FRACTIONALLY INTENSIFIED CHEMEXFOLIATION (FICEX): A NOVEL CONCEPT IN CHEMICAL PEELS

Background: Chemical peels involve the application of a chemical agent to the skin to induce controlled injury to the epidermis, with or without involvement of the dermis. The depth of penetration of the peeling solution is mainly determined by its ingredients and their concentrations.  The basic paradigm of chemical peels is that deeper penetration provides more significant clinical results but is associated with longer downtime and increased risk of complications. Objective: This study introduces the FICEX (fractionally intensified chemexfoliation) concept - a technique that combines fractionated controlled mechanical skin wounding (microneedling) with superficial peeling. Methods: Skin specimens harvested from cosmetic surgeries were treated by microneedling only, by application of Alcian blue-stained 30% glycolic acid solution, or by a combination of application of Alcian blue-stained 30% glycolic acid solution followed by microneedling. All the specimens were examined histologically. Results: Microneedling, using 1.5 mm length needles, created slits in the epidermis.  Alcian blue-stained 30% glycolic peeling solution was found only in the uppermost layers of the epidermis. In the skin treated by application of the peeling solution followed by microneedling, columns of Alcian blue-stained 30% glycolic acid were found in the mid-dermis. Conclusions: This study validates the clinical hypothesis that controlled mechanical skin wounding intensifies the depth of penetration of the peeling solution. This intensification goes beyond the depth of the microchannels created by the microneedling.  These findings substantiate the mechanistic rationale for combining microneedling with chemical exfoliation, affirming that the synergistic approach facilitates deeper, more targeted delivery of peeling agents within the skin.