The most practical, most effective, and safest method of chemical peeling for the novice is to use 30 % trichloroacetic acid. This removes the entire upper layer of skin, down to the reticular dermis. Nerve block anesthesia of the infraorbital and/or mental nerves can be used in patients who are particularly sensitive to pain, but local anesthesia using an occlusive dressing is usually sufficient.
■ Following disinfection, the skin is treated with acetone to remove superficial skin scales. This allows better penetration of the acid into the skin. After the acid has been applied, the area to be treated is marked. The acid is applied homogenously over the entire surface at a consistent pressure. This is the true art of any type of peeling. The application of the acid may be repeated several times, depending on the depth of the wrinkles, using slight pressure. Each area of skin must be treated with the same intensity so that the skin relief does not vary later. The typical blanching, which is a sign that the treatment has started to take effect (frost effect), begins before the treatment has been completed.
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