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Before and After

Melasma—which is most common in women and affects about 45 million people worldwide—appears as irregular patches of brown skin on the forehead, cheeks, upper lip and nose. Like most other pigmented lesions, Melasma is not dangerous, but it can be a self-confidence crusher, prompting many women to hide behind a mask of make-up.

Melasma is most common during hormonal fluctuations associated with pregnancy, oral contraceptives or hormone replacement therapy. So instead of celebrating the beauty of motherhood, women with Melasma must wear what's often called "the mask of pregnancy.

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What Is BOTOX® Cosmetic?

BOTOX® Cosmetic is a prescription medicine that is injected into muscles and used to improve the look of moderate-to-severe frown lines between the brows in people 18 to 65 years of age for a short period of time (temporary).

BOTOX® Cosmetic is administered by a healthcare professional as a simple, nonsurgical treatment that is injected directly into the muscles between the brows. It works by blocking nerve impulses to the injected muscles. This reduces muscle activity that causes moderate to severe lines to form between the brows.

Facts about BOTOX® Cosmetic:

• BOTOX® Cosmetic, introduced in 2002, is the first botulinum toxin to be approved by the FDA to temporarily treat moderate to severe glabellar lines between the brows.
• With real, noticeable results, no surgery and no recovery time, there are many reasons why BOTOX® Cosmetic has been chosen by millions of women and their doctors.
• Approximately 11.8 million1 BOTOX® Cosmetic procedures have been administered in the United States since 2002.
• 92% of 303 patients surveyed were satisfied with the results of their BOTOX® Cosmetic experience2,3.

Individual results may vary.

BOTOX® Cosmetic (onabotulinumtoxinA) Important Information

Approved Uses

BOTOX® Cosmetic is a prescription medicine that is injected into muscles and used to improve the look of moderate to severe frown lines between the eyebrows (glabellar lines) in adults for a short period of time (temporary).

BOTOX® Cosmetic is a prescription medicine that is injected into the area around the side of the eyes to improve the look of moderate to severe crow's feet lines in adults for a short period of time (temporary).

IMPORTANT SAFETY INFORMATION

BOTOX® Cosmetic may cause serious side effects that can be life threatening. Call your doctor or get medical help right away if you have any of these problems any time (hours to weeks) after injection of BOTOX® Cosmetic:

• Problems swallowing, speaking, or breathing, due to weakening of associated muscles, can be severe and result in loss of life. You are at the highest risk if these problems are pre-existing before injection. Swallowing problems may last for several months
• Spread of toxin effects. The effect of botulinum toxin may affect areas away from the injection site and cause serious symptoms including: loss of strength and all-over muscle weakness, double vision, blurred vision and drooping eyelids, hoarseness or change or loss of voice (dysphonia), trouble saying words clearly (dysarthria), loss of bladder control, trouble breathing, trouble swallowing. If this happens, do not drive a car, operate machinery, or do other dangerous activities

The dose of BOTOX® Cosmetic is not the same as, or comparable to, any other botulinum toxin product.

There has not been a confirmed serious case of spread of toxin effect when BOTOX® Cosmetic has been used at the recommended dose to treat frown lines or crow's feet lines.

Serious and/or immediate allergic reactions have been reported. They include: itching, rash, red itchy welts, wheezing, asthma symptoms, or dizziness or feeling faint. Tell your doctor or get medical help right away if you are wheezing or have asthma symptoms, or if you become dizzy or faint.

Do not take BOTOX® Cosmetic if you: are allergic to any of the ingredients in BOTOX® Cosmetic (see Medication Guide for ingredients); had an allergic reaction to any other botulinum toxin product such as Myobloc® (rimabotulinumtoxinB), Dysport® (abobotulinumtoxinA), or Xeomin® (incobotulinumtoxinA); have a skin infection at the planned injection site.

Tell your doctor about all your muscle or nerve conditions, such as amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease), myasthenia gravis, or Lambert-Eaton syndrome, as you may be at increased risk of serious side effects including severe dysphagia (difficulty swallowing) and respiratory compromise (difficulty breathing) from typical doses of BOTOX® Cosmetic.

Tell your doctor about all your medical conditions, including: plans to have surgery; had surgery on your face; weakness of forehead muscles, such as trouble raising your eyebrows; drooping eyelids; any other abnormal facial change; are pregnant or plan to become pregnant (it is not known if BOTOX® Cosmetic can harm your unborn baby); are breast-feeding or plan to breast-feed (it is not known if BOTOX® Cosmetic passes into breast milk).

Tell your doctor about all the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal products. Using BOTOX® Cosmetic with certain other medicines may cause serious side effects. Do not start any new medicines until you have told your doctor that you have received BOTOX® Cosmetic in the past.

