skin and hair , fresh smelling too is ‘IN’. A great face wash, brilliant cream & makeup and a trip to the Dermatologist is considered absolutely worth the investment. But dont lose sight of all else around you. weigh the pros & cons, the rights & wrongs and most important dont get your expectations up so high as to veer into unrealism. We are all not born with great looks but we can make best with what we can reach out to !

Now that Dermatologists are concentrating on skin care products you are getting the power of prescriptions and the benefit of expertise !

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