Currently, facial rejuvenation is likely the most sought out cosmetic modality. Dermatologists and their patients seek an effective, minimally invasive procedure with minimal downtime and side effects with long-lasting results.
A 58-year-old woman with a history of moderate acne scarring presented to our office requesting noninvasive facial rejuvenation. The patient was seeking improvement of moderate acne scarring as well as overall texture of skin and fine lines with minimal downtime. After discussing various treatment options, it was decided to combine a Jessner peel followed by retinol with a short-pulsed neodymium-doped yttrium aluminum garnet (Nd:YAG) laser treatment 1 week later.
On week 1, the patient presented for the Jessner peel. The face was cleansed with gentle cleanser and a pretreatment photo was taken (Figure 1). The area was pretreated with alcohol. The peeling agent was applied to the face (salicyclic acid, resorcinol, lactic acid) for 2 passes. Immediately following the peeling agent, a retinol solution was applied to the treatment area. The procedure was well tolerated. She initially noted subjective skin tightening of pores, fine lines, and brightening of her complexion followed by even superficial peeling on postpeel day 3 to 5.
Figures 1 and 2: Before (left) and after (right) pictures of 58-year-old woman who received a Jessner peel + retinol combined with a short-pulsed Nd:YAG laser treatment.
On week 2, the patient presented for the short-pulsed Nd:YAG treatment. In our patient, the forehead, cheeks, nose, and chin were treated. The settings included a spot size of 8 mm, fluence of 7J/cm2, and pulse duration of 0.3 ms with a repetition rate of 7 hz. The forehead and cheeks were treated with 1000 pulses, the nose with 250 pulses, and the chin with 500 pulses. The patient had mild erythema and edema immediately posttreatment that lasted approximately 2 to 3 hours. Typically, a series of 6 treatments are recommended at 2- to 4-week intervals for optimal improvement. Our patient had only 1 treatment session.
Our patient showed significant improvement in overall skin texture, fine lines, dyspigmentation, and some improvement in acne scarring after combining a Jessner peel with retinol treatment followed by the short-pulsed Nd:YAG laser treatment (Figure 2).
The short-pulsed 1064 Nd:YAG emits a monochromatic light in the near-infrared spectrum,1 which has little predilection for water, hemoglobin, or melanin and therefore targets the mid-dermis, thermally heating the area. Heating of the dermis causes neocollagenesis, increased elastin, and dermal remodeling.1
A study by Tanaka and colleagues2 found improvement both clinically and histologically of dilated pores, rhytides, and skin texture after 3 treatments with the short-pulsed laser. One month posttreatment histology showed evidence of increased elastin and epidermal thickening.2 The short-pulsed Nd:YAG is safe for all skin types and is an ideal nonablative treatment for patients seeking improvement of acne scars, skin tightening, and improvement of skin complexion.
The Jessner peel, originally formulated by Max Jessner, has been used for more than 100 years. The peel is a combination of 3 main ingredients: 14 g lactic acid, 14 g salicylic acid, and 14 g resorcinol dissolved in ethanol. The combination of these chemicals reduces the possibility of toxicity to any one agent. The peel is classified as a superficial peel (penetrating from the stratum corneum to the basal layer). It can be used safely in skin types I-VI.3
Indications for a Jessner peel include treatment of photoaging, lentigines, acne, postinflammatory hyperpigmentation, melasma, and superficial rhytides.4 This peel should not be used in pregnant patients or if the patient has an allergy to any of its components. Prepeel prophylaxis should be given to patients with a history of oral herpes simplex virus.
Each of the components of the Jessner peel are discussed below and compared with the other more common superficial peels, the trichloroacetic acid (TCA) peel and glycolic acid peel.
