Client looks like she has cigarette burns on her face after yesterday's treatment

I used the Dermafile and followed it with a glycolic 30 peel. Today my client said she look like she has cigarette burns on her cheeks. I am very worried.

Replies to This Discussion

Permalink Reply by Sandee Regier on August 16, 2014 at 2:23pm

Hi Madalene - If I were dealing with situation I would call the client in for a complimentary follow-up immediately to evaluate her. Two things you are dealing with are wound healing principals and the resultant hyper pigmentation that may or may not result depending on how the wounds are healed. Protecting against infection would be the greatest concerns at this time and only your personal observation will determine the approach and whether or not medical intervention is necessary. Documenting home care directly following your procedure is needed, so listening carefully to those aspects of what happened and documenting all precisely will be helpful. My suspicion is that the derma file procedure did remove more cells in some areas and the glycolic penetrated those areas at a greater depth. Therefore you are working with medium depth protocols for chemical peeling instead of superficial peel protocols in these areas. Evaluation of her Fitzpatrick skin type and how her skin has dealt with pigmentation in the past will determine the potential for this to occur. Hopefully she is a able to fully comply with your directions for care of these areas by blocking any UV exposure until wound healing is complete and for some time after. For guidance in wound care I would reach out to professionals for advice if you have questions on what products will manage this process either through the Skin Scripts professionals or with others. I do have information on this to provide you should you be interested. I would follow her closely in the office for a couple weeks and document all carefully.

Permalink Reply by Madalene MaGee on August 16, 2014 at 3:23pm

Thanks so much for your input. I did a little research, and so,e recommend using. Vaseline or polysporin on the spots, amd a lot of moisturizer. Any advice you can give regarding instruction on healing process would be welcomed! Thank you

Permalink Reply by Christine Byer Esthetics on August 16, 2014 at 4:03pm

If you have a led panel or probe I would use it on her ASAP. Led heals everything very quickly. I would not be in practice without it. Since you are doing aggressive peeling combined with derma filing I would definitely invest in a good panel, it's just too risky to go so deep on some clients. Accidents happen. If you don't have one or are saving up for one you can get one for $40, I explain how in this video. http://youtu.be/T2gBEb7uZ0U. (my channel is for esties). Good luck!

Permalink Reply by Sandee Regier on August 17, 2014 at 11:39am

Hi Madalene - There are several phases of wound healing. Throughout the healing phases there is a need for antioxidants (A,C, and E) which will help to reestablish the skin barrier and support the reconstruction of dermis/epidermis junction. Also Omega 3 which helps to reduce inflammation and appropriate cleansers to keep the area clean. There are many growth factors, cells types, and processes involved. In the early phases and throughout the healing phases lymph drainage treatments can help remove cell waste (from the initial cell breakdown) and restore the fluid balance caused in the inflammatory phase. MLD can speed healing by reducing the extracellular transport distance (two treatments in the first 5 days is ideal and continued weekly at one treatment per weeks for three weeks is an estimate) as this enhances the absorption of nutrients, which again in the important aspect to reconstructing good collagen versus fibrous tissue. LED can also be of assistance in the early phases to speed the reconstruction of the epidermis. Good home care products for sensitivity, hydration, and containing anti-oxidants and absolute UV protection needs to be followed for up to 28 days and beyond until the collagen has truly been reconstructed to its final stages.

As for the recommendations for vaseline or polysporin I noted the polysporin is bacitracin zinc, which is a innate immune stimulator mineral as well as containing a topical antibiotic polymyxin B. So I would choose this over Vaseline, which is just an occlusive petroleum jelly, and combine the polysporin with the use of antioxidants A, C and E underneath, unless the client has a sensitivity to polysporin (check for prior use or other allergies to meds).

Permalink Reply by Madalene MaGee on August 17, 2014 at 8:47pm

Thank you Sandee. Much appreciated!

Permalink Reply by Cindy Greenwood on August 18, 2014 at 8:44am

Hot spots from the peel on the dermafiled patches.

I am not a fan of the dermafiles.

I only do microdermbarasion with a peel for people who have been conditioned with previous peels.

Permalink Reply by Madalene MaGee on August 18, 2014 at 1:26pm

It was not the Dermafile. Turns out she was on prednisone and did not disclose that. Also, this client has been getting peels amd Dermafiling from me for a while no. Every month. I checked with a friend of mine who is a pharmasicist and she confirmed that it was the steroid, which we all know, you should not be peeled or exfoliated when you are on them.