The best chemical peel for erasing years [Shannon O'Brien, MD, Portland]

Eva Sheie (00:00):
You're listening to Where Before Meets After.

Dr. O'Brien (00:03):
Hi, I'm Shannon O'Brien. I'm a plastic surgeon in Portland, Oregon at Portland Plastic Surgery Group.

Eva Sheie (00:10):
And today we're going to talk about a really interesting new peel that's not new in the world, but new at Portland Plastic Surgery Group and it is called the Luxe Peel, but what is it also called?

Dr. O'Brien (00:22):
It's also a croton oil peel, which also utilizes phenol as one of its ingredients.

Eva Sheie (00:28):
Something must have inspired you and the team there to decide to take this on and bring it to your patients. Is there a story behind that or how did that happen?

Dr. O'Brien (00:38):
Yeah, so Dr. Richard Bensimon spent a greater part of his career working on advancing, he did general plastic surgery as well, aesthetic plastic surgery, but he spent a great deal of time working and really honing in the percentages of the croton oil side of it and kind of identifying that that was the ingredient that needed to be tweaked to create different results for different goals. And he had an office right across from ours until he retired recently. And so at that point we decided to receive training for how to do this and take over his work.

Eva Sheie (01:18):
So he was seeing lots of patients for this, but then he retired and so he was a little bit of a passing the torch?

Dr. O'Brien (01:24):
A little bit of passing the torch.

Eva Sheie (01:26):
Yeah. Well, he must have been passionate enough about it as a treatment to want you all to do it.

Dr. O'Brien (01:33):
He is very passionate about this peel and trains people demonstrates it around the world.

Eva Sheie (01:40):
Oh, still to this day?

Dr. O'Brien (01:41):
Still, he still is talking, communicating with people about how to perform this peel.

Eva Sheie (01:48):
Would you do it yourself?

Dr. O'Brien (01:49):
I would. I actually asked him specifically, am I ready? And his answer was something to the effect that everyone could be appeal candidate, but obviously there are more specific goals and so I'm not really quite ready for it, but absolutely would have it done. It's very exciting.

Eva Sheie (02:10):
So who would be, quote, unquote, ready? What kind of person is that?

Dr. O'Brien (02:14):
Well, there are a number of things that the peel treats, including sunspots, hyperpigmentation, acne scarring, wrinkles, which is the most difficult thing to treat. It actually treats wrinkles that are fairly deep. It treats a little bit of skin laxity, which kind of goes with wrinkles, but some people have laxity without really having a lot of lines. It changes pore size. It actually probably erases some superficial sun damage that could even be pre cancerous, although there's no scientific proof that that goes away. We do know that the top layers of the skin are removed and so it may even treat that adequately for certainly improves it.

Eva Sheie (03:01):
If you were deciding between the facelift and a peel like this, what could this peel do that a facelift cannot do?

Dr. O'Brien (03:11):
The difference between the facelift and the luxe peel is in what our goals are. If someone has significant skin laxity and their neck bothers them in that they have skin laxity on their neck, this peel cannot treat that adequately because they can't address the peel. In which case we start talking about facelifts and surgery as an option to remove significant amounts of extra skin. That person who has that type of skin may still benefit from the peel afterwards to improve the elasticity, the tone, the color, the character of their skin. But sometimes people are candidates for a facelift because the degree of skin laxity or if the fat in their face has really settled down around the jawline is kind of heavy in that area. The tightening of the skin alone with the peel may not be enough to elevate that back where it originally was. And so that person may still be a candidate for a facelift first. The peel candidates are going to be very impressed with the change of the skin around the mouth, around the appearance and the brightness of the skin, the change in the pore sizes, the consistency in the skin, sort of thickness, the texture, all of those things are completely rejuvenated. And that change to the skin is a permanent reset on the skin and people have to age forward from that as if they're aging forward from years back.

Eva Sheie (04:54):
And so I think the most logical next question anyone would ask is does it really work? It's probably a good time to put a picture on the screen so that we can answer that.

Dr. O'Brien (05:05):
Sounds good.

Eva Sheie (05:06):
Was this one of your patients?

Dr. O'Brien (05:08):
It's one of my patients,

Eva Sheie (05:09):
Yes. All right. Can you tell us her story?

Dr. O'Brien (05:11):
So she lost some weight and also had reached an age where her elasticity in her skin had changed. She has some little sun spots. She just was feeling like she was seeing her lines and wrinkles. And the most difficult area to treat of the skin is the area around the mouth, kind of in between the nasal labial lines in between the marionettes, we call 'em the commissures, but the corners of the mouth. That whole area is very difficult to treat with anything else. And we have long used Botox and fillers and lighter resurfacing options to try to in combination correct those areas. And so she was really bothered by that area around her mouth and also starting to see some aging around her eyes, her forehead, her glabella, those lines up there between your eyebrows and was interested in having some resurfacing and trying to get any amount of skin tightening that we could, although that is probably realistically somewhere between 20 and 30% skin tightening. Those were our goals.