Lactic acid is an a hydroxy acid, an organic compound derived from the sugars in fruit carboxylic acids as well as sour milk. When applied to the skin, it produces a very superficial, gentle desquamation. Lactic acid has been shown to inhibit Propionibacterium acnes proliferation, decrease keratinization, and has effects on melanogenesis. Lactic acid has a low toxicity profile and is hydrophilic leaving the skin well moisturized.2
Salicylic acid is a b hydroxy acid derived from the bark of a willow tree. It is a metabolite of aspirin. This acid is keratolytic and lipophilic and has anti-inflammatory properties. Salicyclic acid is most often used to treat acne and also can improve dyspigmentation. It is combined for use in a Jessner peel but can also be used solely as a superficial peeling agent.2
Resorcinol is a benzenediel and is related to phenol both structurally and chemically. It is a potent antiseptic and disinfectant.2
Retinol solution is a derivative of vitamin A. The solution is keratolytic and helps to induce regular corneocyte differentiation and decrease hyperkeratosis. Retinol also induces neocollageneisis. When applied following the Jessner peel, it has greater depth of penetration allowing for increased effects of collagen stimulation, regulation of corneocytes as well as treating dyspigmentation.2,3
Glycolic acid, similar to lactic acid, is also an a hydroxyl acid. Its particles are smaller than lactic acid, which allows for deeper penetration into the dermis. Glycolic acid peels come in various concentrations with higher concentrations having increased penetration. Glycolic acid has the ability to reach the dermis stimulating collagen production. Glycolic acid peels can treat various conditions including lentigines, rhytides, acne, scarring, large pore size, and oily skin.2,5
In a study comparing the Jessner peel with a 70% glycolic acid peel, Kim and colleagues6 found that the Jessner peel yielded a similar cosmetic outcome to the glycolic acid peel and also had increased exfoliation.
TCA has been used for over 100 years as a peeling agent. It is available in various concentrations, with higher concentrations having increased penetration. Superficial peels typically have a concentration between 10% to 20% and 25% to 35%. Medium peels are typically between 40% to 50%. TCA and deeper peels are categorized with concentrations greater than 50%. TCA at a concentration higher than 35% can cause scarring, hyperpigmentation, and hypopigmentation and is therefore ideal for darker skin types.1,2
The Jessner peel with retinol offers a good option for patients who seek noninvasive skin rejuvenation or for treatment of acne and/or acne scarring. Combining a superficial peel (targeting some rhytides, textural abnormalities, and dyschromia) with the short-pulsed Nd:YAG treatment (targeting dermis stimulating collagen synthesis) offers a dual modality approach with minimal downtime for improvement of acne scarring, fine lines, and dyschromia.
By combining a Jessner peel with retinol followed by a treatment with a short-pulsed Nd:YAG, our patient had significant improvement of overall skin complexion, fine lines, acne scarring, and dyschromia with minimal downtime. The Jessner peel targeted dyschromia and skin complexion with the added retinol stimulating collagen synthesis. The short-pulsed Nd:YAG targeted the dermis stimulating collagen growth.
Based on our observations from clinical practice a superficial chemical peel such as the Jessner peel paired with a the nonablative Nd:YAG laser, offers another safe and well-tolerated option to treat acne scars as well as improve skin texture and complexion in all skin types.
Dr Lombardi is a fellow at Affiliated Dermatologists in Morristown, NJ.
Dr Lee is a practicing dermatologist and the director of Procedural Dermatology of the ACGME-approved Procedural Dermatology Fellowship at Affiliated Dermatologists & Dermatologic Surgeons in Morristown, NJ.
Disclosure: The authors report no relevant financial relationships.
References
1. Green J. Short-pulse applications of 1064 nm laser devices useful in clinical presentations. Dermatology Times. February 1, 2012.
2. Tanaka Y, Matsuo K, Yuzuriha, S. Objective assessment of skin rejuvenation using near-infrared 1064-nm neodymium: YAG laser in Asians. Clin Cosmet Investig Dermatol. 2011;4:123-130.
3. Linder J. Superficial chemical peeling: minimal effort, maximum results. The Dermatologist. 2011;19(4):32-36.
4. Baumann L. Cosmetic Dermatology Principals and Practice. 2nd ed. New York, NY: The McGraw Hill Companies Inc; 2009.
5. Grimes PE. Aesthetics and Cosmetic Surgery for Darker Skin Types. Philadelphia, PA: Lippincott Williams & Wilkins; 2007.
6. Kim SW, Moon SE, Kim JA, Eun HC. Glycolic acid versus Jessners solution. Which is better for facial acne patients? A randomized prospective clinical trial of split face model therapy. Dermatol Surg. 1999;25(4):270-273.
