The ABC's of Chemical Peels
The variety and effectiveness of chemical peels make them one of the most important tools in skin rejuvenation and the treatment of wrinkles, scars, and skin discoloration.
Chemical peels refer to the application of different types of chemicals to the skin in order to peel the outer layers of the skin. The use of chemical peels for a more youthful look dates back to ancient times and is based on the observation that certain chemicals, such as fruit acids, when in contact with the skin, result in “exfoliation”. In addition to skin rejuvenation, there are many other indications why a physician may recommend a chemical peel. These include the removal of sunspots and other discolored lesions, the treatment of acne and acne scars, and decreasing the appearance of fine lines and wrinkles.
Depending on the type, strength, and concentration of the chemical used, peels are divided into superficial depth, medium depth, and deep peels. The physician will discuss the indications of each and recommend the most appropriate peel.
- How are chemical peels performed?
In general, the face or any area being treated should be thoroughly cleaned because any debris on the surface of the skin may interfere with the uniform contact and penetration of the chemical. Make-up is first removed, and the area is washed with a gentle cleanser. Then any remaining residue is removed with a solvent, which is usually acetone.
The physician may decide to prescribe an antibiotic or other medication to be taken a few days before the peel. This part of the treatment is especially important in patients who have had a history of cold sores on the face. The next step is to apply the chemical peeling agent.
Almost all types of chemical peels result in a burning or stinging sensation on the skin. The degree of burning depends on the type of peel used and is usually more intense with deeper peels. For almost all types of peels, anesthesia is generally not required, and the degree of burning can be tolerated by patients. The use of a fan is usually enough to relieve the excess sensation. The exception may be the phenol peels in which the physician may decide to administer a local anesthetic or prescribe sedation.
- Main groups of chemical peels
Alpha and Beta-Hydroxys Acids/ Fruit Acids: The most commonly used acids in this category are glycolic acid and salicylic acid. They are available in different strengths, and many skin aestheticians regularly and effectively use the lower concentrations for the purpose of exfoliation. In fact, because these peels are superficial peels, they are mainly used for the purpose of skin rejuvenation.
Trichloroacetic Acid (TCA)/Jessner’s solution: These peels are usually considered medium depth peels; although at higher concentrations, the TCA peel may cause deep peeling. Their main use is for skin rejuvenation, removal of fine lines and wrinkles, and the treatment of a variety of skin darkening and discoloration, including those caused by the sun (sunspots).
Phenol: This chemical, when carefully mixed with certain other ingredients by the physician, can be extremely beneficial in treating facial wrinkles, such as those around the mouth and eyes, as well as skin discoloration.
- What to expect after the chemical peel
A patient may notice moderate to severe redness (depending on the strength of the peel) because the chemical peel has removed the outer layers of the skin. Because the goal of any peel is to generate new healthy skin, the care given to the skin after the peel is extremely important. First and of utmost importance is keeping the peeled area well moisturized at all times. This practice will create a healthy environment in which the new skin cells will flourish. Secondly, avoid exposure to continued sunlight for a period of a few weeks. The color or pigment cells in the new skin environment are sensitive, and in response to ultraviolet radiation in sunlight, can potentially produce more pigment than normal. This side effect results in a darker colored patch of skin known as “hyper-pigmentation.” This darkened skin can usually be treated with bleaching agents. The physician will emphasize the importance of sun light avoidance and may also recommend the use of sunscreens. Also make sure to continue any medications that were prescribed.
- How long do the results last?
The greater the strength and depth of the peel, the longer the results will last. In fact, because superficial peels usually result in mild exfoliation, some patients receive these peels frequently (every 2-3 months) to maintain a “glow” from their skin. The effect of the deeper peels lasts much longer, and they are performed less frequently.
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"The ABC's of Chemical Peels"
Dr. Mendelsohn is the Medical Director of the Advanced Cosmetic Laser and Surgery Center in Cincinnati, Ohio. He specializes in facial plastic surgery and is double board certified by the American Board of Facial Plastic and Reconstructive Surgery. D...