British Journal of Plastic Surgery (2001), 54, 89 �9 2001 The British Association of Plastic Surgeons

B R I T I S H J O U R N A L OF

Book review doi: 10.1054/bjps.2000.3474

Obagi skin health: restoration and rejuvenation By Zein E. Obagi. Springer Verlag, New York, 2000. ISBN 0-387-98469-0. Pp xvi + 300; ill. Price s US$195.00.

Dr Obagi, a dermatologist from Beverly Hills, USA, has devel- oped the 'Obagi Skin Restoration Programme' for skin rejuve- nation. He describes it in this elegant book with beautiful illustrations in colour and very clear tables.

The book is in A4 hardback format with 300 pages and 196 illustrations. It has 11 chapters and a clear index. The first two chapters are dedicated to the anatomy and physiology of the skin and the concepts of skin health and photo-ageing. He presents his clinical objectives for skin conditioning and skin-health restoration using didactic, well-designed tables. Tretinoin, alpha hydroxy acids and de-pigmenting agents used for skin restoration are described clearly, including their mecha- nism of action, histological results and side effects. Chapter 4 describes Dr Obagi's skin classification system, which takes into account the pre- and postoperative skin condition and reaction to treatment as well as his skin colour types and their stability during treatment.

His skin corrective treatment affects the epidermis by exfo- liation, control of keratinocyte and melanocyte function. The

P L A S T I C S U R G E R Y

stimulating treatment affects the dermis by regulating fibroblas- tic activity, improving circulation and increasing collagen pro- duction. The programme ranges from aggressive to standard by varying the concentrations of tretinoin and the frequency of application. The tables explaining the expected reaction are clear and well presented.

The book has a good chapter on chemical peels, both tradi- tional and the Obagi modified TCA peels, which include the blue peel and the controlled-depth peel. The blue peel has a fixed concentration of 15-20% TCA with added blue colour base, which leads to slower skin penetration, giving time to observe the depth signs and increasing the safety margin of the peel. The depth of the blue peel is limited to the papillary der- mis or reticular dermis. The controlled-depth peel reaches the upper or mid-dermis and can be used on black skin as it does not damage the melanocytes. It uses 25-40% TCA modified by a saponin component, which slows penetration.

The discussion on complications is honest with useful tips about their management. This book is very much Obagi's per- sonal view on skin health. It is well structured with extensive and useful references. I would recommend it both to dermatolo- gists and to plastic surgeons interested in skin rejuvenation.

DALIA V. NIELD MB, ChB, FRCSEd Consultant Plastic Surgeon,

149 Harley Street, London W1N 2DE, UK.

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