Eva Sheie (06:23):
Did she know what she wanted when she came in to see you or did you steer her toward this peel?

Dr. O'Brien (06:29):
Well, so I do facial surgery including facelifts, and so we discussed surgery versus this peel as sort of two ways to approach some of her concerns. The beauty of a facelift is it gets rid of excess skin and it allows us to reposition structures to sort of support fat pockets and things like that. But a facelift does not address the area around the mouth and it doesn't address crow's feet and other things adequately. And so that area around her mouth being her biggest concern, I felt like if she was going to pick something, this peel was probably going to be her best first option. And then if she decides to come back and do surgery at some point, she can do that. But that was our goal and the reason for sort of leaning toward the peel as a first option for her.

Eva Sheie (07:28):
You didn't do anything else. She did not have surgery.

Dr. O'Brien (07:31):
She had no surgery.

Eva Sheie (07:32):
But she looks like a completely different person.

Dr. O'Brien (07:35):
Very refreshed. She looks very refreshed. Yeah, significant change.

Eva Sheie (07:40):
And so what's her reaction been?

Dr. O'Brien (07:42):
She's very happy. She looks back at pictures and is very pleased with her results. She feels like it was worth it.

Eva Sheie (07:51):
You don't see an after photo where you can tell somebody's happy very often, and it's pretty obvious here that she is.

Dr. O'Brien (07:59):
Yeah, she's a very positive person at baseline, but she is definitely pleased with her results. Yeah.

Eva Sheie (08:07):
Okay. Let's look at her other angles here. What do you see here that we should notice as well?

Dr. O'Brien (08:13):
I will say she's smiling slightly in this second picture, which changes a little bit, but what you can clearly see are the lines around her on her forehead, the shine of her skin, the pigmentation changes are significantly gone. On her chin itself, you can see that the cobbling of the skin on her chin and some of the lines around her nose are significantly improved. There are some lateral lines below the corner of her mouth that even with the smile were present before, even when she animated, that are not present in the after picture. The area around her eyes as well, you can see some tightening of the skin on the eyelids, which I also treat at the time, and a little bit of smoothing to the lower eyelid as well. And then again with her smile, we see a little bit of lines around the eyes, but when we see her relaxed, those lines are significantly improved if not gone.

(09:11):
I think this is a good angle and it being closer, you can really see the changes of the skin. All the way at the top, you can't quite see her crow's feet area, which is improved, it doesn't fan down onto the cheek as much, but what we can see very well is the area around her mouth, her chin, the lip lines are significantly improved. As you come down the nasal labial fold and marionette lines, way less skin laxity, much more tightness of the skin along the jawline. And then it's extremely obvious how much her skin is refreshed and rejuvenated just in its texture, its color. There's a nicer, brighter, more vascular complexion to it as far as the shine to it, whereas it had been a bit flatter in its tone and definitely had some more hyperpigmentation in the upper picture before picture.

Eva Sheie (10:09):
How much time went by between the treatment and the after photo?

Dr. O'Brien (10:13):
I'm pretty sure this is right around four months afterwards.

Eva Sheie (10:18):
Okay, so let's maybe talk about what happened in between.

Dr. O'Brien (10:21):
Sure. So when someone has the peel, they do go under general anesthesia. It takes about an hour and a half of general anesthesia for the peel to be applied and a mask to be applied afterwards. The peel is a deep peel. It is not a mid deep peel, it is not a lunch peel. It is a deep peel. It goes well into the dermis, which is why we get such impressive results. The peel itself is too hot to put on the skin effectively with you awake, even with numbing medicine and what have you, which is why we do have patients go to sleep. And then when they wake up, they have a mask on their face and that initial mask is made with a tape that has some antibacterial protection within it, and then the following day they return to the office and that mask with the tape is removed and it's replaced with more of a mask that looks more like what we consider or familiar with, more like a mud type mask or something like that, that then firms up on the skin and it stays on for the rest of the first week.

(11:31):
That mask is green. Nobody should be planning to see anybody unless they just have friends that are curious. But it is not something that you want to be wandering around your neighborhood. You're not going to be looking your best at that moment. The process is typically not painful, but it is uncomfortable or awkward to have the mask on your face. And so that is something that patients deal with. And then as the skin is healing, they do sometimes deal with itchiness. They definitely feel tightness or a sense of dryness afterwards. And so we use products to moisturize and do things like that. Once that green mask has been on for a week, we start dissolving that off and we shift over to, as I mentioned, the moisturizing products and things like that. The skin is very tender for a while, so you do end up needing to protect your skin from the sun.

(12:24):
And we are very gentle and careful with what products we put on our skin. After two weeks you can do some makeup and there are certain makeup types that are well tolerated on more sensitive skin. And then once you're a couple weeks out, we start potentially adding in other skin products. Again, more normal things that somebody might put on their face every day, just depending on how someone's skin is feeling. I would say after the first couple of weeks people are still pink and that pinkness lasts variable amounts of time. Someone should expect to have some pinkness for several weeks to even months, but that is typically coverable with makeup.

