Dr. Sam Lam Plastic Surgery Forum

Heh, just got another Q - do u think 23% peels are safe? have u seen any complications? Was going to train up for it but not sure... I notice v few docs do sclerotherapy also. My friend Dr. B is a leading expert in Fraxel in the UK and said she's just had much better results with lasers, even for leg veins. I suppose I'm just debating what new 'stuff' I should learn beyond botox and fillers. I hear peels are good, but to stick to the lower percentages

i used to do a ton of peels. now i use principally plasma and lasers. i get a deeper collagen change. 23% will only really get you the very superficial skin damage. nothing deeper. when i did peels, i did jessners followed by 35% TCA peels. i would apply 3 to 4 coats and work by subunits looking for visual endpoints (light to medium and uniform white but not gray), as video'd in my first textbook, Comprehensive Facial Rejuvenation. However, you can burn an individual with almost any strength acid peel depending on how you use and dilute it. If I aggressively scrubbed 23% TCA for example, i could replace a result of a 35% or beyond so be careful. What I am saying is you could burn someone with almost any strength. If you go beyond 35% you are really risking things. However, if you use 23% and apply it just once then dilute down with water soaks, in most cases that should be pretty benign. As far as lasers, I really want to refrain from trying to compare technologies. There are simply too many out there right now to reasonably say I have experience to make legitimate comments.

thanks for this great response! Maybe I should pursue the laser route... for now company still wants to push me into the rest, so I'm doing Sculptra and peels this coming week. Fun fun.

btw i'm not sure why, but i just have a funny feeling about doing sclero. You know how there's discomfort with the unknown which simply requires action, and just a gut level feeling of uncertainty that usually means something else? It's the latter. While I know it's not your area, do you think the kind of risks associated with it for thread veins warrant a re-evaluation of cost-benefit?

honestly, i refuse to speak out of ignorance. i only answer things that i can speak with authority on so i will have to pass on a response that is tantamount to speculation. ask someone who has experience with sclero.
best,
sml

strangely, alot of docs I know in the aesthetic industry at least here in the UK don't seem to do sclero either. I suppose it's for that reason that I'm a bit reserved. Nevermind! Thanks for your thoughts

no problem.