Chemical peeling is the application of a liquid agent to the skin resulting in dissolution of the portions of the epidermis or dermis with subsequent regrowth of new tissue. Chemical peels have been used for many years by dermatologists and cosmetic surgeons to battle the signs of aging skin. Chemical peels may give the skin an improved texture, may decrease the fine lines and wrinkles, and provide a more even color. In those patients with many actinic keratoses (pre cancers), these will peel off, and thus, future skin cancers may also be prevented.
Chemicals that have been used include: Jessners; Salicylic Acid; Lactic Acid; Retin-A; Glycolic Acid; Tricloracetic Acid (TCA); and Phenol. Unfortunately, chemical peels are not covered by insurance.
What type of skin conditions will potentially respond to chemical peels?
- Aging or “crepey” appearing skin
- Sun damaged skin
- Precancerous patches
- Blotchy or discolored skin
- Melasma or (hormonally induced skin discoloration)
- Freckled skin
- Superficial scarring of the skin
- “Liver spots”
The type and strength of peel used depends on many factors, which may include: the patient’s normal skin color, the condition being treated, the age of the patient, the depth of peeling desired and how much downtime the patient can tolerate. A medium depth peel (combination peel) will provide quicker results after one peel, whereas a light peel (superficial peel) will take months with 5-6 peels needed for desired results. The medium peel causes peeling, redness, and flaking for about a week, whereas the lighter peels cause redness and flaking for only a couple to a few days. Most patients achieve better results with a peel after they have used Retin-A for at least a month. If treating brown patches on the face, or if a patient has an olive skin tone, he or she will need to use a prescription bleaching cream two weeks prior to each treatment to avoid a reactive hyperpigmentation after the peel. As with most procedures, results are variable and depend on the patient’s post procedure care and rigid sun protection.
Can chemical peels be used in areas other than the face?
A light chemical peel can be performed on areas such as the neck, chest, arms, and hands. In general, most chemical peels are performed on facial skin. Both men and women are candidates for chemical peels.
Are there patients who should not have a chemical peel?
There are certainly people who are more at risk for complications of a chemical peel. Darker skin tones and African American patients run more of a risk of having pigmentary alterations (either light or dark discoloration) and possible scarring than do fair skinned patients. Patients who have a history of keloids or unusual scarring are at increased risk after a chemical peel for scarring. Chemical peels are not performed on patients who have been on Accutane therapy within the last year. Whether or not you are a good candidate for a peel and the strength of peel that best fits your goal will be determined on your initial consultation.
How is a chemical peel performed?
The face is initially cleansed thoroughly with an antibacterial cleanser after all make-up has been removed. A ‘degreasing” agent (acetone mixture) is then applied to completely remove all skin oils. Following this, the chemical is applied to the skin with cotton swabs or gauze. There may be several layers applied. Frosting of the skin is seen at a certain point, and the peel is stopped. Burning is common for a brief period of time during the procedure. A fan or ice packs are put on the skin for comfort. The white frosting may persist in deeper peels for 15-30 minutes or more, but in all cases this is replaced by redness of the skin similar to a sunburn.
How much pain is involved with a chemical peel?
Most chemical peels (excluding phenol) do not cause any postoperative pain or discomfort. Depending on the strength of the chemical peel, most patients experience varying degrees of stinging and burning, all which resolve within 15-30 minutes of the procedure.
What happens in the days following the application of a chemical peel?
After leaving the office, the face is generally red, appearing similar to a sunburn. Depending on the depth of the peel, the skin will either exfoliate and peel on a day to day basis, or will become very dark and tight feeling, and will peel in sheets. In light peels, a small to moderate amount of skin comes off on a day to day basis and resolves in 4-5 days. In deeper peels, the skin darkens after a few days and then peels off in sheets over the next week.
What are the complications of a chemical peel?
The most common complications of a chemical peel are alteration in skin pigment, especially increased pigmentation of the skin, for a variable length of time after the peel. This increased pigmentation usually temporary and resolves over several weeks or months. Occasionally it may persist for as long as a year, but rarely is permanent. There are creams which may be used to reduce this complication. Most fair skinned individuals have returned to their normal skin color in a couple of months. Interestingly, chemical peels are also used to treat such discolorations. Women on estrogen therapy or who have olive skin tones have greater risk for increased pigmentation after a chemical peel. Please let us know if you have ever had a cold sore/fever blister as the peel can reactivate the virus. If you are getting a medium strength or stronger chemical peel, we will treat you prophylactically with an antiviral (Valtrex) starting one day prior to your procedure.