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Chemical peels: Principles, peeling agents, and

pretreatment assessment
Author: Suzan Obagi, MD
Section Editor: Jeffrey S Dover, MD, FRCPC
Deputy Editor: Abena O Ofori, MD

All topics are updated as new evidence becomes available and our peer review process is complete.

Literature review current through: Aug 2022. | This topic last updated: Feb 25, 2022.

INTRODUCTION

Skin resurfacing procedures produce improvements in skin quality, texture, and appearance
through harnessing the normal wound-healing processes that follow skin injury ( table 1A).
Chemical peels are one of the most common facial skin resurfacing procedures; laser
resurfacing, dermabrasion, and microneedling are examples of other common skin resurfacing
procedures. (See "Nonablative skin resurfacing for skin rejuvenation" and "Ablative laser
resurfacing for skin rejuvenation".)

The major advantages of chemical peels include the extensive clinical experience with this
modality, the quickness of chemical peel procedures, relatively low cost, and unparalleled
therapeutic flexibility due to the wide variety of chemical peeling agents available. Knowledge
of the appropriate indications and risks of chemical peeling and familiarity with the properties
of individual peeling agents are essential for counseling patients, planning treatments,
optimizing results, and minimizing risk for complications.

The general principles of chemical peeling, common peeling agents, and the assessment of
candidates for chemical peels will be reviewed here. Guidance on skin preparation prior to
chemical peels, performance of chemical peels, and post-treatment care is provided separately.
(See "Chemical peels: Procedures and complications".)

GENERAL PRINCIPLES
Chemical peels induce controlled skin injury through the application of caustic substances to
the skin. The most common indications for chemical peels are actinic keratoses, solar
lentigines, ephelides, dyschromias, rhytides (wrinkles), acne scars, and photoaging
( table 1A). Chemical peels are typically performed on the head or neck but can be safely
adapted to use on the chest, forearms, and hands [1].

Combining chemical peels with other cosmetic interventions is helpful in some scenarios. (See
"Management of acne scars", section on 'Chemical peels' and "Photoaging" and "Melasma:
Management" and "Postinflammatory hyperpigmentation".)

Mechanisms of action — The primary mechanisms of action of chemical peeling agents are

the induction of keratolysis (separation of epidermal keratinocytes), keratocoagulation, and
protein denaturation. Keratolysis (a mechanism of alpha- and beta-hydroxy acids) results in
superficial exfoliation, which can improve skin texture and facilitate even distribution of
pigment in the epidermis. Keratocoagulation and protein denaturation (a function of
trichloroacetic acid [TCA] and phenol) in the epidermis and dermis lead to the release of
proinflammatory cytokines and chemokines that stimulate restorative and rejuvenating effects
in the skin. Examples of these effects include regeneration of keratinocytes, the production and
deposition of new collagen and elastin, and the reorganization of structural scaffold proteins
and dermal connective tissue [2].

Peel types — The depth of skin injury a chemical peel induces correlates with the clinical effects
and is dependent upon the agent used and application technique. Peel depths are typically
described as light (superficial), medium-depth, or deep ( table 1A). The potential for more
profound changes to the skin increases as the depth of the peel increases.

Light (superficial) chemical peels cause injury only to the epidermis. The effects of light peels
generally consist of improving acne, skin brightening, and evening out skin color and texture.
Medium-depth peels injure the epidermis and papillary dermis, allowing for both the effects of
light peels and improvement in features related to abnormalities in the superficial dermis, such
as mild wrinkling and mild scarring. Deep chemical peels induce the greatest degree of injury,
extending into the reticular dermis. Deep chemical peels can lead to improvements in deep
wrinkles and deep acne scars. (See "Management of acne scars", section on 'Chemical peels'.)

COMMON PEELING AGENTS

The depth of a chemical peel is dependent on the specific peeling agent and its mechanism of
action as well as factors such as the concentration of the peeling agent, the number of
applications or volume of acid applied during the treatment session, the duration of contact
with the skin (glycolic acid peels), and the characteristics of skin in the treated area (thin skin
versus thick, sebaceous skin).

Keratolytics — Keratolytic agents disrupt the bonds between keratinocytes, causing shedding

of keratinocytes ( table 2). The most common keratolytic peeling agents are [3]:

● Glycolic acid
● Salicylic acid
● Jessner's solution (14% resorcinol, 14% salicylic acid, and 14% lactic acid mixed in ethanol)

Most keratolytic acid peels do not penetrate past the epidermis, making them the primary
agents used for light (superficial) chemical peels. Use of high concentrations or combination
treatment with other peeling agents may result in deeper peels.