Currently, facial rejuvenation is likely the most sought out cosmetic modality. Dermatologists and their patients seek an effective, minimally invasive procedure with minimal downtime and side effects with long-lasting results.
A 58-year-old woman with a history of moderate acne scarring presented to our office requesting noninvasive facial rejuvenation. The patient was seeking improvement of moderate acne scarring as well as overall texture of skin and fine lines with minimal downtime. After discussing various treatment options, it was decided to combine a Jessner peel followed by retinol with a short-pulsed neodymium-doped yttrium aluminum garnet (Nd:YAG) laser treatment 1 week later.
On week 1, the patient presented for the Jessner peel. The face was cleansed with gentle cleanser and a pretreatment photo was taken (Figure 1). The area was pretreated with alcohol. The peeling agent was applied to the face (salicyclic acid, resorcinol, lactic acid) for 2 passes. Immediately following the peeling agent, a retinol solution was applied to the treatment area. The procedure was well tolerated. She initially noted subjective skin tightening of pores, fine lines, and brightening of her complexion followed by even superficial peeling on postpeel day 3 to 5.
Figures 1 and 2: Before (left) and after (right) pictures of 58-year-old woman who received a Jessner peel + retinol combined with a short-pulsed Nd:YAG laser treatment.
On week 2, the patient presented for the short-pulsed Nd:YAG treatment. In our patient, the forehead, cheeks, nose, and chin were treated. The settings included a spot size of 8 mm, fluence of 7J/cm2, and pulse duration of 0.3 ms with a repetition rate of 7 hz. The forehead and cheeks were treated with 1000 pulses, the nose with 250 pulses, and the chin with 500 pulses. The patient had mild erythema and edema immediately posttreatment that lasted approximately 2 to 3 hours. Typically, a series of 6 treatments are recommended at 2- to 4-week intervals for optimal improvement. Our patient had only 1 treatment session.
Our patient showed significant improvement in overall skin texture, fine lines, dyspigmentation, and some improvement in acne scarring after combining a Jessner peel with retinol treatment followed by the short-pulsed Nd:YAG laser treatment (Figure 2).
The short-pulsed 1064 Nd:YAG emits a monochromatic light in the near-infrared spectrum,1 which has little predilection for water, hemoglobin, or melanin and therefore targets the mid-dermis, thermally heating the area. Heating of the dermis causes neocollagenesis, increased elastin, and dermal remodeling.1
A study by Tanaka and colleagues2 found improvement both clinically and histologically of dilated pores, rhytides, and skin texture after 3 treatments with the short-pulsed laser. One month posttreatment histology showed evidence of increased elastin and epidermal thickening.2 The short-pulsed Nd:YAG is safe for all skin types and is an ideal nonablative treatment for patients seeking improvement of acne scars, skin tightening, and improvement of skin complexion.
The Jessner peel, originally formulated by Max Jessner, has been used for more than 100 years. The peel is a combination of 3 main ingredients: 14 g lactic acid, 14 g salicylic acid, and 14 g resorcinol dissolved in ethanol. The combination of these chemicals reduces the possibility of toxicity to any one agent. The peel is classified as a superficial peel (penetrating from the stratum corneum to the basal layer). It can be used safely in skin types I-VI.3
Indications for a Jessner peel include treatment of photoaging, lentigines, acne, postinflammatory hyperpigmentation, melasma, and superficial rhytides.4 This peel should not be used in pregnant patients or if the patient has an allergy to any of its components. Prepeel prophylaxis should be given to patients with a history of oral herpes simplex virus.
Each of the components of the Jessner peel are discussed below and compared with the other more common superficial peels, the trichloroacetic acid (TCA) peel and glycolic acid peel.
