Chemical Peel
What Is a Chemical Peel?
A chemical peel consists of the application of an acid to the skin which causes the destruction of the outermost layers of skin. New skin then grows which is healthier and even toned. Wrinkling and blotching of the skin is improved. I make the analogy to the use of wax on a dirty car. Wax the car the the new finish can change the appearance of the car tremendously. There are many different acids that are used in the peeling process, but ultimately they can be broken down into three categories based on their strength (the stronger the acid, the deeper the peel, the longer the recovery, the greater the risk of potential complications). It’s important to know that although acid treatment removes a layer of damaged skin, it does not thin the skin. The new layers that grow from the “bottom” are actually thicker and more youthful in appearance.
Category I is the Phenol peel. This is a powerful peel that is used for deeper wrinkles and severly sun damaged skin (when I was growing up I used to travel to Florida and see many people who looked like they had “leather” skin–is was dark brown and very wrinkled). This is a serious peel that has the potential for reversing severe sun damaged skin but not without significant risks such as scarring, a long recovery time and the potential to “bleach” the skin (the skin looks permanently white and unnatural). I don’t offer this peel in my office because I don’t have much experience with it and, frankly, patients have to go through quite a bit to recover from the peel injury.
Category II peel is a TCA (trichloroacetic acid) peel. This is a moderate strength peel that I perform fairly commonly. The most common indication for this peel is in those patients with moderate sun damaged skin, some blotching of the skin, hyperpigmentation and fine to moderate depth wrinkling. It is commonly performed in patients who have other procedures performed and they would like the benefit of this skin peel while they are recovering.
Category III peels consist of the light acid peels like Alphahydroxy Acid, Fruit Acid, Citric Acid, Lactic Acid and others. This is what is usually offered by your local esthetician when you get a “facial”. The acids are not that strong and the recovery from treatment is brief. These lighter acids work best for people with decent skin, mild sun damage and very fine wrinkles. These peels are every day workhorse treatments for all those who simply want their skin to look its best. This is a “lunch time” peel.
Your Options in Chemical Peels
There are very minor peels and there are deeper, more serious, peels requiring sedation and extensive recovery time. We will discuss the available options today so that you may make a well-rounded, informed decision. These peels can be used not only on the face, but on the neck. chest, back, arms, hands, etc. Anywhere you wish to rejuvenate or improve your skin.
- Alphahydroxy Acid:These peels help with fine, superficial wrinkles, sun damage, unevenness, white and black heads, pimples and splotchiness. These peels can also improve dryness and dehydrated skins. They aren’t very invasive and provide mild resurfacing results. They produce a mild rejuvenation without the extended downtime of a more invasive peel.
- Fruit Acids:There are five main fruit acids: citric acids (citrus-derived), glycolic (derived from sugar cane), lactic acid (although derived from milk, this is still considered a “fruit acid”), malic (derived from apples) and tartaric (derived from grapes).
- Citric Acid peels: Usually derived from lemons, oranges, limes and pineapples. These peels are simple and effective, although not incredibly invasive or capable of significant improvement with one treatment.
- Glycolic Acid Peels:formulated from sugar cane, this peel creates a mild exfoliating action. Glycolic acid peels work by loosening up the horny layer and exfoliating the superficial top layer. This peel also stimulates collagen growth.
- Lactic Acid Peel:An in-office 70%or less alphahydroxy facial peel to remove dead skin cells, and promote healthier, softer and more radiant skin. This peel is derived from either sour milk or bilberries. Cleopatra was said to bathe in asses’ milk.
- Malic Acid Peel: This peel is the same type of mildly invasive peel derived from the extracts of apples. It can open up the pores, allow the pores to expel their sebum and reduce acne.
- Tartaric Acid Peels: This peel is derived from grape extract and is capable of delivering the same benefits as the above peels. Have your skin technician determine which is best for your individual needs.
- Fruit Acids:There are five main fruit acids: citric acids (citrus-derived), glycolic (derived from sugar cane), lactic acid (although derived from milk, this is still considered a “fruit acid”), malic (derived from apples) and tartaric (derived from grapes).
- Jessner’s Peel:This is a medium depth peel designed for more extensive damage than AHA’s can improve. It is made from salicylic acid (a beta hydroxy acid), lactic acid (an alpha hydroxy acid) and resorcinol. Your surgeon or skin technician will apply a glycolic cleanser over your face to fully remove the oils and horny layer so that your Jessner’s solution will penetrate properly. Then he or she will apply the Jessner’s solution to your face, it will then burn slightly (although this uncomfortable sensation can be relieved by a fan blowing cool air on your treatment area). you may have several layers applied depending. You may develop a whitened look, known as “frosting” that will dissipate within a few hours. Then your skin technician will neutralize the acid and remove your solution with cool water. Your technician may apply a calming mask and you will be sent home. You will peel and flake for about 7 days and turn pink or brown afterwards. After you heal nice, smooth skin will be revealed.Do NOT ever pick or pull at the flaking or peeling skin, it can cause scarring or an infection which can spread all over your skin and cause scarring. Also moisturizing will lessen the benefits of the peel. Although extensive cracking an bleeding will not help. Moisturize these areas or apply a calming serum such as Neova Calming Green Tea Serum with Copper Peptide. This will heal these areas and lessen cracking and bleeding which can scar your newly uncovered skin, but may burn a little if you place it on raw skin — I use a fan to blow on it at first. Peeling or exfoliating your sensitive skin at this time can significantly scar your skin. This peel may be reapplied at 2-3 week intervals.