Glycolic acid — Glycolic acid, a hydrophilic chemical peeling agent, is the most common
alpha-hydroxy acid utilized for chemical peels and is generally used in concentrations of 20 to
70%. Light chemical peels are typically performed with 30 to 50% glycolic acid, whereas 70%
glycolic acid is capable of inducing a medium-depth peel [2]. In contrast to salicylic acid and
Jessner's solution, application of a neutralizing agent (eg, sodium bicarbonate, water) is
necessary to halt the action of glycolic acid on the skin.

Salicylic acid — Salicylic acid is more lipophilic than glycolic acid, allowing for better
penetration through the skin's lipid layer. This characteristic may facilitate treatment of acne, as
salicylic acid may offer greater penetration of acne lesions and oily skin. Salicylic acid is used for
light chemical peels; typical concentrations for chemical peeling are 20 to 30%.

Jessner's solution — Jessner's solution contains 14% resorcinol, 14% salicylic acid, and 14%
lactic acid mixed in ethanol. Jessner's solution has strong keratolytic effects and primary
indications include acne and hyperkeratotic disorders.

Other agents — Other keratolytic peeling agents include 40% mandelic acid (an alpha-
hydroxy acid), the combination of 20% salicylic acid and 10% mandelic acid, 10 to 30% lactic acid
(a beta-hydroxy acid), 40 to 70% pyruvic acid (an alpha-ketoacid), retinoic acid, and resorcinol
[2].

Protein denaturants — Protein denaturants penetrate the skin and coagulate proteins that
comprise the epidermis, dermis, and blood vessels. The major protein denaturants used in
chemical peels are trichloroacetic acid (TCA) and phenol ( table 2).
 Trichloroacetic acid — TCA has a long history of use for light and medium-depth peels and is
typically applied in concentrations of 10 to 35%. The depth of TCA peels increases with the
concentration of TCA and with successive applications during a treatment session. The main
indications for TCA peels are photodamage, actinic keratoses, lentigines, fine rhytides, and
superficial acne scars.

TCA is used both alone and in combination with other peeling agents. Risk for scarring and
dyspigmentation with higher concentrations of TCA (eg, 50%) has contributed to a preference
for use of lower concentrations (eg, 35% TCA) in combination with other peeling agents to
achieve similar results. Combination therapy with a keratolytic agent (also known as modified
TCA peels or accelerated TCA peels) allows for better control of the peel because the keratolytic
agent disrupts the stratum corneum and allows for rapid and uniform penetration of TCA.
Examples of keratolytic agents used in combination with TCA include Jessner's solution, glycolic
acid, and solid carbon dioxide ice.

Other measures have been taken to improve the safety of TCA peels. Penetration of TCA may be
slowed through use of peel products containing additional ingredients, such as glycerin and
saponin. Saponin facilitates mixing of hydrophilic TCA and hydrophobic glycerin to create an
emulsion that promotes even penetration of the mixture through the lipid layers of the skin.

In addition, because reapplication of TCA to a particular area augments penetration of the peel,
blue dyes are included in some TCA products to facilitate tracking of skin areas in which TCA has
been applied. Moreover, TCA should be acquired from a reliable source that uses the
weight:volume (W:V) method to formulate the peel solution and ensure accuracy of the
concentration.

Phenol and croton oil — Phenol is a protein denaturant that is primarily utilized for deeper
peels. The addition of croton oil, a vesicant and epidermolytic agent, to phenol is an important
determiner of the effect of phenol peels; compared with high concentration of phenol alone,
croton oil promotes deeper and more uniform keratocoagulation [4].

Major formulations used for these peels have contained phenol, croton oil, water, and,
historically, hexachlorophene and include the Baker-Gordon formula and Hetter's formula. The
latter incorporates lower concentrations of croton oil (2.1% versus ≤1.6%) to improve the safety
of the peel, and many clinicians now prefer Hetter's formula over the older Baker-Gordon
regimen [5]. In place of hexachlorophene, solutions incorporate surfactants containing sodium
C14-16 olefin sulfonate and triclosan or polyethylene glycol (80) sorbitan laurate, based upon
availability and stability [6,7].
Phenol peels result in protein denaturation extending into the reticular dermis. The primary
benefit of these peels compared with more superficial peels is the induction of marked dermal
neocollagenesis [5]. Common indications include photodamage, rhytides, and acne scars. Other
uses have included xanthelasma, actinic keratoses, actinic cheilitis, and lip augmentation and
eversion [5]. (See "Photoaging" and "Management of acne scars", section on 'Chemical peels'.)