Especially tell your doctor if you: have received any other botulinum toxin product in the last 4 months; have received injections of botulinum toxin, such as Myobloc®, Dysport®, or Xeomin® in the past (be sure your doctor knows exactly which product you received); have recently received an antibiotic by injection; take muscle relaxants; take an allergy or cold medicine; take a sleep medicine; take antiplatelets (aspirin-like products) or anticoagulants (blood thinners).

Other side effects of BOTOX® Cosmetic include: dry mouth, discomfort or pain at the injection site, tiredness, headache, neck pain, and eye problems: double vision, blurred vision, decreased eyesight, drooping eyelids, swelling of your eyelids, and dry eyes.

For more information refer to the Medication Guide or talk with your doctor.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Please see BOTOX® Cosmetic full Product Information including Boxed Warning and Medication Guide.

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Before and After

BOTOX/Dysport Before and After photos

In addition to cosmetic treatment, BOTOX® Cosmetic is used to treat:

• Uncontrolled blinking
• Excessive sweating
• Migraine headaches

Detailed info

Surgery Overview

In a chemical peel, a chemical solution is applied to the skin and allowed to soak in. Over the next 1 to 14 days, depending on how deeply the chemical penetrated the skin, the skin peels off. This procedure destroys parts of the skin in a controlled way so that new skin can grow in its place. The chemicals used are sometimes called exfoliating or wounding agents.

The types of chemical peels differ based on how deeply the chemical penetrates and what type of chemical solution is used. Things that may affect the depth of a peel include the acid concentration in the peeling agent, the number of coats that are applied, and the amount of time allowed before the acid is neutralized. Deeper peels result in more dramatic effects as well as higher risks, increased pain, and longer healing time. There are three basic types of peels:

• Superficial peels are the mildest type of chemical peel and can be used on all skin types. Superficial peels usually use liquid containing a mild (dilute) acid, most often glycolic acid. Dry ice (solid carbon dioxide) is sometimes used.
• Medium peels penetrate the skin more deeply than superficial peels and cause a second-degree burn of the skin. Trichloroacetic acid (TCA) is the main peeling agent used for medium peels, though the peel may also be done in several steps using a different chemical solution followed by TCA.
• Deep peels penetrate several layers of skin and cause a second-degree burn of the skin. They are used only on the face. A chemical called phenol is usually used for a deep peel. Deep peels may not be used on darker skin types, because they tend to bleach the skin (hypopigmentation). Even in lighter-skinned people, phenol peels—or any type of deep resurfacing—may bleach the skin. A deep peel can be done only once in most cases.

Before the peel

Your doctor can help you decide what depth of peel and what type of chemical solution is most appropriate, based on your skin type, which areas you want peeled, what kind of results you want, how much risk you are willing to take, and other issues. A small "test spot" may be peeled to get a better idea of the results, especially for people who have darker skin.

Two to three weeks before the peel, you will need to begin preparing your skin by cleansing it twice a day, applying a special moisturizer or cream once or twice a day, and using sunscreen every day. In some cases, daily use of tretinoin (Retin-A) a topical medicine usually used to treat acne is also recommended and may speed healing. This skin care regimen will help the skin peel more evenly, speed healing after the peel, and may reduce the chance of infection and other complications, especially uneven color changes in the skin.

For medium and deep peels of the face, you may be given a short course of medicine (such as acyclovir) to prevent viral infection. This is especially likely if you have had cold sores before and if the peel will be in the areas near the mouth or eyes.

How a superficial peel is done

Right before the peel, the skin is cleaned. The chemical (usually a liquid or paste) is then applied to the skin with a small brush, gauze, or cotton-tipped applicators. The chemical is left on the skin for several minutes, depending on the type of chemical used. Water or alcohol may be used to neutralize the acid and end the chemical reaction, then it is wiped off. You may feel a little burning while the chemical is on your skin. A handheld fan can help cool the skin and relieve any discomfort.

How a medium peel is done

The technique used to do a medium peel is similar to that used for a superficial peel, but the chemical may be left on for a longer period of time. Medium peels are more painful than superficial peels, because the chemicals are stronger and they soak deeper into the skin. You may be given a pain reliever and an oral sedative to reduce pain and anxiety during the procedure. Cool compresses and fans can be used to cool the stinging and burning caused by the chemical. The procedure takes about 40 minutes. There is little or no pain after the peel is finished.

How a deep peel is done

Deep peels take the most time and are the most painful type of chemical peel. The procedure for a deep peel using phenol is also more complicated than for other types of peels.

• You may be given an oral sedative and pain relievers. This is usually in the form of a shot or intravenousinjection. General anesthesia may also be used.
• You may be put on a  heart monitor and receive intravenous (IV) fluids during the procedure, because phenol is toxic when absorbed into the body's systems in large doses. These measures may not be needed if only a single, small area is being peeled.
• After the skin has been thoroughly cleaned, the chemical will be applied and allowed to penetrate. After one area of the face is treated, there will be a 15-minute break before the next area is treated to avoid getting too much phenol in your system.
• Tape or ointment may be applied to the area after the peel to treat deeper problem areas. When tape is used, it is removed after 2 days. Ointment is washed off with water after 24 hours and then reapplied as needed.

