From sixties until almost twenty years ago, the Baker-Gordon phenol peel stood as a standard for skin rejuvenation. It is a deep chemical peeling with dramatic and long-lasting results, due to repositioning of a vast amount of collagen, which is then properly levelled into the dermis of the skin.
The usage was limited to older population with aged and quite light skin because of the hypopigmentation and waxy, porcelain look it gave. The skin changes were instantly deep, dense and irreversible. The surgeon had to be really brave and self-confident to perform that kind of peel.
Croton oil peels Hetter (peeling with croton oil according to Hetter, aka Dragon peel) actually revisits Baker-Gordon peel in the best possible way. Thanks to Doctor Hetter, a genius who discovered several key fact through his research. Although both peelings use the same components (water, septisol, phenol and croton oil), their concentration and understanding of their function in the process itself are completely opposite. Hetter has found out that a smaller concentration of phenol does not have a deeper effect, as they used to think before, so such a high concentration of it is not necessary. He has also established that the critical substance for peeling is croton oil (dragon oil) and not phenol, the substance that had too high a concentration in Baker-Gordon’s peel. The new formula is Baker-Gordon’s in its essence, but has no questionable croton oil concentration and much less of phenol in it.
Different croton oil concentrations gave surgeons open hands to choose freely the depth of peel depending on the skin type, age and clinical needs. Besides, the technique in peeling itself represents the second most important factor in getting the appropriate depth.
Application
During the preparation phase, the skin is treated with various creams for four to six weeks prior to the procedure. The aim of the preparation phase is to regulate different skin functions and lessen the risk of postoperative pigment changes.
Croton peel is done under a general or local anaesthesia with intravenous sedation. Gauze or wadded wooden sticks dipped into croton oil are used for the peel. Both concentration and manner of oil application are extremely important. Theoretically, the same depth could be reached with various techniques or even using different oil concentration.
Early postoperative phase lasts about 14 days. The skin looks moisty, it excretes liquid; patient’s face is swollen and generally unrecognisable. The patient must apply antibiotic-anaesthetic cream daily as it prevents skin dehydration and eventual formation of skin coating. The next phase of recovery is signified by erythema and it usually takes 8-12 weeks.
The reward is a dramatic and long-lasting skin texture improvement, which is not possible to achieve by any other method.
Side effects are possible and they are usually in the form of hyperpigmentation, which could appear during the recuperation period. They are transitional and are successfully treated with Retin A and hydroquinone. Sunscreen is also very important. In addition, herpes simplex can appear but is reacts well to antiviral treatment. Milia can appear in early phases but it reacts well to an adequate therapy.
Most important features of croton oil peeling:
- Does not interrupt the melanocyte functions.
- Deeper peeling provides better collagen repositioning.
- Repeated peelings add-up – the skin looks younger as younger skin is produced.
- The person that underwent a deep peeling is under no risk of basal cell carcinoma in squamous cell carcinoma.
- Impressive long-lasting results.
- It is important that this kind of peel can be used on neck as well and therefor there is not a visible demarcation line on the lower jaw, which is there after a laser procedure.
- We can make the peeling of the whole face or just a segmental peeling, e.g. upper and lower eyelid or the mouth area.
- Lately this peeling using milder concentrations is very popular with younger population.
It is a wide range kind of peel; it is appropriate for all age groups and skin types. The reward is a dramatic and long-lasting skin texture improvement, which cannot be achieved by any other method.