Phenol peels must be performed with caution. Phenol penetrates the skin quickly, making it a
difficult agent to control. Potential serious complications include cardiac arrhythmia and
scarring. (See "Chemical peels: Procedures and complications", section on 'Special precautions
for phenol peels' and "Chemical peels: Procedures and complications", section on 'Application'.)

INDICATIONS

The most common indications for chemical peels are reviewed in a table ( table 1A). Details
on the role of chemical peels for these and other conditions can be found in UpToDate topics
reviewing treatment of specific conditions. Examples include:

● (See "Photoaging", section on 'Chemical peels'.)

● (See "Management of acne scars", section on 'Chemical peels'.)
● (See "Postinflammatory hyperpigmentation", section on 'Chemical peels'.)
● (See "Light-based, adjunctive, and other therapies for acne vulgaris", section on 'Office-
based superficial chemical peels'.)
● (See "Treatment of actinic keratosis", section on 'Chemical peels'.)
● (See "Melasma: Management", section on 'Chemical peels'.)
● (See "Striae distensae (stretch marks)", section on 'Chemical peels'.)

PRECAUTIONS AND CONTRAINDICATIONS

Avoidance of chemical peels or measures to minimize risk for side effects may be indicated in
the setting of increased risk for dyspigmentation, poor healing, scarring, or exacerbations of
pre-existing skin disease after peeling ( table 1B). Risk for these types of adverse outcomes
generally increases as the depth of peeling increases:

● Increased risk for dyspigmentation – The major risk factor for cosmetically significant
postinflammatory hyperpigmentation (PIH) and permanent hypopigmentation following
chemical peels is moderately to highly pigmented skin (skin phototypes III to VI
( table 3)). Treatment of this population with light, medium-depth, or deep peels
warrants thorough counseling of patients. Patients should be informed of the potential for
 PIH and the need for careful adherence to pretreatment and post-treatment measures
designed to reduce risk for PIH. For most patients, PIH is a temporary issue that can be
remedied with topical therapies and light peels. In contrast, hypopigmentation is usually a
function of depth of peeling and is, for the most part, permanent. (See "Chemical peels:
Procedures and complications".)

● Increased risk for poor wound healing – Caution is necessary for medium-depth or deep
chemical peeling in patients with medical conditions that can inhibit normal wound
healing after the procedure. Peels of this depth should be avoided in patients with
malnutrition or severe protein deficiency. Relative contraindications include other factors
that may impede healing, such as smoking (tobacco, marijuana, electronic cigarettes [e-
cigarettes]), history of radiation therapy in the treated area, and certain medications (eg,
systemic glucocorticoids) or diseases that impair wound healing [8-10]. (See "Risk factors
for impaired wound healing and wound complications".)

● Increased risk for hypertrophic or keloidal scarring – Patients with a history of

hypertrophic or keloidal scarring may have increased risk for such scarring following
medium-depth or deep chemical peels. We consider a history of keloidal scarring on the
face an absolute contraindication for medium-depth or deep facial chemical peels.
Hypertrophic or keloidal scarring in other body areas is considered a relative
contraindication for medium-depth or deep facial chemical peels [11,12]. (See "Keloids and
hypertrophic scars".)

● Current or recent isotretinoin therapy – The validity of the longstanding

recommendation to avoid chemical peels for at least 6 to 12 months following isotretinoin
therapy because of concern for increased risk for poor wound healing or scarring has
been questioned [13,14]. The results of a systematic review suggest that there may not be
a risk for increased scarring or poor wound healing following superficial chemical peels in
patients with current or recent isotretinoin use and that delaying treatment may not be
necessary [13,14]. However, more data are necessary to confirm best practices for
chemical peels in this population.

