Complications

• Phenol Toxicity: cardiac toxicity (must monitor for arrhythmias), neural (muscle weakness, slowed respiration), hepatic and renal toxicity, headache, nausea, hypotension, coma, and death; Rx: avoid by evaluating cardiac, renal, and hepatic function prior to phenol peel; avoid single large surface areas of peel; preoperatively should hydrate patient; if occurs, remove peel and address arrhythmia, hypotension, etc

• Hypopigmentation: normal sequela after deep peels (typically resolves), may result from melanocytic injury from deep dermabrasion; Rx: sunscreen, makeup, consider tattooing if severe, psoralens (increases pigmentation)

• Hyperpigmentation: more common in superficial peels; Rx: sunscreen, consider tretinoin, corticosteroid, and hydroquinone creams

• Melasma: hyperpigmention in face (common with estrogen, birth control pills, pregnancy)

• Milia: small epidermal cysts, common 1 month postoperatively; Rx: mild abrasive cleaners, unroofing, tretinoin therapy

• Scarring: higher risk for deep peels, perioral and chin peels, keloid formers; Rx: compression, massage, corticosteroid injections, silicon gel sheeting

• Ectropion: may occur with phenol eyelid peels

• Prolonged Erythema: should resolve after 1 month; Rx: topical corticosteroids and tretinoin for prolonged erythema

• Herpes Simplex Outbreak: reactivation from quiescent herpetic infection (HSV-2) in the trigeminal ganglion, occurs within 24 hours; Rx: perioperative high-dose acyclovir for prophylaxis, topical and oral acyclovir for active outbreak

• Telangiectasias: may become more prominent after peel; Rx: electrocoagulation/laser

• Persistent Rhytids: may repeat peel

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