Depending on how large an area is being treated, the entire procedure may take 60 to 90 minutes.

What To Expect After Surgery

Recovery time after a chemical peel depends on what kind of peel was done and how deep it was. With all types of peels, proper care of the skin after the peel is very important to speed healing, help results last longer, prevent infection, and avoid color changes in the treated area caused by sun exposure. Proper skin care after a peel is very similar to the care used to prepare for a peel and typically involves:

• Cleansing the skin frequently with water or a special wash that your surgeon tells you to use.
• Changing the dressing or ointment on the wound (for medium and deep peels).
• Moisturizing the skin daily.
• Avoiding any sun exposure until peeling has stopped and sunscreen can be used. After peeling has stopped, sunscreen should be used every day. New skin is more susceptible to sun damage.

Some doctors may also recommend using tretinoin cream nightly, usually starting 2 to 3 weeks after the peel.

Superficial peels

Superficial peels are done on an outpatient basis, do not require anesthesia, and cause only slight discomfort afterwards. Most people can return to their normal activities immediately. The skin heals quickly after a superficial peel. The skin may turn pink, and usually only minimal peeling occurs. You can use makeup to hide any redness until it fades.

Medium peels

Medium peels are usually done on an outpatient basis, but you may need to take a few days off work to recover. A medium peel causes a second-degree burn of the skin. The skin takes 5 to 7 days to heal to a point where you can use makeup to hide the redness caused by the peel. There is little or no pain after the peel, but there may be some swelling, especially if the area around the eyes is treated. The skin will turn reddish brown in 2 to 3 days, become crusty, and then flake and peel over the next few days.

Deep peels

A deep peel causes a deeper second-degree burn of the skin. Skin regrowth takes between 10 to 14 days after a deep peel. The skin remains extremely red for 3 weeks, up to 2 months for some people. Most people take about 2 weeks off from work. Complete healing of the skin may take several months.

• Oral pain relievers may be given to reduce pain after the peel.
• Some people have severe swelling, especially around the eye area. Elevating the head may reduce the swelling to some extent, and corticosteroids may be used for more severe swelling.
• You may be given a short course of antiviral and antibiotic medicines to prevent infection after the peel.
• Proper wound care is extremely important after a deep peel to speed healing and prevent infection of the wound. You may be asked to shower several times a day to reduce crusting. And you may have to return to the doctor's office frequently to have the wound cleaned and checked.

Why It Is Done

• Superficial peels are used to improve the appearance of pigment changes in the skin, acne scars, mild sun damage, or fine wrinkles in all skin types. They can be done on the face and on other parts of the body. A superficial peel may also be used to prepare the skin for a deeper peel.
• Medium peels are used to treat mild to moderate wrinkles, long-term sun damage, pigment changes, and precancerous lesions of the skin (usually caused by sun exposure). Medium peels are used most often on the face.
• Deep peels are used to treat severe wrinkles, long-term sun damage, pronounced pigment changes, and lesions and growths on the skin. They are done only on the face. Deep peels are not done on darker skin types, because they bleach the skin.

Chemical peels are sometimes done with dermabrasion or laser resurfacing for a more dramatic overall effect.

A chemical peel (except for a superficial peel) may not be done if you have:

• Recently used isotretinoin (a drug used to treat acne).
• Had recent facial surgery or facial  radiation therapy. This can make regrowth of the skin more difficult.
• An active  herpes infection affecting the area to be treated.
• An  impaired immune system. This can delay healing and increase the risk of infection and skin color changes after the peel.
• Known  allergies to certain medicines.

How Well It Works

The results of a chemical peel depend in part on the depth of the peel.

• A superficial peel may slightly reduce but does not eliminate sun damage and signs of aging. The results may not appear for some time, and when they do appear, they may be minimal. Repeated peels are often needed to produce the effect the person wants.
• A medium peel can be very effective in evening out pigment differences and in reducing fine wrinkles and signs of sun damage. Retreatment may be needed after 3 to 6 months to produce the best effect.
• A single deep peel eliminates wrinkles and may tighten the skin. The effects are often dramatic. In general, a person cannot have repeated deep phenol peels.

Your skin type, skin care before and after the peel, the doctor's level of experience, and your lifestyle after the procedure can also affect the results. Some types of skin problems respond better to chemical peeling than others. People with lighter skin who limit their sun exposure after the procedure tend to have better results than those who have darker skin and those who continue to spend lots of time in the sun.

Before you decide to have a chemical peel, talk to your doctor about the kind of results you can expect.