Although we perform light chemical peels shortly after cessation of isotretinoin therapy,
we typically avoid these procedures during the active treatment period because skin
dryness and peeling related to isotretinoin may contribute to uneven penetration of the
peel solution. We typically avoid medium-depth or deep chemical peels until at least three
to four months have elapsed after completion of isotretinoin. (See "Oral isotretinoin
therapy for acne vulgaris", section on 'Cutaneous procedures'.)
 ● Pre-existing skin disease – Relative contraindications for medium-depth and deep
chemical peeling include active inflammatory skin conditions, such as rosacea, eczema,
and acne vulgaris, in the treatment area and skin disorders that exhibit the Koebner
phenomenon (induction of new lesions in sites of skin trauma) because of the potential for
chemical peel-induced exacerbations. Examples of disorders that may exhibit the Koebner
phenomenon include flat warts, lichen planus, psoriasis, and vitiligo.

● Active skin infection – Active skin infection is typically a contraindication to light,

medium-depth, or superficial chemical peels. The compromised state of the skin barrier
after a chemical peel may contribute to the spread of the infection to the treated area. The
chemical peel can be performed after resolution of the infection.

● Pregnancy and lactation – Medium-depth and deep chemical peels are generally avoided
in pregnant patients because chemical peels are typically elective procedures, and there
are insufficient data to confirm safety in pregnancy. (See "Common problems of
breastfeeding and weaning", section on 'Maternal use of medications'.)

There are insufficient data for definitive conclusions on the safety of chemical peels during
lactation. Light chemical peels are likely safe, given that transmission to breast milk is
likely to be minimal. We typically avoid trichloroacetic acid (TCA) and phenol peels during
lactation.

● Hepatic or renal disease – Individuals with hepatic or renal insufficiency may be at

increased risk for toxicity from phenol peels. Phenol is metabolized by the liver and
excreted via the kidneys. Hepatic and renal disease are considered relative
contraindications for phenol peels.

PATIENT ASSESSMENT

The selection of appropriate candidates for chemical peels includes not only the recognition of
an appropriate indication but also an assessment for characteristics that may require a cautious
approach to the procedure or avoidance of chemical peeling ( table 1A-B).

History and physical examination — A focused patient history allows for the identification of
patient characteristics that influence eligibility for chemical peels, risk for adverse effects, and
the protocol for treatment. (See 'Precautions and contraindications' above.)

We typically obtain the following information:

 ● Medical history, including current and past cutaneous and systemic infections and
diseases

● Current and recent medications

● Smoking history

● History of radiation therapy in the treatment area

● History of postinflammatory hyperpigmentation (PIH), delayed wound healing, or

excessive scarring (eg, keloids, hypertrophic scars) following other cutaneous procedures
or injury

● History of facial surgeries that may compromise blood supply and impair wound healing

● Pregnancy and lactation status of females

A focused physical examination should include careful inspection of the area to be treated to
ensure that there is an appropriate indication for chemical peeling and assess the general
health of skin in the area to be treated. The physical examination should assess features that
may influence the approach to treatment, including baseline skin pigmentation and signs of
skin disease or abnormal scarring. (See 'Precautions and contraindications' above.)

Obtaining a history of prior treatments for the condition of concern can also help to guide the
approach to treatment. Patients who have failed to achieve adequate results with previous
chemical peels may benefit from a different approach to treatment.

PEEL SELECTION

Selection of an appropriate peel begins with identification of the appropriate depth of peel
(light, medium depth, deep) based upon the condition being treated. Selection among the
agents and peeling procedures available to achieve a particular depth may be further
influenced by the specific condition, clinician comfort and experience with specific agents, and
local availability of peeling agents.

Guidance on the preferred approach for specific conditions can be found in UpToDate topics
that review the treatment of specific conditions. (See 'Indications' above.)

PATIENT COUNSELING
Candidates for chemical peeling should be counseled carefully regarding the nature of the
procedure, preoperative and postoperative care and responsibilities, expected outcome,
adverse effects, and alternatives to chemical peeling. Patient expectations for treatment results
and recovery should be discussed thoroughly to ensure that expectations are appropriate.
Providing sample high-quality pretreatment and post-treatment photographs of other patients
with similar concerns often helps patients conceptualize expected responses.

Ultimately, patients who will proceed with chemical peeling should be able to comprehend the
procedure, alternatives, risks, and expected cosmetic outcomes and should be willing and able
to adhere to pretreatment and post-treatment instructions. (See "Chemical peels: Procedures
and complications".)

SUMMARY AND RECOMMENDATIONS

● Chemical peels are common skin resurfacing procedures that can improve a variety of
cutaneous abnormalities. The most common indications for chemical peels are actinic
keratoses, solar lentigines, ephelides, dyschromias, rhytides (wrinkles), acne scars, and
photoaging ( table 1A). (See 'General principles' above and 'Indications' above.)

