LAS VEGAS When it comes to facial peels, Dr. Devinder S. Mangat has traveled full circlegoing from chemical peels to using lasers and back again.
After 16 years of doing chemical facial peels, Dr. Mangat switched to laser peels "because that's what the public was demanding," he recalled at an international symposium sponsored by the American Academy of Facial Plastic and Reconstructive Surgery.
About 8 years ago, though, he switched back to using chemicals because they provide more predictable outcomes, cost less than lasers, and produce better results than noninvasive modalities, he said.
Using the more modern Hetter peel solution instead of the traditional Baker-Gordon formula offers greater flexibility in treating different facial areas with less risk of hypopigmentation, added Dr. Mangat, president of the American Board of Facial Plastic and Reconstructive Surgery.
The traditional Baker-Gordon formula contains a 58% concentration of phenol and a 2.1% concentration of croton oil among its ingredients. A few years ago, however, Dr. Greg Hetter of Las Vegas varied the formula's concentrations and discovered that the depth of peel was related to the concentration of croton oil, not the phenol or Septisol, as had been believed.
Dr. Mangat uses different concentrations of the Hetter formula for peels on different facial areas in his practices in Cincinnati and Vail, Colo.
Hetter solutions maintain a lower and constant concentration of phenol35%while varying the croton oil concentration in a mixture of water, phenol, Septisol, and croton oil, he explained.
In general, Dr. Mangat prefers a Hetter formula with 0.8%1.2% croton oil for perioral skin, which is thicker and has deeper rhytids: "Really get into those rhytids either with a Q-tip or the broken end of a Q-tip," he said.
He prefers applying the solution with a cotton-tipped applicator rather than gauze sponges for better control.
For peeling the cheeks and forehead, he usually limits the formula to no more than 0.4% croton oil. Eyelids may require anywhere from 0.1% to 0.4% croton oil, depending on the thickness of the skin and the depth of the rhytids, he said at the meeting.
Dr. Mangat also uses the Hetter formula on the neck, but at nothing stronger than a 0.1% croton oil solution.
Since switching to the Hetter formula, he has not had any cases of hypopigmentation after peels.
With Hetter peels, "once you've selected and prepared patients carefully, they will be, without a doubt, the happiest patients you have in your practice," he predicted.