Changes in the color and texture of the skin caused by aging and sun exposure may continue to develop after a chemical peel. Chemical peels are not a permanent solution for these problems.

Risks

In general, the deeper the peel, the greater the risk of side effects and complications. Chemical peels can result in:

• Redness (erythema). Expect some redness of the skin after a chemical peel. With deeper peels or with certain skin types, redness can be severe. It may fade within a few weeks, or it may last several months.
• Color changes in the skin. Treated areas may be darker or lighter than the surrounding skin.
• Crusting and scaling.
• Swelling ( edema ), especially around the eyes.
• Scarring.
• Allergic reaction to the chemical.
• Infection. People who have a history of herpes outbreaks are especially prone to infection after a chemical peel.
• Increased sensitivity to sunlight.

Special concerns with deep peels

In rare cases, deep peels using phenol can cause more severe complications during the procedure, including heart, liver, or kidney failure.

What To Think About

Expectations

Chemical peels are designed to wound and remove the upper layers of the skin. You need to prepare yourself for how your skin will look immediately after the peel and throughout the healing process. You also need to be prepared to use cosmetics to blend skin tones between treated and untreated areas, such as between the face and jawline.

It is important that your doctor understands what you hope to achieve and that you understand what results you can realistically expect. Even with realistic expectations, you may not see results for several weeks or months after a chemical peel.

Sun protection

During the early healing period after a chemical peel (before the skin has finished peeling), you will need to avoid sun exposure. After the early healing period has passed, you will need to wear sunscreen every day and limit sun exposure as much as possible. New skin is more susceptible to damage and discoloration from sunlight.

Options for skin resurfacing

Chemical peel, dermabrasion, and laser resurfacing are the most commonly used techniques for improving the texture and appearance of the skin. Although these techniques use different methods, they have basically the same effect on the skin—they destroy and remove the upper layers of skin to allow for skin regrowth.

No one technique is necessarily better than the others. When done by an experienced surgeon, laser resurfacing may be slightly more precise than chemical peeling or dermabrasion. But the choice of technique is based on the site you want to treat, your skin type and condition, the doctor's experience, your preferences, and other things. Some people may get the best results using a combination of techniques.

from WebMD Medical

FAQ

What are chemical / skin peels?

Chemical peels produce controlled injury to the skin, which promote growth of new skin and improved appearance. A variety of chemicals can be used as peeling agents and include glycolic, trichloroacetic (TCA), salicylic and resorcinol. The different chemical solutions produce different degrees of injury to the skin.

What are chemical peels used for?

Chemical peels are used for the treatment of photo-aging (from sun damage), wrinkles, scarring, acne, precancerous lesions, and discoloration (including melasma, freckles, and age spots).

How are chemical peels performed?

There are numerous chemical peels and each one is performed differently. In general, chemical peels usually begin with vigorous cleansing of the skin, followed by application of the appropriate peel.

What is the most popular peel solution?

Glycolic Acid - probably due to the fact that all skin types benefit from Glycolic Acid - is the most commonly recognized chemical peel solution. Salicylic Acid is also very common for use in acne treatments.

How long do chemical peels take?

Most peels can be performed within a few minutes, depending on size of the area being treated.

What will my skin feel like after a chemical peel?

The state of your skin after a peel depends on the type of chemical used and your skin type. Superficial peels have limited effects. Medium peels may cause some redness and the deeper peels may require 10-14 days to recover.

How many peels will I need?

Generally chemical peels are done once every 2-3 weeks, until the desired results are achieved. Maintenance peels can then be performed once a month.

How long do the results last?

With good sun protection, results can last months, even years. This is dependent upon the depth of the peel. The deeper peels generally provide a long-lasting effect.

What are the risks of chemical peels?

Superficial peels are quite safe, although minor irritation of the skin can occur. The risk of deep peels can include infection, scarring, redness, and discoloration. During a very deep peel (administered under the care of a physician only), anesthesia should be used and vital signs monitored.

How long after a chemical peel before I can return to normal activities?

• Light Peels- The light peel takes approximately three to five days to complete the shedding process. No downtime required.
• Medium Peels- Medium peels usually persist for five to seven days. The skin may or may not flake and fall away. AHAs can produce some redness with little or no flaking, depending on the individual.
• Deep Peels- May take several weeks to fully recover. This type of peel is usually effective in treating hyperpigmentation, acne scarring, fine lines and wrinkles.

What should I use at home to maintain the condition of my skin after a chemical peel?

You can use a mild cleanser (Green Tea Cleanser) and always include either Hyaluronic Replenishing Serum / Green Tea Anti-Oxidant Serum as often as needed. You may resume regular skincare 3-5 days after a peel or once redness or peeling is no longer apparent. Sun protection is a must!

from NaturalSkinshop.com

Before and After

Chemical Peels BEFORE AND AFTER PHOTOS

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