● Chemical peeling of the skin involves the induction of keratolysis, keratocoagulation,

and/or protein denaturation through the application of caustic substances to the skin. A
variety of peeling agents are utilized to achieve different effects on the skin. Common
peeling agents include glycolic acid, salicylic acid, Jessner's solution, trichloroacetic acid
(TCA), and phenol ( table 2). (See 'General principles' above and 'Common peeling
agents' above.)

● Chemical peels can be divided into light, medium-depth, and deep peels. Light peels
induce injury limited to the epidermis. Medium-depth peels injure the epidermis and
papillary dermis. Injury from deep peels extends from the epidermis to reticular dermis.
(See 'Peel types' above.)

● Patients who may be candidates for chemical peels should be carefully assessed for an
appropriate indication as well as characteristics that may increase risk for complications
( table 1B). A focused history and physical examination can identify patients for whom
precautions are indicated. (See 'Indications' above and 'Precautions and contraindications'
above and 'Patient assessment' above.)

● Preparation for treatment involves selection of the most appropriate peeling agent and
procedure as well as careful and thorough patient counseling. Patients who will proceed
 with chemical peeling should be able to comprehend the procedure, alternatives, risks,
and expected cosmetic outcomes and should be willing and able to adhere to
pretreatment and post-treatment instructions. (See 'Peel selection' above and 'Patient
counseling' above and "Chemical peels: Procedures and complications".)

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REFERENCES

1. Willis C. Trichloroacetic acid peels of the neck, chest, and arms and hands. In: Procedures in
Cosmetic Dermatology: Chemical Peels, 3rd ed, Obagi S (Ed), Elsevier, 2020. p.70.
2. Soleymani T, Lanoue J, Rahman Z. A Practical Approach to Chemical Peels: A Review of
Fundamentals and Step-by-step Algorithmic Protocol for Treatment. J Clin Aesthet
Dermatol 2018; 11:21.
3. Castillo DE, Keri JE. Chemical peels in the treatment of acne: patient selection and
perspectives. Clin Cosmet Investig Dermatol 2018; 11:365.
4. Hetter GP. An examination of the phenol-croton oil peel: part IV. Face peel results with
different concentrations of phenol and croton oil. Plast Reconstr Surg 2000; 105:1061.

5. Wambier CG, Lee KC, Soon SL, et al. Advanced chemical peels: Phenol-croton oil peel. J Am
Acad Dermatol 2019; 81:327.

6. Wambier C, Brown University, 2021, personal communication.

7. Kass LG, Rullan PP, Brody HJ. Clinical preliminary evaluation of PEG-80 sorbitan laurate
(Novisol) versus sodium C14-16 olefin sulfonate & triclosan (Septisol) in deep-peeling
Hetter formulas. J Am Acad Dermatol 2020; 82:e255.
8. Manzoni AP, Weber MB. Skin changes after bariatric surgery. An Bras Dermatol 2015;
90:157.
9. Halawi A, Abiad F, Abbas O. Bariatric surgery and its effects on the skin and skin diseases.
Obes Surg 2013; 23:408.

10. Troiano C, Jaleel Z, Spiegel JH. Association of Electronic Cigarette Vaping and Cigarette
Smoking With Decreased Random Flap Viability in Rats. JAMA Facial Plast Surg 2019; 21:5.

11. Avram MM, Tope WD, Yu T, et al. Hypertrophic scarring of the neck following ablative
fractional carbon dioxide laser resurfacing. Lasers Surg Med 2009; 41:185.
12. Costa IMC, Damasceno PS, Costa MC, Gomes KGP. Review in peeling complications. J
Cosmet Dermatol 2017; 16:319.
 13. Spring LK, Krakowski AC, Alam M, et al. Isotretinoin and Timing of Procedural
Interventions: A Systematic Review With Consensus Recommendations. JAMA Dermatol
2017; 153:802.

14. Obagi S, Obagi ZE, Bridenstine JB. Isotretinoin Use During Chemical Skin Resurfacing: A
Review of Complications. The American Journal of Cosmetic Surgery 2002; 19:9.
Topic 121148 Version 2.0
GRAPHICS

Common indications for chemical peels

Light peels Medium-depth peels Deep peels

Acne vulgaris Acne scars (CROSS Deep wrinkles

technique)

Melasma (epidermal) Melasma (dermal or mixed Deep acne scars

epidermal plus dermal)

Postinflammatory Fine to medium-depth Acne scars (CROSS

hyperpigmentation wrinkles technique)

Lentigines Actinic keratosis  

Ephelides Photodamage  

CROSS: chemical reconstruction of skin scars.

