By  Danne Montague-King copyright January 2018

The word “peel” in regard to age management or cuneiform scar treatments has echoed down through over a hundred years!

In Egyptian times resins were used along with vinegars to “peel” layers of skin from the upper class Egyptian women who were trying to look ageless. Depending on the practitioner, results were often successful, but mainly due to the social stigma the wealthy did not have to go out and labor in the sun thus staying shielded all day long.

This eventually worked its way into the China and the Russia’s. Katherine the great used a masque made of mildew, apples and oats. The effects of this may be due to a mild form of AHA’s and polysaccharides from the mold resembling beta glucan activity, Oats are also in the Beta Glucan family. A Nobleman in Kiev, on Icon painter, also became a legendary Dermatolog treating acne by peeling with his Gesso mixture used in paint fixatives which was basically egg white.

The rest is slow history—first Europe and then the USA with stronger and stronger peeling mediums being used for more dramatic results.

Regardless of what ingredients were being used—and a great deal of secrecy was employed by so called “youth experts, it all boiled down to one facture. PH.

When common acids such as phenol, Trichloroacetic etc. are applied to the epidermis with a PH of 3.01 or lower, the protein in the redundant cuticle build-up is “hardened”, the cell group becomes brittle sort of like broken tiles on a floor, break up and detach from the epidermis. In some cases, dealing with age management treatments, skin suffering from Solar Elastosis or even ichthyosis, it is a highly effective way of removing superficial dead cells as a “door opener” to get down to the fresher cell migration and support epidermal growth and natural stem cell proliferation via Enzymatic treatments and amino acid, anti-oxidant and Langerhans cell support for maximum immune defenses. I found by adding a rubefacient, a thermogenic factor, to the formula stimulates a capillary back-flush that rids topical toxins from the area. This increased blood flow supercharges the mitochondria in each cell to product more ATP-or at least kick-starts the increased oxygen flow that becomes more significant with Enzymatic type treatments. This can be used with all kinds of machines such as LED etc. but, this simple but deep chemistry renders machines unnecessary.

For other skin anomalies going up to the other end of the PH scale is suggested.

Alkaline compounds carefully timed and buffered, will raise the PH temporarily to around 12 on the scale. The skin practitioner need a sharp eye and a good sense to timing to accomplish this—alkaline burns can occur it the treatment is left on too long and the surface is not kept moist.

This is applicable to acne situations where large pustules and papules are present, congesting the vellus hair follicle. Not only will all redundant cuticle be immediately being desquamated within minutes, clearing the area, but the hair follicle will be eroded, the top of the cyst opened and all pre-deposited waxes and bacteria-ridden fats will flush out. Any Demodex Mite, leading to rosacea, will also be destroyed via desquamation, including their eggs.

The control of this medium eliminates excess trauma to the skin and can lower inflammation.

The peel craze shows no sign of winding down as a primary treatment. Unfortunately, the stronger the serum the better the peel is thought to be. I have been guilty myself decades ago, going along with this theory of burning up the epidermis with chemicals. I had created a 95% phenol acid peel with highly caustic croton oil (some instinct told me to add olive lipids for more control that was painted on after anesthetizing the patient with a twilight anesthesia. We then taped the patient full face (allowing space for nostrils and eyes) and kept them in this painful masque for 4 days with nurse in attendance.

Of course, there was enormous erythema, a lot of valium and tramadol administered and after the tapes were removed, gross weeping and deep erythema!

At that time, we powdered their face down with Thymol iodide which started to resemble cookie monster!

After a few more days of this copious powdering we applied a thick vegetable based “grease” and warm-cloth soaks, breaking away this eschar crust.

Of course, at the end of the removal the patient had no wrinkles and a tightened appearing skin.

But also, no pigmentation or very little, a line of demarcation under the mandibles and ghostly, waxy looking skin!

A lot of older women (and some men) did not mind this, thinking that make up would restore their colour if there were no wrinkles. But the true story was that the original youthful look was due to the rapid defense mechanisms in the healing process and the real effects would show up a year later.

I had compromised all the “policemen” of the skin that regulated normal cell proliferation rhythm to the epidermis!  This included the rete pegs, the desmosomes, the enzyme collagenase was destroyed (the enzyme that determines how much collagen is brought to a site of injury, too much will result in a scar) and even the Langerhans and their dendrites were crippled.

I knew there had to be a better way and a few top Chicago plastic surgeons agreed with me and helped me in my research on how to not only remove superficial dead cell material without aggressive attack, but to rebuild the living cell sub dermis and even facial and neck muscle activity providing skin with everything it needed to resurrect itself for a life time.

During this research “peeling” or removal became only step one in a process of actual skin revision.

After removal, using low level acids, alkaline, the hydroscopic alpha hydroxy acids and intercellular “glue” dissolution using gluconic acids (I modified the old Jessner solution, salicylic acid with precursors that reduced inflammation, as a booster only) we focused on giving the skin what is wanted, needed and RECOGNIZED” in order for the natural reproductive systems of the skin to flourish!

