Patient Selection

There are many relative contraindications to deep chemical peels, which depend on the patient’s Fitzpatrick skin type and medical history (Table 4.2). Therefore, patient selection is critical in deep chemical peeling. The ideal patient is a fair-complexioned female with thin, dry skin and fine wrinkles, that is, Fitzpatrick skin type I or II and Glogau type III or IV [43].

It is important to remember that phenolic peels pose systemic risks so that patients with a preexisting history of cardiac, hepatic, or renal disease should not undergo a deep chemical peel (Table 4.3). Patients with active herpes simplex labialis infections are not candidates for this type of peel.Also, if a patient has a prior history of HSV infections, they should be prophylactically treated with acyclovir, valacyclovir, or famciclovir prior to the peel and continue until re-epithelialization is completed.

Patients with Fitzpatrick skin type IV–VI are not candidates for deep chemical peels secondary to the increased risk of pigmentary changes, especially hypopigmentation and scarring [44].Male patients are less favorable candidates for deep chemical peeling, not only because of their unwillingness to use cover-up makeup to camouflage postoperative pigmentary changes, but also because their thick, sebaceous skin does not respond well [43].

Also, patients with diminished or absent normal dermal appendages (e.g.,previous radiation treatment or taking Accutane) are poor candidates [5]. Because epidermal regeneration is dependent on migration of epithelium from skin adnexa, in their absence, wound healing is delayed and can result in atrophic and scarred skin with abnormal color and texture. Normal skin topography, including the number of vellus hairs, usually indicates that the epidermis is capable of re-epithelializing after a chemical peel [40]. Also, deep chemical peels should be delayed a minimum of 2–3 months in patients who have had recent rhytidectomy, blepharoplasty, or deep-plane face lifts.