I am a 48-year-old woman with very bad skin.

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Question: I am a 48-year-old woman with very bad skin. I am thinking about getting a chemical peel, and I am pretty sure I am going to need the most invasive type of peel (I believe called the phenol peel). In addition to the basic risks of a chemical peel, are there any risks unique only to the phenol peel?

Answer: There are several risks unique to the phenol peel, one of which is that it can be injurious to the kidneys, liver, and even heart and, due to this fact, we need to apply the peel over an extended period of time so that the phenol that is actually absorbed into the bloodstream can be excreted through the kidneys before more phenol is applied to other regions of the face.

This is well known to providers who perform phenol peels, and I personally have never heard of anyone having any sort of phenol toxicity due to a phenol facial peel.  Another inherent risk of the phenol-type peels is that it also can be toxic to melanocytes, which are the skin cells that provide pigment.  This is one of the reasons that most patients end up having bleaching or a lightening of their natural skin tone after a phenol peel, and this is one of the reasons that I personally prefer the Erbium laser resurfacing over the phenol peels.

I personally have performed many Baker-Gordon-style phenol peels in the past and have definitely seen lightening of the patient’s skin due to these peels.  Once we switched over to the Erbium laser, these complications really have essentially disappeared.

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