Lactic acid is an a hydroxy acid, an organic compound derived from the sugars in fruit carboxylic acids as well as sour milk. When applied to the skin, it produces a very superficial, gentle desquamation. Lactic acid has been shown to inhibit Propionibacterium acnes proliferation, decrease keratinization, and has effects on melanogenesis. Lactic acid has a low toxicity profile and is hydrophilic leaving the skin well moisturized.2
Salicylic acid is a b hydroxy acid derived from the bark of a willow tree. It is a metabolite of aspirin. This acid is keratolytic and lipophilic and has anti-inflammatory properties. Salicyclic acid is most often used to treat acne and also can improve dyspigmentation. It is combined for use in a Jessner peel but can also be used solely as a superficial peeling agent.2
Resorcinol is a benzenediel and is related to phenol both structurally and chemically. It is a potent antiseptic and disinfectant.2
Retinol solution is a derivative of vitamin A. The solution is keratolytic and helps to induce regular corneocyte differentiation and decrease hyperkeratosis. Retinol also induces neocollageneisis. When applied following the Jessner peel, it has greater depth of penetration allowing for increased effects of collagen stimulation, regulation of corneocytes as well as treating dyspigmentation.2,3
Glycolic acid, similar to lactic acid, is also an a hydroxyl acid. Its particles are smaller than lactic acid, which allows for deeper penetration into the dermis. Glycolic acid peels come in various concentrations with higher concentrations having increased penetration. Glycolic acid has the ability to reach the dermis stimulating collagen production. Glycolic acid peels can treat various conditions including lentigines, rhytides, acne, scarring, large pore size, and oily skin.2,5
In a study comparing the Jessner peel with a 70% glycolic acid peel, Kim and colleagues6 found that the Jessner peel yielded a similar cosmetic outcome to the glycolic acid peel and also had increased exfoliation.
TCA has been used for over 100 years as a peeling agent. It is available in various concentrations, with higher concentrations having increased penetration. Superficial peels typically have a concentration between 10% to 20% and 25% to 35%. Medium peels are typically between 40% to 50%. TCA and deeper peels are categorized with concentrations greater than 50%. TCA at a concentration higher than 35% can cause scarring, hyperpigmentation, and hypopigmentation and is therefore ideal for darker skin types.1,2
The Jessner peel with retinol offers a good option for patients who seek noninvasive skin rejuvenation or for treatment of acne and/or acne scarring. Combining a superficial peel (targeting some rhytides, textural abnormalities, and dyschromia) with the short-pulsed Nd:YAG treatment (targeting dermis stimulating collagen synthesis) offers a dual modality approach with minimal downtime for improvement of acne scarring, fine lines, and dyschromia.
By combining a Jessner peel with retinol followed by a treatment with a short-pulsed Nd:YAG, our patient had significant improvement of overall skin complexion, fine lines, acne scarring, and dyschromia with minimal downtime. The Jessner peel targeted dyschromia and skin complexion with the added retinol stimulating collagen synthesis. The short-pulsed Nd:YAG targeted the dermis stimulating collagen growth.
Based on our observations from clinical practice a superficial chemical peel such as the Jessner peel paired with a the nonablative Nd:YAG laser, offers another safe and well-tolerated option to treat acne scars as well as improve skin texture and complexion in all skin types.
Dr Lombardi is a fellow at Affiliated Dermatologists in Morristown, NJ.
Dr Lee is a practicing dermatologist and the director of Procedural Dermatology of the ACGME-approved Procedural Dermatology Fellowship at Affiliated Dermatologists & Dermatologic Surgeons in Morristown, NJ.
Disclosure: The authors report no relevant financial relationships.
References
1. Green J. Short-pulse applications of 1064 nm laser devices useful in clinical presentations. Dermatology Times. February 1, 2012.
2. Tanaka Y, Matsuo K, Yuzuriha, S. Objective assessment of skin rejuvenation using near-infrared 1064-nm neodymium: YAG laser in Asians. Clin Cosmet Investig Dermatol. 2011;4:123-130.
3. Linder J. Superficial chemical peeling: minimal effort, maximum results. The Dermatologist. 2011;19(4):32-36.
4. Baumann L. Cosmetic Dermatology Principals and Practice. 2nd ed. New York, NY: The McGraw Hill Companies Inc; 2009.
5. Grimes PE. Aesthetics and Cosmetic Surgery for Darker Skin Types. Philadelphia, PA: Lippincott Williams & Wilkins; 2007.
6. Kim SW, Moon SE, Kim JA, Eun HC. Glycolic acid versus Jessners solution. Which is better for facial acne patients? A randomized prospective clinical trial of split face model therapy. Dermatol Surg. 1999;25(4):270-273.
