Medium-Deep Chemical Peel Utilizing Jessner's Solution, 20% TCA, and Baker's Phenol Solution

Abstract

Chemical peels have revolutionized the care of the cosmetic surgical patient over the past 10 years. Although the technique of peeling has been around since the early 1900s, only recently has the technique gained tremendous popularity. The three basic chemical peels used in the 1990s are the superficial, medium, and deep varieties. Of these three, the Baker's phenol peel gives the most dramatic improvement—primarily because it penetrates deeper than all other peels into the midreticular dermis. With this peel, however, there is a higher risk of scarring, and the actual process takes approximately 1–2 hours owing to organ toxicity concerns. In an attempt to combine the safety of a medium peel with the dramatic results of a deep peel, the author began using a medium peel (multiple coats of Jessner's solution and 20% TCA) all over the face in combination with Baker's phenol solution applied lightly into the deeper rhytids. The results with the first 10 cases have been consistently good and the complications negligible. All patients, however, develop temporary streaking of the area of the Baker's phenol application that lasts for 2 to 3 months. So far, this appears to be an efficacious method for chemical peeling.