- It involves the use of an acid to rejuvenate the skin.
- It is best for those with sun damaged and/or wrinkled skin.
- The best peel occurs in light skinned patients who have been pretreated with medical grade skin care products.
- Chemical peels and laser treatments are two ways to achieve the same benefit.
- The most common areas of treatment include the face, neck and chest area.
- Chemical peeling is easily performed in an office setting.
- A chemical peel can be performed with or without the use of anesthesia.
- The actual treatment consists of the application of the acid to the skin until the desired effect is achieved. A stinging or burning sensation occurs while the acid is being applied.
- Recovery takes from 5 days to 2 weeks, depending on the depth of the peel.
- You will need to perform simple skin care during your recovery.
- You will look worse before you look better.
A chemical peel is a straight forward procedure. A medical acid is painted on the skin in order to cause the destruction of the outermost layers. The treated skin then flakes off (peels) in the coming days and new, youthful, pink skin appears. Treatment areas typically include the face, neck, and upper chest.
The chemical irritation results in a natural inflammatory response which thickens the epidermis, increases collagen deposition, reorganizes the structure of damaged skin, and increases the dermal volume (the skin becomes thicker after a chemical peel). The result can be very impressive, but some patients respond better to peels than others. The benefit of a peel is fewer wrinkles, smoother skin texture, even skin coloration, and a youthful “glow.” A peel does not “tighten” the skin as much as it improves the appearance and feel of the skin. A chemical peel is not likely to provide a “lift” that you would see as a result from a face lift.
Unlike the recent use of lasers to treat sun damaged skin, chemical peels have been used since the time of ancient Egypt. One of the major benefits of a chemical peel over laser treatments is the ability to treat a large area all at once in a simple and uniform manner, with results that blend in nicely and look natural, rather than “patchy.” Chemical peels have withstood the test of time because they work very well and they are predictable. You also get much more value for your money because peels are generally far less expensive than laser treatments. The cost of a laser service has to offset the huge expense of the laser itself. Most patients like the idea of getting more for less!
There are a variety of acids that can be used for a chemical peel. By custom, they are broken down into three groups based on their strength (the stronger the acid, the deeper the peel, the longer the recovery, and the greater the risk for potential complications):
Strong Peel. The most powerful peeling agent in use today is the Phenol peel. This is a very powerful peel that is used for deeper wrinkles and severely sun damaged skin. Potential risks include scarring and “bleaching” of the skin (the skin appears white and unnatural). Recovery time for this peel is the longest. I don’t offer this peel in my practice because I don’t see patients with such sun-damaged skin (thankfully!).
Medium Peel. The most common peeling agent in this group is the TCA or Trichloracetic acid peel. This is currently the only peeling agent that I use in my practice. This peel is best suited for patients with moderate sun damaged skin. Wrinkling of the skin is moderate to fine, the skin has lost all “luster” and there are often patches of different colored skin as well as freckles.
Weak Peel. This group of acid peels consists of Alphahydroxy Acid, Fruit Acid, Citric Acid, Lactic Acid and others. These weak peels are usually offered by Aestheticians when providing facials (“lunchtime peel”). These acids are not strong and the recovery from treatment is brief. They work best for people with relatively good skin, mild sun-damage, and very fine wrinkles. These peels are every day “workhorse” treatments for those who simply want their skin to always look its best. This is a good “maintenance” peel.
Who is a good candidate for a chemical peel?
Chemical peels work best on people with light colored skin. Those with darker toned skin are more prone to hyper-pigmentation issues after a chemical peel (the skin may appear darker or lighter in color than “normal”).
Patients with significant sun damage are also ideal candidates for a chemical peel. This skin appears freckled, blotchy, wrinkled, and discolored. The skin looks old, feels rough, and lacks a healthy glow. A good peel offers these patients the opportunity to clarify their skin and reverse the sun damage accumulated over the years. It’s a fantastic way to clean things up without surgery.
Who is not a good candidate for a Chemical Peel?