Of course, this also segued into very successful scar revision based upon the same principles of remove, rebuild, protect and maintain that we used for acne or age management treatments. We just used various combinations of tools and applications, no special magic ingredient or machine for the alleged quick fixes people tend to be fascinated with. And it was all highly individual as to skin condition as opposed to “skin type”, another misnomer most skincare lines seemed to depend upon.

Retinoids had to enter this research as well—and back then not much was known about the marvelous rebuilding aspects of retinoid combinations. The drug Retin A (tretinoin) and it bad sister Isotretinoin (used as primary ingredient in the drug Roaccutane) were relatively unknown then, but I was fascinated with beta-carotene due to its non-toxic aspect in the skin and body.

Vitamin A from fish liver is very potent but also has a toxic boundary. Too much or too little can create the same contraindications in the human body. Supplement companies who had integrity would caution users not to consume over 20,00 IU in a day.

However, Beta Carotene is NOT toxic in any amount and in fact does not become a retinoid until it is INSIDE the body or the skin, where it turns to vitamin A via enzyme conversion.

So, we embarked upon retinoid removal using minimal amounts of carefully selected retinoid esters plus a great deal of beta-carotene from various sources and managed to effectively remove superficial epidermal tissue whilst strengthening the underlying structures at the same time (remove and rebuild).

This stronger skin was especially good for 60 plus men and women whose epidermis and inter-cellular matrix were becoming thinner, looser and crepe’-like!

Apparently and previously unbeknownst to me infusions of vitamin A produced more fibroblast activity in the skin (collagen factories as I imagine them to be) so we had newer cell material to work with-but that had to be protected and maintained.

This is where compliance from the patient is absolute! Without daily maintenance along the lines of the actual professional treatment and its various chemical modalities, the ongoing results that I was becoming known for in those early years of exploration would not exist. In a way my little medical clinical trial team had its own Apotek!

The surgeons were happy because having their own prescriptions in stock was ongoing passive income that did not require hours of surgery or injections! Yet the patients had to come back on a regular basis for refills and many times booked in for other aesthetic treatments. When practitioner does great work, the patients want a “one stop shop” place where they get all their treatments, injections and clinical advice that may even extend to supplements, nutrition and surgeries if needed. It becomes a true life-style operation of wholistic control.

In today’s modern world a skin professional needs an arsenal of tools that back of a concept—as opposed to being dependent on the next new miracle ingredient product, machine, filler or toxin.

I stress CONCEPT as a working philosophy of science based upon the four things I have covered in this article: Remove, Rebuild, Protect, Maintain. In truth, this is all we can literally do topically. Yet it is a great deal when one considers that the skin and body is a complex organic computer comprised of water, a few chemicals, protein, orchestrated by enzymes and held in shape by electromagnetic waves and electricity!

Learning to control these elements by keeping everything in homeostasis has taken me a lifetime—50 years to be exact. And a lot of our research has been the result of contribution of giants in the field of science, many in fields unrelated to skin care but with pieces of a very large puzzle depicting the human condition and how to create an environment and habit that not only extend our lives and how we appear but to have a quality of life that allows each patient to fulfill their potential in personal relationships, careers and endeavors in the arts and sciences of our planet.

I am a mere observer of things around me—often a cynic when things appear too good to be true—the ‘latest thing in aesthetics often being some old idea, not that great at its inception yet dressed up in new high-tech terminology and pseudo-science that sounds great but often has no relation to how the whole of the skin actually works.

I now realize that I will never remove the word “peel” from our nomenclature! It is too provocative sounding, onion-like in concept like “rip off a layer of the epidermis and voila! New skin!”

The price I pay to being 75 years of age is seeing everything become trend, fade away and comeback again to a new generation often ignorant of what the older generation has already discovered not to be that effective and in some cases, downright fraudulent.

A good example was during my recent trip to Indonesia I discovered the entire aesthetic field to be controlled by a few “famous” European doctors (strangely unknown in their countries) and Americans touting fake epidermal growth factor nostrums and very dodgy injectables. All claiming to be FDA approved but in fact none were. Of course, the FDA has no real power in many countries so it is often used as a marketing device to assure safety and efficacy when in fact there is none.

In synopsis: yes, we do need removal systems for good skin revision treatment. Most of the things we see in the mirror or nothing more than the results of skin trying to defend itself from environmental damage and hormonal irregularities.

If you examine the areas of tissue that are consistently covered against solar attack etc. you will see skin much younger than those areas exposed—in fact skin that is our real biological age.

Our mission is to match the exposed skin, face, neck, decollate and hands to the self-renewing younger areas providing the skin with the elements that allows it to do what does best—regenerate and stay in homeostasis with all its wonderful defense mechanisms working on concert day in and day out.

We do not have to chemically burn the epidermis nor vaporize it (CO2 laser) to get great and long-term results. I have worked with every type of “peeling” medium on the planet and none of them -no matter if considered gold standard or not are in my opinion a primary treatment.