Chemical Peels Niti Khunger
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1Step by Step® CHEMICAL PEELS2
Second Edition
Editor Niti Khunger MD DDV DNB Professor and Consultant Dermatologist Department of Dermatology and STD Vardhman Mahavir Medical College and Safdarjung Hospital New Delhi, India
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© 2014, Jaypee Brothers Medical Publishers
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Step by Step® Chemical Peels
First Edition: 2009
Second Edition: 2014
Printed at
5Dedicated to
All my patients who inspire me to Innovate, Improvise and Implement
To my family Drs Jitender, Monica and Arjun who encourage me to Aspire, Ascend and Achieve
7Contributors 9Preface to the Second Edition
The overwhelming response of the first edition compelled me to bring the second edition. Three new chapters have been added on chemical peeling in acne and acne scars, facial melanoses and periocular peels. There is a definite place for chemical peels in active acne, particularly in comedonal acne, pustular acne and acne with pigmentation. The focus of the chapter on facial melanoses is on selecting the right peel in darker skin types. The response in darker skins can be unpredictable and an inappropriate peel can lead to aggravation of the pigmentation. The chapter on periocular peels highlights the special considerations when peeling the sensitive periocular region. Modification of standard techniques can make this area safer to peel.
The popularity of the previous edition was based on the practical readability, cookbook approach and convenient pocket size of the book. This format has been retained at the cost of repetition, to make the book a handy reference for a busy practitioner in the clinic as well as a fresh physician beginning a career in chemical peels.
Niti Khunger
11Preface to the First Edition
Chemical peeling is an ancient procedure that has stood the test of time for rejuvenating the skin. It is the application of a chemical agent of defined strength to the skin that causes destruction at the required depth, followed by remodeling without scarring.
In recent times, there has been an explosive interest in procedural techniques for skin rejuvenation and the trend is increasingly for procedures that are noninvasive or minimally invasive, requiring little downtime. The majority of the chemical peeling procedures fit into this category. The long-term experience with chemical peels has shown them to be safe and effective for a variety of common conditions like dyschromias, photoaging and acne. An added advantage is the relative low cost of these procedures as compared to lasers and other procedures to rejuvenate the skin. Lasers are still very expensive to acquire and maintain. This has led to a resurgence in the use of chemical peels, which is now a re-emerging art with newer peels and newer combinations.
New advances in peel approaches including combination, sequential and segmental peels are safer and lower-strength peeling agents are allowing clinicians to tailor their practices to patients' needs, often without added costs. Chemical peels are thus not only a part of the cosmetic scene of the past, but also a definite cornerstone of the future.
This book is a step-by-step practical guide to perform chemical peels. There is some repetition of the basic procedure in the chapters with the aim that the reader will find easier to follow, while doing a particular peel and not miss any important step. The interesting cases give examples of treatment in difficult situations, while ten golden rules summarize the essence of chemical peeling.
The aim of the book is to expose young physicians to the array of chemical peels available today and guide the practicing dermatologists how to safely use this versatile technique in the treatment of common day-to-day conditions such as skin rejuvenation, photoaging, melasma and acne.
Niti Khunger
The birth of the book was initiated by young dermatologists, eager to start their practice, who always questioned me during various scientific meetings. It incubated and took shape through interactions with all my colleagues, who shared their expertise and knowledge gathered worldwide. I am also indebted to Dr Philippe Deprez for teaching the fine art of combining sand abrasion with chemical peels. All this crystallized with unwavering support from my patients who reposed complete faith in me.
I am thankful to my teachers, particularly Dr Chetan Oberai and late Dr PN Behl who injected me with academic enthusiasm right from the beginning of my career.
I am indebted to the staff at M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, who made my work very easy by their technical expertise.
My deepest thanks goes to my family, my spouse Dr JM Khunger and my children, Dr Monica and Dr Arjun, who let me work unhindered in writing the book.