Anthony M. Rossi, MD
Dr. Rossi is a Fellow in Procedural Dermatology and Mohs Surgery, Memorial Sloan-Kettering and Weill Cornell/New York-Presbyterian Hospital, both in New York, New York.
Dr. Rossi reports no conflicts of interest in relation to this post.
The December 2012 issue of Dermatologic Surgery (2012;38:2011-2015) contained a histopathologic case study of 3 patients with facial wrinkles treated with an in-office 88% phenol peel based in a punctuated fashion. The 88% phenol peel was applied in a localized dot manner with a toothpick soaked in phenol solution. The dots were separated by 3 mm along the length of the facial wrinkles. None of the patients were sedated and there was no patient downtime seen. This same procedure also was performed on the preauricular region. Five sessions were done in total. The authors then performed histopathologic evaluation on the preauricular region using a 3-mm punch biopsy. The first sample was obtained before the start of the procedure and the second approximately 30 days after the fifth session. A section of each sample was selected for routine hematoxylin and eosin stain and Verhoeff elastic tissue stain, which showed a slightly thinner epidermis, indicating less keratinization, along with an increase at the dermoepidermal interface. There was an increased number of and thicker collagen fibers in the dermis arranged in a more parallel fashion as compared to the original biopsy. In postprocedure samples, Verhoeff stain revealed elastic fibers that were better arranged in the reticular dermis and slightly thicker in the papillary dermis.
What’s the issue?
This study showed a novel technique to an old peel that localizes and minimizes its surface application, which in turn minimizes any potential toxicity. The application of pure 88% phenol to facial rhytides in a serial punctuated fashion achieves the deep peel in these areas but without the need for cardiac or respiratory monitoring. Also, because the surface area is quite limited in this technique, adverse effects such as hypopigmentation, seen with the more traditional full-face Baker-Gordon phenol peel, is not seen with this serial technique. Also, there is no associated downtime experienced by the patient. However, this 88% phenol technique is less potent and may require multiple applications. The histopathology analysis in this study confirmed the improvement with collagen production and a thickened upper dermis. Therefore, it is an inexpensive and novel approach for fine facial rhytides.