Eva Sheie (13:13):
Do you have to do the full face with this peel?

Dr. O'Brien (13:17):
So as far as what options we have as far as coverage with the peel, because the changes on the skin are so dramatic, you have to be careful about doing segmental peels with this. So really we offer an eyelid only option. We offer full face, which includes eyelid peel as the second option. When Dr. Bensimon before me who trained me and other folks around have done just the area around the mouth, the contrast in the skin between that area and the cheeks was too great, and therefore people felt like they had something that they had to cover up that transition. And so really it breaks down the area around the eyes can be done without creating disharmony. And then full face with eyelids is the other option.

Eva Sheie (14:15):
It's kind of like when you get your door painted, your door on your car, and then the one door looks really good and the rest of the car.

Dr. O'Brien (14:22):
Yes, exactly. Yes.

Eva Sheie (14:23):
Yeah. Does the recovery if you're just doing eyelids, is that a little shorter?

Dr. O'Brien (14:28):
It's shorter. It's about a week before the green mask comes off, and definitely people have less to kind of cover up early on. There's less healing, it's a little less stressful to just have it around your eyes. Having the green mask for a week is just annoying. Having it just around your eyes is a little easier to deal with.

Eva Sheie (14:49):
Has anyone in your office done it?

Dr. O'Brien (14:51):
We've had a number of people in our office do the eyelids. We have not had anyone in our office do the full face yet.

Eva Sheie (14:58):
So if you wanted to ask questions, you could potentially connect with somebody in the office who's already done it themselves.

Dr. O'Brien (15:05):
We do, and honestly, we probably have patients who would be willing to talk to someone as well because they generally are so excited about their results.

Eva Sheie (15:17):
Just to recap, how do you know if you're a good candidate for this peel?

Dr. O'Brien (15:21):
You're a good candidate for this peel, if you have changes to your skin, such as scarring, hyperpigmentation, sun damage, photo damage, wrinkling, laxity, even younger patients are potentially candidates for lighter versions of the peel to get rid of heavy freckling, that type of sun change. And then patients well into their seventies and eighties, maybe candidates, even if they are not necessarily surgical candidates, but can experience some significant improvement to the way they look and feel.

Eva Sheie (15:57):
Are there any risks we should be aware of with this treatment?

Dr. O'Brien (16:00):
The main risks we worry about is scarring. And so obviously being careful not to pick at the mask, those types of things can set you up for scarring because the skin is very fragile underneath those early days, and so we need it to have coverage until it heals. Also, protecting it from the sun early on because you can sunburn or cause some early hyperpigmentation if you're not careful with it when it's early healing. Other than that, just the general risks of an hour, hour and a half of light anesthesia, which are pretty mild, and those are the key things that we worry about.

Eva Sheie (16:40):
If it sounds like a good idea, and I'm listening today and I want to schedule a consultation for this, what should I do?

Dr. O'Brien (16:47):
If you want to schedule a consultation for the Luxe Peel, you would call us at Portland Plastic Surgery Group. Our number's 5 0 3 2 9 2 9 2 0 0.

Eva Sheie (16:57):
I'm struck by just the results from this case, and I think if I wanted to see more photos, they'll be added to the website and we will continue to add more as they come in. I don't know that I've ever seen any non-surgical device get results like this.

Dr. O'Brien (17:15):
I haven't either, honestly. I worked with fractionated lasers for years. I even did some research when I was a resident on fractionated lasers, and they do make a difference. The CO2 goes the deepest and it has the longest recovery of those types of lasers, but even when done as a heavy treatment does not seem to get the results. I've never seen or personally been able to get the results with a laser the way that I have with this peel.

Eva Sheie (17:44):
The CO2 laser is, at least my impression that the recovery is pretty awful for that.

Dr. O'Brien (17:51):
It's hot and you're swollen and it's a little weepy. And I can't say that this peel does not create a little weepiness in the first day or so. But the interesting thing about this peel is that the phenol component in it numbs the skin. So the patients are much more comfortable with this than they are after laser treatments.

Eva Sheie (18:14):
And it doesn't cause that kind of swelling that the laser does.

Dr. O'Brien (18:17):
Oh, patients are swollen, they're puffy, but it's covered up initially with the mask. But then I would also say that we set patients up as far as their expectations, set expectations to be off for two weeks. And at two weeks you are presentable, you look good. And really, some people at 10 days are probably okay, but two weeks is really the time where you're ready to go and can put makeup and you've already seen the change, which is a little bit of the challenge with some of the lasers is you have to wait to see some of the change. You see some really impressive immediate changes with this peel and even as the swelling goes down, it only gets better.

Eva Sheie (19:03):
Thanks for listening. I'm your host, Eva Sheie. Follow the show and submit questions for our experts at wherebeforemeetsafter.com. Where Before Meets After is a production of the Axis.