Chemical Peels

Every year, millions of chemical peels are performed. Chemical peeling is a skin rejuvenation technique that has been used by physicians for decades. We are dedicating this month’s newsletter to a thorough discussion of chemical peels.

What is a chemical peel?

A chemical peel is a skin rejuvenation technique designed to improve the appearance of the skin. During a chemical peel, a solution is applied to the skin surface, causing the surface cells to separate and peel off, thus allowing new skin to regenerate. The new skin is generally smoother and less wrinkled. Following a chemical peel, the skin color may also be more uniform.

What can a chemical peel accomplish?

Chemical peeling can be used to treat fine lines, especially around the eyes and mouth, and the wrinkles that result from sun damage. Chemical peeling can also be used to improve the skin’s color. Thus, sunspots, age spots, and the blotchiness that can occur with birth control pills or pregnancy (melasma) can all be improved by chemical peeling. In addition, the pre-cancerous skin changes that result from excessive sun exposure (actinic keratoses) can also be improved with a chemical peel. The procedure can also be used to improve acne and to treat mild scars that were caused by acne. A chemical peel will make dull appearing skin appear more vibrant and revitalized.

Who are the best candidates for a chemical peel?

The best candidates have fine lines and wrinkles with minimal skin sagging. They do not have severe skin excess. Patients with lighter complexions are preferred because there is less of a chance of the skin getting darker (known as hyperpigmentation) following the procedure.

What areas of the body can be treated with a chemical peel?

A chemical peel may be performed on the face, neck, chest, hands, arms, and legs.

Why are there so many different kinds of chemical peels?

Physicians have developed many different solutions for chemical peeling in order to provide patients with a choice of treatment options. With so many different peels available, the physician and patient can select a peel designed specifically for what the patient wishes to improve and the amount of downtime the patient can allow.

How do I decide which kind of chemical peel is best for me?

A peel should be selected based upon the type of skin condition that needs improvement. If the skin changes are confined to the upper layers of the skin, then a superficial peel will be effective. However, if the changes in the skin involve the deeper layers of the skin, then a deeper and more aggressive peel will be required to obtain improvement.

Which skin changes are superficial and which skin changes are deeper?

Changes limited to the superficial layers of the skin include increased skin pigmentation and a roughened skin texture without wrinkles. When the textural changes include wrinkling around the eyes and mouth, the changes in the skin have extended deeper into the skin. The most severe changes in the skin include generalized deep wrinkling with a leathery appearance and feel to the skin. These changes imply still deeper damage to the skin.

What are the different types of peels that are available?

Superficial peels are commonly performed with either TCA (10-25%) or Jessner’s solution. Salicylic acid can also be used for superficial skin peeling. It has been used for decades and is a good peeling agent for patients who also have acne. Alpha hydroxy acids, such as glycolic acid at 30-50%, are also commonly used for superficial peeling.

Medium depth peels are usually done with TCA (35-50%), glycolic acid (70%), or 35% TCA augmented with Jessner’s solution or with glycolic acid.

Deep chemical peels are generally done using phenol. Deep peels are only done in individuals who have significant changes in the skin, and have deep wrinkles. As a general rule, the deeper the peel, the longer the healing time. Thus, full face deep chemical peels will have the longest healing time, and the redness can last for as long as six months. In addition, deep chemical peels have a higher incidence of temporary and permanent pigmentation changes. For these reasons, relatively few deep chemical peels are performed today.

Due to the increased risk with deep chemical peels, many patients prefer to undergo repetitive superficial and medium depth peels. By repeating their peels, patients obtain additional improvement that is far beyond what only one lighter peel can accomplish.

How long is the recovery period following a chemical peel?

A superficial peel has a recovery period of a few hours to a few days, depending on how aggressive the treatment was. Recovery from a medium depth peel generally takes about one week. A deep chemical peel will take from several weeks to several months to completely recover.

Is a chemical peel a painful procedure?

Generally speaking, a light to medium depth chemical peel is not painful. Most patients experience a warm to somewhat hot sensation that lasts for five to ten minutes. This may be followed by a mild stinging sensation. However, a deep chemical peel may require pain medicine during and after the procedure.

When is chemical peeling not indicated?

Wrinkles that occur during muscle action (known medically as dynamic wrinkles), deep scars, and skin sagging due to aging are generally not improved with chemical peeling. For this reason, other procedures should be used to treat these problems.

How do I know if I am a good candidate for a chemical peel?

If after reading this newsletter you believe you might benefit from a chemical peel, please feel free to call our office and make an appointment to see Dr. Amerian. Dr. Amerian will give you good advice as to what rejuvenation techniques she feels would be best for your unique skin condition.