ABSTRACT
Immediate post-peel care The care required for the skin and patient after an application of phenol largely depends on the formulation and the doctor’s experience.
Hospitalization or ambulatory peel? The first question to ask is whether or not the patient should be hospitalized. Some hospitals or cosmetic clinics like to combine a phenol peel with other treatments: surgical or medical, nutritional or cosmetic. In these cases, patients remain in the hospital, clinic or spa for 8-15 days. Some peels require complex and repeated sessions of postpeel care that can only be given if the patient is hospitalized for 8-10 days. It is clear that hospitalization can contribute to patients’ wellbeing, making life easier and helping them avoid any contact with the public, friends or relatives during the first week of – unsightly – skin regeneration. Some practitioners, for fear of the potential toxicity of phenol and the possibility of heart rhythm disorders, prefer to hospitalize patients the first night after the peel until the occlusive mask has been removed 24 hours later. This brief period of hospitalization can also be beneficial to the patient, who can be given a titrated intravenous analgesia until the morning after the peel. Some more recent techniques provide a phenol peel of the same quality and are completely ambulatory. Patients are taken home by a friend or relative. They can leave the clinic a few hours after the end of the phenol application,1 on condition that someone stays with them around the clock for the first 72 hours and that the patient can get to the doctor’s surgery quickly,2
whenever advised or necessary. The severity of the edema on the first day means that the patient is completely dependent on others, and it is important that any localized treatment can be given rapidly. Cardiac toxicity has been discussed in Chapter 28: in summary, when the peel is performed slowly, in over 1 hour, there is no cardiac toxicity. If phenol is applied too quickly on too large an absorption
area, arrhythmias develop rapidly: this is a problem that occurs while the phenol is being applied. Detoxification starts immediately. A few hours after the peel, the risk of phenol-induced arrhythmia is practically non-existent, if the liver has been able to detoxify the phenol and the kidneys eliminate it normally (see Chapter 28). Peels of the Baker-Gordon or Litton type are often performed with hospitalization. Exoderm® or full-face Lip & Eyelid® peels are usually ambulatory procedures. With the exception of some techniques, hospitalization, even if brief, no longer seems to be a necessity but is more of a comfort factor for both patient and doctor. Patients are often happy to be able to go home and be in familiar surroundings.
