CAROLINE MURRAY is a fair-skinned woman who grew up near a sun-drenched beach in San Diego. By the age of 43, her suntans had taken their toll. "I had just ruined my skin," she says. More and more, Murray had to have precancerous growths removed from her face, forcing her to greet clients of her interior design firm with unsightly scabs and red marks on her skin.
Then an acquaintance tried a treatment called a chemical peel. She told Murray it took away all those precancerous places -- as well as wrinkles. Murray visited the woman's doctor, a family practitioner who advertised "facial rejuvenation."
The doctor didn't give her many details: "He touted the deal as being you just go in, and in seven to 10 days, you come out with nice new, pink skin, like a baby's," says Murray. So she made an appointment for a peel. "As a businesswoman, I can't believe I was that naive," she says. "But I thought, 'This guy's an M.D., and he knows what he's doing.' "
Her confidence wavered as she was about to go into the procedure room. "I was given a sedative, and at the very last minute, they slid a consent form under my nose saying I could die of this. That was the first I ever heard of risks. I was terrified from that point on."
Murray's "facial rejuvenation" was a deep chemical peel, a technique that dermatologists and plastic surgeons have dabbled in since the early 1900s, with varying degrees of success -- and disaster.
Deep peels use an acid called phenol, which is swabbed onto the face, creating a second-degree burn that eats through the skin. (Superficial peels most often use trichloroacetic acid in differing dilutions; other chemicals may also be used.)
After the acid is applied -- usually under a sedative or general anesthetic -- the physician covers the face with an ointment or a mask of adhesive tape. After about two days, the tape comes off, and an itchy crust develops. (The ointment stays on about a week.)
This "weeping scab," as one plastic surgeon describes it, sheds after a few more days, revealing red, swollen skin underneath. The swelling usually lasts two to six weeks, the redness as long as six months. But the patient has new skin, which is tighter and smoother than the old.
Both deep and superficial peels are effectively and safely used to remove precancerous patches and uneven pigmentation. Still, the vast majority are done to erase wrinkles. While both trichloroacetic acid and phenol are safely used for this purpose, reputable practitioners usually reserve deep peels for septuagenarians with substantial wrinkling.
But as more consumers seek a formula for youth -- and more doctors, a formula for profit -- peels are being promoted for
anyone with the merest smile lines or crow's feet. They're touted as "non-surgical facelifts," when in fact they are surgery (of the chemical sort) and not facelifts (they won't counteract gravity).
Legally, the procedure can be done by anyone with a medical license, and, indeed, doctors from gynecologists to psychiatrists are taking up the trade. But in the wrong hands -- someone who doesn't know the complications that can arise when you paint something as corrosive as lye on a face -- peels can be dangerous. Even done correctly, they aren't quick and easy makeovers.
"Chemical peels can have very good results on the right patient," says Robert Singer, a San Diego plastic surgeon. "But in the hands of someone who is not ethical, who is not fully trained, the wrong procedure is being done on the wrong patient for the wrong reason."
Caroline Murray got the wrong results. After her peel, she was taken to a retreat center, where for seven days she lay in bed, groggy from pain and medication, and sipped pureed food. In 48 hours, the tape came off, and she had a thick, heavy scab over her entire face -- which was normal, but hadn't been explained to her. "By that time I realized I hadn't really thought this thing through very clearly," she says.
When the crust came off in a couple of more days, she didn't recognize herself. "My face was burned and red and so swollen I could hardly open my eyes." She couldn't open her mouth to talk or to brush her teeth. Finally, after three months, the swelling went down, and she saw "terrible, raised scars."
This frightening side effect is not unusual. In a survey of 588 plastic surgeons, 21 percent reported that phenol scarred significantly, especially around the mouth and chin. Trichloroacetic acid in strong concentrations is even more likely to leave scars than phenol.
At the very least, Murray could have expected the skin on her new face to be thinner, extremely sensitive to sun, more susceptible to burns, more tender to irritants. And a lighter color.
"In fair-skinned people, the face is left a porcelain white color, which doesn't match the neck or the rest of the body," says Los Angeles plastic surgeon Sheldon Rosenthal. "The patient is committed to using makeup after the procedure."
For women with darker skin, the treatment often leaves red or dark blotches along with whiter spots. Permanent dark patches can develop if a peeled patient becomes pregnant, sits in the sun, or uses birth control pills, estrogen, or photosensitizing drugs such as the antibiotic tetracycline. These patches are most likely to show up in the first six months after the peel, but they can develop any time.
According to the plastic surgeon survey, two out of three who use phenol report pigmentation problems.
When Caroline Murray went back to the family practitioner who gave her the peel, he told her scars like hers "happen sometimes," and he injected them with steroids. "I had long ridges of tissue," Murray says. Then she saw a dermatologist, who gave her steroid injections for a year. "Nothing happened. I was so disgusted and despondent over this thing," says Murray. The dermatologist told her the family practitioner had either rubbed the skin too vigorously, applied too much phenol, or there was something wrong with the chemical itself.
Murray sued the doctor who did the peel nd eventually settled out of court for $59,000. Her scars, though they've diminished somewhat, are permanent. And the doctor still performs and gives seminars on his "facial rejuvenation."