What Is a Chemical Peel?
Chemical peels are topically applied acids that help rejuvenate the skin surface. They create an even and controlled shedding of several layers of skin cells. This allows new layers to be exposed and creates a fresh appearance to the skin surface. In addition, new cells and collagen are stimulated, creating a more even tone.
A peeling agent is placed on the skin surface, creating a superficial type wound. The depth of the peel is dependent on the concentration and type of acid, the duration of contact, and a person s skin type and sensitivity. We perform superficial and medium depth peels, extending from the superficial epidermis to the top layer of the dermis (papillary).
We use Glycolic and/or trichloroacetic acid. These can also be combined or used with other agents to increase the depth of peel. A variety of other chemicals, such as phenol, can also be used for deeper peels, and may be quite helpful, but because of a higher risk of scarring, we do not use these.
A light-to-medium depth chemical peel is not a replacement for a facelift and cannot reverse the aging process. It can, however, create a fresher tone and healthier appearance to the skin. Specifically the following may benefit from a peel:
- solar damage
- blotchy hyperpigmentation
- fine wrinkling
- early actinic keratoses precancers of the skin
Although a peel may benefit all skin types, the following guide may help you:
- Type A no wrinkles, typically age less than 35, requires little make-up
- Type B wrinkles with motion only, such as smiling, typically age 25-45, sallow color with early actinic damage
- Type C wrinkles at rest, especially around the eyes, mouth and forehead, ages 30-65, discoloration, and blood vessel growth
- Type D severe, nothing but wrinkles
Patients with types B and C skin will usually find the most benefit from superficial to medium depth peels. These peels do not remove deeper wrinkles. Most satisfied patients have realistic goals, and are trying to make their external image correspond more to how they feel internally rather than look twenty again.
The skin must first be prepared. This may begin several weeks prior to the actual peel by the prescribed use of retinoic acid and/or glycolic acids. The peel begins by cleansing the skin thoroughly to remove all oil and debris. (no make-up should be worn to the office). The peeling agent is then applied evenly to the skin surface with Q-tips or with sterile gauze. This is then rapidly neutralized after several minutes with another solution. An antiseptic cream or emollient is then applied and you may leave the office without bandages.
With Glycolic acid peels, a burning gradually develops after several minutes. A fan and cool compresses may help. The neutralizing solution removes most of the burning sensation immediately after it is applied, though there may be several areas that continue to burn or sting over the next 24 hours. Glycolic acids are more of a superficial peel and because of this may need to be repeated several times over several weeks.
With the trichloroacetic acid (TCA), a more intense burning sensation is followed by a tightening sensation that lasts for 7-10 min. A fan and cool, wet compresses help alleviate much of this discomfort as well. Most patients do not require any anesthesia.
With Glycolic acid, most patients are somewhat reddened or flushed , which decreases over the next 24-48 hours. Occasionally patients will develop mild facial swelling. The area beneath the eyes is most sensitive to this, as well as the chin region. Some areas may even develop crusting and superficial scaling.
With TCA of medium depth, the inflammation and swelling are more intense. Initially the skin is whitened by the acid and then gradually turns red in approximately 1/2 hour. The face increases in redness over the next 24 to 48 hours and then peels similarly to the peeling after a severe sunburn. This lasts for 4-8 days and faint redness may persist for several weeks as the skin continues to rejuvenate.
Most patients with Glycolic acid feel fairly comfortable continuing with their daily routine. Some patients with deeper TCA peeling feel more comfortable at home, especially during the heavy peeling time, approximately the 3rd to 8th day.
A person s response to the chemical peel is variable and depends upon skin type, as well as the peeling agent. The goal initially is to keep the skin clean and moist. No dressing is required, but a thin layer of Bacitracin or Vaseline should be kept on at all times. (Showering gently or washing may be performed frequently, and the moisturizing agents should be applied afterwards.) The skin can be gently massaged, but the scales should not be peeled off vigorously. Both Retin-A and Glycolic or alpha-hydroxy acid moisturizers may be helpful.
Yes and no. And a lot depends on what you do. With sun exposure and time, further damage accrues. A regular program of sunscreens and sun protection will help. Retin-A and glycolic or alphahydroxy acid use may also prolong the benefits of a chemical peel. Dr. Monique Cohn or your physician will instruct you as to their proper usage.
Patients are usually very pleased with the results of peels and they have become quite popular because of their ease and relative lack of complications. However, as with any procedure, a small number of patients do have adverse outcomes. The most common include uneven pigmentation and, even more rarely, scarring. At Advanced Dermatology, we perform only superficial and medium depth peels and do not perform deeper peels which have higher risks. Sunscreen usage is mandatory after the healing is complete for at least six months. A person having a peel is making a commitment to improving their skin quality. Character and sun protection is part of this overall commitment.