Anyone who has used Accutane in the past should not entertain a chemical peel. Accutane is used for severe acne and works by shutting down the skin glands that are needed during the healing process after a chemical peel. A chemical peel is also not recommended for those who plan to worship the sun, as the peel will sensitize the skin to further sun damage. Pregnant and lactating mothers should only consider weak peels. Those who have a known sensitivity to any peel should obviously avoid them. Anyone considering a peel should also not have any active infection on the skin (including acne).
Prep, Recovery & Risks
Preparing for a Chemical Peel
In order to ensure the safest peel and the best peel result, I recommend that patients “pre-treat” their skin for 4 to 6 weeks before having a chemical peel. My office carries the Obagi Medical skin care line that is well known as one of the best skin care product lines available. The chemical ingredients that provide the most benefit include Retin-A, light acids, and hydroquinones (a bleaching agent).
Patients who have pretreated their skin for 4 to 6 weeks before their peel show a greater and more uniform response following the application of the peeling agent. In addition, they appear to heal more quickly.
The Road to Recovery
A chemical peel is interesting in that it is a relatively simple, straight forward procedure, but the recovery can be difficult since it involves the face. We all tend to lead busy lives and prefer not to have to sit around while we recover—we have better things to do! However, healing from a chemical peel is a process, and the process takes time. Anyone undergoing a chemical peel must be patient during the recovery.
Recovery from a peel is not painful, but the skin must be tended to afterwards. This can be emotionally challenging, so the best way to make sure one copes with a peel is to know what to expect to see (hint: one’s face is going to look much worse before it looks better).
Patients should expect to look like they sunned at the equator for way too long or that their face got just a bit too close to the campfire. The tissues will swell and the skin will shed and flake. The skin will also feel very tight and somewhat itchy during the healing process.
It is important to accept a simple fact of chemical peeling—the greater the reaction to the peel, the better the result. This is a form of “no pain, no gain.” The issue here isn’t pain, but instead it’s swelling and peeling. Peeling is the prime indicator of treatment success. Multiple peels from a single treatment are not unheard of.
Gentle skin washes followed by the application of a soothing ointment are the duties of the day. Don’t tug or pull the flaking skin (it’s tempting!), and don’t scrub too hard when washing one’s face. The dead skin needs to come off on its own time. Additionally, don’t pick, poke, or prod the skin, as this can cause scarring.
New skin will grow from the bottom to the surface. The shedding of the dry skin typically occurs 3-5 days after a peel. Patients should be presentable in public about five to seven days after treatment. Makeup can be applied when the peeling has subsided. Expect a 7-10 day recovery from a TCA (medium) peel.
The new skin after a peel will be more sensitive than the “old” skin, so patients need to be gentle with cleansing and must make sure to use non-irritating skin care products in the months following a peel. Long-term use of bleaching agents and Retin-A will also help minimize the potential for pigmentation irregularities and preserve the benefits of the peel. As always, use sunscreen and use it properly.
The application of an acid to the face requires expertise and experience. The two main risks associated with acid peels are scarring and hyperpigmentation (the treated areas can develop a darker pigmentation after treatment). Scarring should be very rare (I have never seen it from my hands). Hyperpigmentation is often short-term and related to the individual’s response to the peel. It may take several months for this to resolve.
All patients are required to start an anti viral agent regimen several days before a peel and at least five days following a peel. This will help reduce the possibility of a viral (herpes) outbreak cased by the response of the skin to the chemical peel. This potential infection is the oral form of herpes virus, which is carried in almost 90 percent of the population, and unrelated to the genital form of sexually transmitted herpes. A bacterial infection of the skin after a peel is very uncommon.
Prolonged healing and firmer areas during recovery may mean a visit with the doctor is warranted. Topical steroids may be used to hasten the healing process and calm excessive inflammation.
If any questions or concerns arise about recovery, simply visit with your doctor. The vast majority of post-treatment visits are for reassurance only.
It’s very common for patients to forget what they looked like before their peel. Take a look at our results. We take before and after photos of results so patients can be reminded of the improvement. “Wow” is often heard from patients when they see the changes side by side in pictures.