How do you peel? Lasers or phenol may do the trick

There is evidence of ancient Egyptians using a combination of salt, mustard seed and fire to peel their skin in the name of improving their complexions. Over the millennia, the techniques have changed, but the desire to look younger remains.
In the 1940s, dermatologists began using phenol-based skin peeling methods. The practice, however, did not become widespread until the last decade. According to dermatologists, prior to the late ’80s, the potential side effects of phenol peeling, such as cardiac arrhythmia, long-lasting erythema and scarring, prompted most patients to opt instead for surgical methods to rejuvenate their faces. By 1990, a group of chemists, plastic surgeons and dermatopathologists had developed a new formula, sold under the brand name Exoderm, that the manufacturer claims eliminates most risks of phenol-based peels.
In many countries, a deep chemical peel is seen as an accepted alternative to facelift surgery for removing wrinkles. It is also used to get rid of freckles, acne scars and precancerous lesions.
In late September, a Brazilian dermatologist performed the first deep peel, which penetrates to the middle of the dermis, using Exoderm in Korea. Since phenol is banned by the Korea Food and Drug Administration for use in skin peeling, the Seoul dermatology clinic where the peel was performed had to get special permission for the procedure.
A number of dermatologists in Seoul expect that the September trial peel will help gain approval for Exoderm from the food and drug agency and convince potential patients that the procedure is safe and effective. According to www.exoderm.co.il, the risk is reduced by using a variety of oils, alcohols and buffer substances that simultaneously aid epidermal penetration by causing liquefaction and limit the absorption of phenol into the bloodstream.
Kim Sung-wan, who runs a private dermatology practice in Seoul, says, “The result of the [Exoderm] peel is quite dramatic, and I’m confident it will become a widely accepted peeling method in Korea soon.”
Not everyone agrees. Critics of the method say it is still riskier than other peeling methods, especially carbon-dioxide laser resurfacing.
According to the Exoderm Web site, no toxic effects, such as heart arrythmia, were observed in 558 monitored cases. The Web site says that over 3,000 patients have been treated with Exoderm since those monitored trials and reported no toxic effects. Among the side effects the site notes from the trials is a speeding up of the heartbeat just after the solution is applied around the eyes. The reaction is similar to the body’s response to caffeine, and is triggered by the burning sensation experienced during application of the solution, according to the site. Dr. Kim, the dermatologist, says it is a temporary side effect. Another side effect was persistent redness of the skin, which lasted for about two months after the procedure and then began to slowly dissipate.
In a comparison of exfoliating techniques, the Web site says Exoderm is more effective than carbon-dioxide laser resurfacing at eliminating deep wrinkles. The advantages of the laser method, the Web site says, is its “simplicity and high degree of safety.”
Advocates of the laser method, however, say that not only is it much safer and more precise than chemical methods, but the recovery time is relatively short and patients experience fewer side effects. According to Canada’s Institute of Cosmetic and Laser Surgery, treatment with a carbon dioxide laser can result in a 60-percent to 90-percent reduction of wrinkles. It can also smooth acne-scarred skin by 50 percent to 90 percent. Of course, high-tech lasers do not come cheap; the machines run into the tens of thousands of dollars.
Despite the advancements with lasers, Lim Ee-seok, another Seoul dermatologist, is more upbeat about Exoderm. “It is totally different from the exfoliating techniques currently available to us in Korea,” he says. Dermatologists like Dr. Lim, who advocates allowing Exoderm to be used in Korea, say the procedure is much safer and more effective than other deep chemical peels; they also tout the relatively short recovery period (about a week and a half).
Deep chemical peels and laser resurfacing are usually performed with a local anaesthetic, the patient awake and responsive. The patient’s pulse is monitored to detect any signs of an irregular or fast heartbeat.
In the case of Exoderm, the solution is applied twice to most areas of the face and three or four times to deep folds and wrinkles.
Laser methods use precisely guided pulses of light to basically evaporate the outer layer of the skin. The ultimate result of of both techniques is to stimulate collagen production ― essentially growing new skin to replace the old.

by Park Yun-ji