- The Obagi Blue Peel:In order to have the Blue Peel you usually have to go through one cycle of Obagi Nu-Derm to prep the skin. This will help prevent hyperpigmentations from forming from the peel.This type of peel is relatively new. Also developed by Dr. Zein E. Obagi, this peel is an in-office trichloracetic acid (TCA) peel to correct fine lines, superficial scars, minimal laxity and pigmentation problems. It is performed in 1 to 4 steps and is very beneficial to persons of all skin types. Usually more invasive peels are unfortunately suitable to only those of European Caucasian descent. With the Blue peel, persons of ethnic skin tones such Asian, African-America, Italian and other darker skins tones can safely undergo beneficial resurfacing.The solution is applied in 1 to 4 layers and left on the skin for 25 to 30 minutes. You may feel a slight burning or stinging sensation as each layer is applied which may last from 2 to 5 minutes. A fan will help you tolerate the stinging sensation — so request if this is used. The blue tint will darken and advise the skin technician when the peel is complete. The blue tinge that you get from this peel may last for up to 3 or 10 days, depending. So prepare to take off a few days for this one as well. This peel may be reapplied at 4 week intervals.
For the above peels, do NOT pick or pull at the flaking or peeling skin. Also moisturizing can lessen the benefits of the peel. Although extensive cracking an bleeding will not help either, moisturize these areas or apply a calming serum such as Neova Calming Green Tea Serum with Copper Peptide. This will heal these areas and lessen cracking and bleeding which can scar your newly uncovered skin. Peeling or exfoliating your sensitive skin at this time can significantly scar your skin. These peels may be reapplied at 2 week intervals.
Are You a Candidate for a Chemical Peel?
Depending upon the peel, you may be a candidate for a chemical peel if you have slight wrinkles, hyperpigmentations, splotchiness, unevenness, acne, acne scars, black heads or sun damaged skin. You may not be a candidate if you have oral herpes, as this can spread to your healing skin and cause great, weeping sores which will damage and scar your skin. For deeper peels which require sedation or extensive recovery, first and foremost, you must be in good health, not have any active diseases or pre-existing medical conditions and must have realistic expectations of the outcome of your procedure. Communication is crucial in reaching one’s goals.
Please do not hesitate to address any concerns that you may have during this time and even after your pre-operative appointment. If you remember something when you get home or the next day or even the day of surgery — don’t be afraid to ask.
Preparing for Your Chemical Peel
You will more than likely be asked to closely follow a skin care regimen which includes the use of AHAs, Retin A and Hydroquinone to prepare your skin and even out the skin tone itself. This makes the peel more effective as well as lessens the pigment and fades a tan by bleaching and skin cell turn over. This way you are less likely to hyperpigment after the procedure.
You will be instructed or given a high quality moisturizer, skin preparation lotions and sunblock which you will use as you heal afterwards to protect the newly uncovered skin from the harmful UV rays. The skin will crack and depending upon your instructions, peel and skin type you will either be asked to cover it with a thin layer of lotion or antibacterial ointment or allow it to dry, crack and fall away NATURALLY. So please adhere to your own physician’s or skin care specialist’s instructions. These steps are very important.
The Road to Recovery
You will feel as though your skin has a windburn or sunburn and will find that your skin is tight. Do not make excessive or widely exaggerated facial expressions. This can tearing of the skin and bleeding, hence — scarring. Just let your skin heal naturally and do not peel or tug on ANY skin that may peel from the face. You can cause excessive damage resulting in sever scarring if you do this. Below is a typical after care instruction sheet, please ask your physician or skin care specialist for your own specific instruction sheet.
- You will cleanse your face as usual but be instructed to use a gentle-formulated cleanser.
- You may be instructed to use a special moisturizing cream or lotion.
- Do not apply any type if glycolic acid or exfoliation products as this can severely damage or irritate the skin during the entire time of healing or the skin will become irritated.
- Avoid sun exposure if you can. Use a high SPF sunblock to help block the harmful UV rays.
- Do NOT peel, rub or scratch your skin at anytime, whatsoever. This WILL cause damage and compromise your results as well as possibly severely scar you.
- Let your surgeon or skin care specialist know immediately if you have a herpes break out. This can also result in severe and permanent scarring.
Important Contraindication of Chemical Peels
You should not have a chemical peel if you will continue to have excessive sun exposure. Active herpes simplex, warts, history of keloidal scarring (excessive ropey scarring where the collagen forms outside of the incision or cut area, Any type of recent facial surgical procedures. You should not have a chemical peel if you’ve used Accutane in the last year (which increases your chances of excessive scarring). If you are pregnant or lactating (although simple, superficial fruit acids may be acceptable, ask your physician). If you have any auto immune diseases, have had any recent radioactive or chemotherapy treatments — have sunburn, windburn or broken skin or have recently waxed or have recently used a depilatory such as “Nair®” or used “Vaniqua®.”
Risks & Complications of Chemical Peels
Do you have oral herpes? You MUST and seek a prescription for oral acyclovir — one brand name is Zovirax®. This is very important! Zovirax® can significantly decrease your chances of a break out. If you have a break out during your healing period, it can spread to your entire face and result in severe and permanent scarring.
Be careful of crusting or excessive weeping. In AHA peels you may think this is normal but there is a borderline appearance that you must watch out for. If for a typical AHA peel, you should feel and look normal within 3 to 4 days. For deeper peels your downtime may take weeks and then months for complete recovery.
Hyperpigmentations (excessive coloration) and hypopigmentation (lack of pigmentation) can be problematic of misdiagnosed skin types, failure to reveal any skin problems or ethnicity and improper post-peel care. Infection is uncommon but possible so keep an eye out for redness and pain.
Scarring is a problem if the above is experienced so please adhere to your post-peel instructions to decrease your chances of long term or permanent, visible signs of damage.
