This document outlines candidacy, preparation, scheduling, recovery, and the normal stages of healing for patients undergoing a 2-day Croton oil/phenol peel.
I. Indications for This Peel
This peel is typically recommended for patients with:
- Advanced skin aging, including deep wrinkles and significant facial skin laxity
- Severe acne scarring
II. Consultation (Telemedicine or In-Person)
A. Qualification Criteria
To be considered a good candidate, you should:
- Be medically healthy
- Have a strong psychological profile and realistic expectations
- Have the appropriate indication for a deep chemical peel
- Be able to commit to the required recovery downtime
III. Pre-Operative Requirements
Before the procedure, the following are required:
- EKG and blood tests to evaluate liver and kidney function
- High-quality baseline photographs for your medical chart
- A reliable support person for the first 3–4 days, including a driver
- Preparation for a liquid diet lasting approximately 7–10 days
- Prescriptions filled for:
- Antiviral medication
- Antibiotics
- Antifungal medication
- Anti-nausea medication
- Pain medication
- Sleep aids
- Review and understanding of all pre- and post-operative instructions (both patient and assistant/support person)
IV. Arrangements to Make in Advance
Please plan for the following:
- Receive the post-operative care kit provided by our office
- Arrange to take two weeks off work
- Light online work may be resumed around Day 4 if tolerated
- Reserve a hotel near Dr. Rullan’s office for approximately 3 days
- Have direct access to Dr. Rullan’s cell phone and be prepared to text daily photos
- Driving home is usually permitted on Day 4
- Flying home is usually permitted on Days 8–9, once the mask has naturally detached
V. Procedure and Recovery Timeline
A. Procedure Schedule
- Day Before the Peel: Begin antiviral medication
- Day 1:
- Approximately 2 hours in the operating room
- IV sedation administered by an RN
- You will leave with tape applied to the face (Figure1)
- Day 2:
- Approximately 1 hour in the operating room
- IV sedation administered by an RN
- You will leave with a powder mask, forming the protective mask (Fig. 2)
B. Early Recovery
- Day 3:
- Typically the most uncomfortable day
- Expect significant pain, swelling, and skin drainage (Fig. 3)
- Day 4:
- Symptoms usually begin to improve
- Less drainage and discomfort (Fig. 4)
- Begin using diluted vinegar/antibiotic spray or compresses
- If you notice a white exudate. In. the eylid region, begin cleaning that area with dilute. Hydrogen peroxide, gently rolling a Qtip over it.
- Apply Aquaphor around the eyes( if it looks clean) and lips
C. Days 5–7: Infection Monitoring
- This is the period of highest infection risk, especially around the eyes (Fig.5)
- Be prepared to start ciprofloxacin (Cipro) pills and eye drops if instructed by Dr. Rullan
- If the mask becomes overly dry and cracks: (Fig. 6)
- Spray with the vinegar/water solution
- Apply a small amount of Aquaphor directly to the crack if advised
- Never apply Aquaphor over infected skin (whitish exudate).
Signs of Infection
- White or yellowish, moist scabbing (Fig. 7)
Care Instructions
- Gently dab the area with a Q-tip moistened with diluted hydrogen peroxide several times daily
- Follow with an antibiotic powder and/or Silver balm
- Never forcibly remove a scab, even if it appears dark or dry (Fig. 8)
- Infection or scratching can result in permanent scarring (see Figs,13)
D. Days 7–10: Mask Separation
- After reviewing your daily photos, Dr. Rullan may advise: (Fig. 9)
- Taking a warm shower
- Shampooing is allowed, but avoid direct water spray on the face
- Allow water to gently run over the face
- The goal is to soften the mask, allow it to dry again, and encourage natural separation
- Never pull off areas of the mask that are firmly attached
- As healing progresses, the mask will release and wash away on its own (Fig. 10)
- Between Days 7–10, you will visit the office so Dr. Rullan or his assistant can safely remove any portions that are ready
E. Skin Care After Mask Removal
- Once approximately 90% of the mask has detached, begin using the Skin Repair System included in your kit (Fig. 11)
- Apply Aquaphor only to areas that remain extremely dry or sensitive
VI. Stages of Skin Healing
A. Immediate Post-Mask Phase
- The mask is removed and you begin the prescribed skin healing regimen
B. Sensitivity, Dryness, and Itching (Fig.12)
- Tightness, dryness, and itching are common
- Helpful treatments include:
- Diluted vinegar/water compresses
- Antihistamines
- Prednisone (if prescribed)
- Topical cortisone cream
C. Redness (Erythema) (Fig 12)
- Prolonged redness is the most common concern
- It indicates active healing with increased growth factors, collagen formation, and new blood vessels
- Redness may worsen with heat and exercise; lighter activity is recommended
- Treatments that may help:
- Topical cortisone creams
- Tinted green sunscreen
- Vascular lasers (e.g., V-Beam, DermaV), when performed regularly
- Medical-grade makeup (e.g., Oxygenetix, Dermablend)
- Exosome serum
- CO₂ Lift gel (very soothing; ask our staff)
D. Skin wounds with infection. Will need management ASAP (Fig 13 x3)
E. Post-Inflammatory Hyperpigmentation (Brown Discoloration) (Fig 14)
- Typically appears about 1 month after the peel, often along the cheekbones
- May respond to:
- Cortisone creams
- Hydroquinone-based products
- Exosome serum
F. Temporary Lightening of Skin Tone (Fig.15)
- Lighter-than-normal skin tone is common for several months
- Improvement may be supported by:
- Tretinoin
- Microneedling
- Bimatoprost (prescription)
G. Long-Term Results (Fig. 16)
- Patients with normal skin tones typically achieve the best overall results
- Significant improvement is usually visible within 2–3 months
- Final results—normal skin tone, improved acne scarring, and enhanced skin quality—continue to develop for up to 12 months after the peel
