The peel that does what lasers can’t [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 (00:09):
How much time went by between the treatment and the after photo?

Dr. O'Brien (00:14):
I'm pretty sure this is right around four months afterwards.

Eva Sheie (00:18):
Okay, so let's maybe talk about what happened in between.

Dr. O'Brien (00:21):
Sure. 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.

(01:32):
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 sort of 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 the 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 with needing to protect your skin from the sun, and we are very gentle and careful with what products we put on our skin. After two weeks you can do some makeup. 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 (03:11):
If you were deciding between the facelift and appealed like this, what could this peel do that a facelift cannot do?

Dr. O'Brien (03:21):
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 kind of as if they're aging forward from years back.

Eva Sheie (05:07):
Do you have to do the full face with this peel?

Dr. O'Brien (05:10):
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 and 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 (06:09):
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 (06:16):
Yes, exactly. Yes.

Eva Sheie (06:18):
Yeah, so you'd have to come back and do the rest so that the rest of the face.

Dr. O'Brien (06:22):
You'd come back and do the rest. Exactly.

Eva Sheie (06:24):
Yeah. That's amazing. Does the recovery if you're just doing eyelids, is that a little shorter?

Dr. O'Brien (06:30):
It's shorter. It's about a week before the green mask comes off, and definitely people have less to 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 (06:52):
How do you know if you're a good candidate for this peel?

Dr. O'Brien (06:54):
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 (07:31):
Are there any risks we should be aware of with this treatment?

Dr. O'Brien (07:33):
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 (08:13):
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 nonsurgical device get results like this.

Dr. O'Brien (08:31):
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 (09:01):
The CO2 laser is at least my impression that recovery is pretty awful for that.

Dr. O'Brien (09:07):
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 (09:29):
And it doesn't cause that kind of swelling that the laser does?

Dr. O'Brien (09:32):
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 and 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 as 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 (10:18):
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 (10:25):
If you want to schedule an appointment for a 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 (10:36):
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.