Graphic 121449 Version 1.0

Properties of specific chemical peel agents

Keratolytic agents Protein denaturants

Glycolic acid Trichloroacetic acid (TCA)

Salicylic acid Phenol

Mandelic acid  

Lactic acid  

Resorcinol  

Pyruvic acid  

Retinoic acid  

Graphic 121452 Version 1.0

Contraindications for chemical peels

Relative contraindications Absolute contraindications

History of hypertrophic scars or keloids off the History of keloids or hypertrophic scars on the
face* face

Daily smoker (tobacco, marijuana, or Active skin infection anywhere on the body
electronic cigarettes [e-cigarettes])*

Active psychiatric disorders that are likely to PregnancyΔ

inhibit tolerance of the procedure, adherence
to postpeel care instructions, or satisfaction
with results of the peel¶

Medical diseases that alter wound healing* Inability to follow pre- or post-peel care
instructions

Medications that impair wound healing*  

Active inflammatory skin conditions that may Malnutrition and severe protein deficiency
be exacerbated by chemical peels, such as (eg, postbariatric surgery)*
rosacea, atopic dermatitis, acne vulgaris, and
koebnerizing skin diseases*

Lactation◊ On or recently completed oral isotretinoin

therapy§

Hepatic or renal disease¥  

* For medium to deep peels.

¶ Examples of psychiatric conditions that may be problematic include depression, skin picking
disorder, and body dysmorphic disorder.

Δ Insufficient data to confirm safety.

◊ Insufficient data to confirm safety. Light chemical peels are generally considered safe.
Trichloroacetic acid and phenol peels are typically avoided during lactation.

§ For medium-depth and deep chemical peels, waiting 3 to 6 months after completion of isotretinoin
is advised due to concern for poor wound healing or scarring. Performance of light chemical peels
during isotretinoin therapy does not appear to be associated with increased risk for these adverse
effects. However, some clinicians delay light chemical peels until after completion of isotretinoin
because of concern that skin dryness and peeling may contribute to uneven penetration of the peel
solution.

¥ Associated with increased risk for phenol toxicity.

Graphic 121455 Version 1.0

Fitzpatrick skin phototypes

Skin type Unexposed skin color Reaction to sun exposure*

I White Always burns, never tans

II White Always burns, minimal tan

III White to olive Burns minimally, gradually tans

IV Light brown Burns minimally, tans well

V Brown Very rarely burns, tans profusely

VI Dark brown to black Never burns, tans deeply

Note: Slight variations on the definitions of the phototypes appear in the literature.

* After the first one hour of sun exposure on untanned skin on the first day of spring.

Graphic 60541 Version 5.0

Contributor Disclosures
Suzan Obagi, MD Consultant/Advisory Boards: Obagi Medical [Skincare]; Nextcell Medical [Skincare]. All
of the relevant financial relationships listed have been mitigated. Jeffrey S Dover, MD,
FRCPC Grant/Research/Clinical Trial Support: AbbVie [Cosmetic dermatology]; Allergan [Cosmetic
dermatology]; Bausch and Lomb [Cosmetic dermatology]; Cutera [Cosmetic dermatology]; Cynosure
[Cosmetic dermatology]; Follica [Cosmetic dermatology]; InMode [Cosmetic dermatology]; L'Oréal
[Cosmetic dermatology]; Lumenis [Cosmetic dermatology]; Lutronic [Cosmetic dermatology]; Revance
Therapeutics [Cosmetic dermatology]; Teoxane Laboratories [Cosmetic dermatology].
Consultant/Advisory
Boards: AbbVie [Cosmetic dermatology]; Allergan [Cosmetic dermatology]; Bausch and Lomb [Cosmetic
dermatology]; Cutera [Cosmetic dermatology]; Follica [Cosmetic dermatology]; Lumenis [Cosmetic
dermatology]; Revance Therapeutics [Cosmetic dermatology].
Other Financial Interest: Controversies and
Conversations in Laser and Cosmetic Surgery [Medical meeting director].
All of the relevant financial
relationships listed have been mitigated. Abena O Ofori, MD No relevant financial relationship(s) with
ineligible companies to disclose.

Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these are
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