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Combination Therapy for Optimal Results

By: Jennifer Linder, MD
Posted: June 24, 2010, from the July 2010 issue of
Woman receiving LED treatment

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Medium-depth peels are those that reach the papillary dermis and typically refer to 30–40% TCA. Deep chemical peels affect the upper reticular dermis and usually refer to phenol peels and TCA in percentages above 40. These types of treatments induce varying degrees of downtime and carry a significantly higher risk of complications than superficial chemical peels. Because of the inflammation involved with these treatments, they are only suitable for a narrow range of patients.5

Regular treatments with chemical peels can also significantly improve outcomes by enhancing the benefits of other rejuvenating procedures such as microdermabrasion, ultrasound, LED, laser and IPL, and topical daily care products. Patients should be prepped with products containing effective ingredients and melanogenesis inhibitors before and following in-office treatments to ensure optimal skin function.6


Microdermabrasion offers mechanical exfoliation combined with vacuum pressure. This type of treatment physically removes skin cells through friction and abrasive media, typically aluminum oxide crystals, rather than chemical exfoliation. The vacuum suction delivered by the microdermabrasion handpiece increases blood flow throughout the treatment area and is thought to ultimately lead to an increase in collagen production. Enhanced blood flow is beneficial for many patients, including those with a sallow complexion, smokers and those seeking treatment for visible aging.7

One of the greatest benefits of microdermabrasion is its ability to promote deeper, more even penetration of corrective topical products. The superficial exfoliation provided by a microdermabrasion procedure will increase the benefits of any product applied post-treatment.8 Low percentage superficial peels may also be applied post-microdermabrasion for even greater penetration and benefits. Of course, the proper training in the selection of appropriate peels and products to use in conjunction with microdermabrasion, and the knowledge of when and with whom this level of treatment is best suited, is of the utmost importance.


Ultrasound is sound with a frequency of more than 20,000 Hz, or cycles per second. Phonophoresis, also referred to as sonophoresis, is the therapeutic technique in which ultrasound waves are used to force topical products into tissue. This treatment uses low frequencies and is the most useful form of ultrasound application to the medical aesthetic professional.