Currently, facial rejuvenation is likely the most sought out cosmetic modality. Dermatologists and their patients seek an effective, minimally invasive procedure with minimal downtime and side effects with long-lasting results.
A 58-year-old woman with a history of moderate acne scarring presented to our office requesting noninvasive facial rejuvenation. The patient was seeking improvement of moderate acne scarring as well as overall texture of skin and fine lines with minimal downtime. After discussing various treatment options, it was decided to combine a Jessner peel followed by retinol with a short-pulsed neodymium-doped yttrium aluminum garnet (Nd:YAG) laser treatment 1 week later.
On week 1, the patient presented for the Jessner peel. The face was cleansed with gentle cleanser and a pretreatment photo was taken (Figure 1). The area was pretreated with alcohol. The peeling agent was applied to the face (salicyclic acid, resorcinol, lactic acid) for 2 passes. Immediately following the peeling agent, a retinol solution was applied to the treatment area. The procedure was well tolerated. She initially noted subjective skin tightening of pores, fine lines, and brightening of her complexion followed by even superficial peeling on postpeel day 3 to 5.
Figures 1 and 2: Before (left) and after (right) pictures of 58-year-old woman who received a Jessner peel + retinol combined with a short-pulsed Nd:YAG laser treatment.
On week 2, the patient presented for the short-pulsed Nd:YAG treatment. In our patient, the forehead, cheeks, nose, and chin were treated. The settings included a spot size of 8 mm, fluence of 7J/cm2, and pulse duration of 0.3 ms with a repetition rate of 7 hz. The forehead and cheeks were treated with 1000 pulses, the nose with 250 pulses, and the chin with 500 pulses. The patient had mild erythema and edema immediately posttreatment that lasted approximately 2 to 3 hours. Typically, a series of 6 treatments are recommended at 2- to 4-week intervals for optimal improvement. Our patient had only 1 treatment session.
Our patient showed significant improvement in overall skin texture, fine lines, dyspigmentation, and some improvement in acne scarring after combining a Jessner peel with retinol treatment followed by the short-pulsed Nd:YAG laser treatment (Figure 2).
The short-pulsed 1064 Nd:YAG emits a monochromatic light in the near-infrared spectrum,1 which has little predilection for water, hemoglobin, or melanin and therefore targets the mid-dermis, thermally heating the area. Heating of the dermis causes neocollagenesis, increased elastin, and dermal remodeling.1
A study by Tanaka and colleagues2 found improvement both clinically and histologically of dilated pores, rhytides, and skin texture after 3 treatments with the short-pulsed laser. One month posttreatment histology showed evidence of increased elastin and epidermal thickening.2 The short-pulsed Nd:YAG is safe for all skin types and is an ideal nonablative treatment for patients seeking improvement of acne scars, skin tightening, and improvement of skin complexion.
The Jessner peel, originally formulated by Max Jessner, has been used for more than 100 years. The peel is a combination of 3 main ingredients: 14 g lactic acid, 14 g salicylic acid, and 14 g resorcinol dissolved in ethanol. The combination of these chemicals reduces the possibility of toxicity to any one agent. The peel is classified as a superficial peel (penetrating from the stratum corneum to the basal layer). It can be used safely in skin types I-VI.3
Indications for a Jessner peel include treatment of photoaging, lentigines, acne, postinflammatory hyperpigmentation, melasma, and superficial rhytides.4 This peel should not be used in pregnant patients or if the patient has an allergy to any of its components. Prepeel prophylaxis should be given to patients with a history of oral herpes simplex virus.
Each of the components of the Jessner peel are discussed below and compared with the other more common superficial peels, the trichloroacetic acid (TCA) peel and glycolic acid peel.
Lactic acid is an a hydroxy acid, an organic compound derived from the sugars in fruit carboxylic acids as well as sour milk. When applied to the skin, it produces a very superficial, gentle desquamation. Lactic acid has been shown to inhibit Propionibacterium acnes proliferation, decrease keratinization, and has effects on melanogenesis. Lactic acid has a low toxicity profile and is hydrophilic leaving the skin well moisturized.2
Salicylic acid is a b hydroxy acid derived from the bark of a willow tree. It is a metabolite of aspirin. This acid is keratolytic and lipophilic and has anti-inflammatory properties. Salicyclic acid is most often used to treat acne and also can improve dyspigmentation. It is combined for use in a Jessner peel but can also be used solely as a superficial peeling agent.2
Resorcinol is a benzenediel and is related to phenol both structurally and chemically. It is a potent antiseptic and disinfectant.2
Retinol solution is a derivative of vitamin A. The solution is keratolytic and helps to induce regular corneocyte differentiation and decrease hyperkeratosis. Retinol also induces neocollageneisis. When applied following the Jessner peel, it has greater depth of penetration allowing for increased effects of collagen stimulation, regulation of corneocytes as well as treating dyspigmentation.2,3
Glycolic acid, similar to lactic acid, is also an a hydroxyl acid. Its particles are smaller than lactic acid, which allows for deeper penetration into the dermis. Glycolic acid peels come in various concentrations with higher concentrations having increased penetration. Glycolic acid has the ability to reach the dermis stimulating collagen production. Glycolic acid peels can treat various conditions including lentigines, rhytides, acne, scarring, large pore size, and oily skin.2,5
In a study comparing the Jessner peel with a 70% glycolic acid peel, Kim and colleagues6 found that the Jessner peel yielded a similar cosmetic outcome to the glycolic acid peel and also had increased exfoliation.
TCA has been used for over 100 years as a peeling agent. It is available in various concentrations, with higher concentrations having increased penetration. Superficial peels typically have a concentration between 10% to 20% and 25% to 35%. Medium peels are typically between 40% to 50%. TCA and deeper peels are categorized with concentrations greater than 50%. TCA at a concentration higher than 35% can cause scarring, hyperpigmentation, and hypopigmentation and is therefore ideal for darker skin types.1,2
The Jessner peel with retinol offers a good option for patients who seek noninvasive skin rejuvenation or for treatment of acne and/or acne scarring. Combining a superficial peel (targeting some rhytides, textural abnormalities, and dyschromia) with the short-pulsed Nd:YAG treatment (targeting dermis stimulating collagen synthesis) offers a dual modality approach with minimal downtime for improvement of acne scarring, fine lines, and dyschromia.
By combining a Jessner peel with retinol followed by a treatment with a short-pulsed Nd:YAG, our patient had significant improvement of overall skin complexion, fine lines, acne scarring, and dyschromia with minimal downtime. The Jessner peel targeted dyschromia and skin complexion with the added retinol stimulating collagen synthesis. The short-pulsed Nd:YAG targeted the dermis stimulating collagen growth.
Based on our observations from clinical practice a superficial chemical peel such as the Jessner peel paired with a the nonablative Nd:YAG laser, offers another safe and well-tolerated option to treat acne scars as well as improve skin texture and complexion in all skin types.
Dr Lombardi is a fellow at Affiliated Dermatologists in Morristown, NJ.
Dr Lee is a practicing dermatologist and the director of Procedural Dermatology of the ACGME-approved Procedural Dermatology Fellowship at Affiliated Dermatologists & Dermatologic Surgeons in Morristown, NJ.
Disclosure: The authors report no relevant financial relationships.
References
1. Green J. Short-pulse applications of 1064 nm laser devices useful in clinical presentations. Dermatology Times. February 1, 2012.
2. Tanaka Y, Matsuo K, Yuzuriha, S. Objective assessment of skin rejuvenation using near-infrared 1064-nm neodymium: YAG laser in Asians. Clin Cosmet Investig Dermatol. 2011;4:123-130.
3. Linder J. Superficial chemical peeling: minimal effort, maximum results. The Dermatologist. 2011;19(4):32-36.
4. Baumann L. Cosmetic Dermatology Principals and Practice. 2nd ed. New York, NY: The McGraw Hill Companies Inc; 2009.
5. Grimes PE. Aesthetics and Cosmetic Surgery for Darker Skin Types. Philadelphia, PA: Lippincott Williams & Wilkins; 2007.
6. Kim SW, Moon SE, Kim JA, Eun HC. Glycolic acid versus Jessners solution. Which is better for facial acne patients? A randomized prospective clinical trial of split face model therapy. Dermatol Surg. 1999;25(4):270-273.
