A chemical peel can revitalize and resurface skin. It can treat wrinkles and fine lines around the eyes and mouth, sun spots, age spots, freckles, blotchy skin, mild scarring, certain types of acne, pre-cancerous keratoses and scaling patches. Chemical peels cannot, however, remove loose or sagging skin, halt the aging process, change pore size, remove deep scars or broken blood vessels. The different types of peels penetrate to different levels and, consequently, produce different results, but all are similar in that they involve applying a chemical solution to remove the damaged outer layers of skin and allow newer layers to replace the old ones. The deeper a peel penetrates, the more profound the results but the more lengthy the recovery period. Chemical peels can also prove to be an excellent additional treatment following more extensive procedures like a facelift, brow lift or eyelid lift.

Most peels can be performed on the face, neck, chest, hands, arms and legs. Peels vary in intensity and depth depending upon the type and strength of chemical used. Your physician may choose to use a combination of chemicals for your procedure, in effect, tailoring the treatment specifically to your skin type and its needs. Your individual skin type, the condition it is in and the severity of the unevenness or wrinkling will allow your physician to determine which of the following types of chemical peel is appropriate.

Superficial Peels use mild chemical solutions like alpha hydroxy acids (AHAs), glycolic acid , lactic acid, salicylic acid, trichloroacetic acids to lightly peel skin. These peels are so called “lunch hour peels” because there is almost no recovery involved but they must be done repeatedly to maintain results over time.

Medium peels or Trichloroacetic Acid (TCA) Peels can correct pigment problems, superficial blemishes, moderate sun damage, fine lines and weathered skin. TCA peels sometimes require two or more treatments, spaced out over weeks or months, to achieve the best results. The Obagi or “Blue Peel” is a commonly used brand of TCA peel.

Phenol (carbolic acid) Peels are the deepest peels and use the strongest chemical solutions. These are usually one-time procedure and produce the most dramatic, long-term results. They are used to treat wrinkling, brown age spots, mild scarring and pre-cancerous growths. Because phenol peels result in permanently lighter skin, they are not recommended for most patients with very dark skin tones and require that sunscreen be used at all times afterwards.

What happens during the procedure?

The treatment begins with cleansing the skin and removing all traces of grease with rubbing alcohol or acetone. The face is then rinsed with water and blown-dry with a small fan. The physician applies the chemical peeling agent so that all areas of the skin to be treated are covered evenly. A grey-white film, referred to as “frost”, develops on the skin by the end of the application. The peeling solution is left in place for a few minutes and then thoroughly removed with water.

AHA peels are performed in the physician’s office and require no sedation or anesthesia. The process usually takes 10 to 15 minutes and although your face may seem a bit red, you can resume normal activities right away. You can expect the redness to be followed by temporary flaking, dryness and scaling until your skin adjusts to the treatments.

TCA peels are performed in the physician’s office or in an out-patient surgery center. No anesthesia is necessary because the chemical solution actually numbs the skin but you may be given a sedative prior to the treatment. You may feel a warm or burning sensation which is followed by some stinging. Your physician will control the depth to which the chemical penetrates but a full-face treatment should only take about 15 minutes.

Phenol peels are usually performed in an outpatient surgical center, either operated by your physician or a hospital facility. If you are having another procedure, such as a facelift or eyelid lift at the same time, then overnight hospitalization may be required. No anesthesia is necessary because the chemical solution actually numbs the skin. A full-face, deep chemical peel requires a sedative prior to the treatment and an analgesic given intravenously during the procedure. You will be monitored with an EKG during a deep chemical peel. You may feel a warm or burning sensation which is followed by some stinging. A full-face phenol peel generally takes one or two hours, while a phenol peel to a smaller area on the face, such as the upper lip, may take only 10 or 15 minutes.

Are there risks or potential side effects?

As with all elective procedures, there is always a possibility of complications including infection, scarring, temporary or permanent color change in the skin and uneven pigment changes. Phenol may pose a special risk for patients with a history of heart disease and any peel carries the risk of cold sores in persons who have a history of recurring fever blisters or herpes.

Before you undergo a chemical peel, tell your physician if you have a history of cold sores, a tendency to scar unusually, a family history of heart problems, or have undergone radiation or numerous x-rays to the face. Be sure to ask your physician about all of the risks associated with the procedure you are considering before you make any decision.

It is important to note that Asians tend to have a darker skin tone than Caucasians, and as a result, have a different set of complications caused by skin peels. Asians are at a higher risk for hyperpigmentation of the skin (darkening of the skin). Although there is a risk for scarring in Asians who elect to have medium to deep chemical peels, they are at no greater risk than Caucasians when opting for superficial peeling. It is recommended that Asians make sure that they see an experienced physician who has performed chemical peels on Asians, and who is aware of how to treat such skin types.

What to expect post-procedure?

Your physician may recommend a soft diet and suggest that you take it easy and try not to talk too much for a few days. A mild pain medication may also be prescribed. Swelling and crusting of the skin are to be expected. You may be given an ointment to apply to your skin for seven to 10 days following the peel to keep it supple and to help in healing.

At the end of a phenol peel, the treated skin may be coated with petroleum jelly or a dressing, which will be left on a day or two. The treated area will be very swollen. If you have had your face peeled, your eyes may swell shut and you will need to have someone to care for you for 48 hours after the procedure.

How soon does normal life resume?

A TCA peel usually results in swelling and blisters that scab over. Most patients can resume their normal activities in a week to ten days when the rawness has subsided and new skin has emerged. The TCA peel does not lighten the skin, so your skin will still be able to produce pigment again, i.e. tan. It is important, however, that you avoid sun exposure for several months after the peel to protect the newly formed layers of skin. Chlorinated pools should be avoided for a month or so. Daily use of a sunscreen with both UVA and UVB protection is essential. We all know that the sun damage and ages skin prematurely, even more so when a new layer of skin is exposed to it.

With a phenol peel, new skin will begin to form in about seven to ten days. Your face will be very red at first, gradually fading to a pinkish color over the following weeks. After about two weeks, your skin will be healed enough that you can resume normal activities and begin to wear makeup. By the end of four weeks, the redness should fade to pink. To protect this delicate new skin, sunscreen must be used at all times so you do not end up with blotchy, unevenly colored skin. Again, avoid chlorine for a month. A deep peel can be a painful, emotionally difficult process to endure, but the end result is smoother skin that lasts for 15 years or more.

Who performs it?

Chemical peels are usually administered by a plastic surgeon, a dermatologist or an otolaryngologist (ENT).

Are you a good candidate?

As with all elective surgery, good health and realistic expectations are prerequisites, but if you want to reduce refine the texture and pigmentation of your skin without surgery, then a chemical peel may be appropriate, however:

• Your skin type and color, ethnic background and age will be factors in determining which type of peel is right for you.
• You must be free of active skin infections, including most kinds of acne and any type of cold sore, including herpes simplex.
• You must not have taken Accutane® for the previous 18 months at least.
• Darker skin poses special considerations due to increased risk of undesirable skin pigmentation changes. Black skin, Asian skin, and other dark complexions may become permanently discolored or blotchy after any skin-refinishing treatment.
• Make sure you are not prone to scarring problems such as keloids.
• Make sure your doctor is aware of any medical conditions or allergies you may have and any medications, herbal supplements or natural supplements you are taking (both prescription and non-prescription).
• Make sure you have a good understanding of the limitations of the procedure.

How to prepare for this procedure?

Your doctor will give you specific instructions to prepare for the procedure. You may prescribed medications to take prior to the treatment to prevent a bacterial infection or fever blisters (herpes simplex) and topical medications to prepare your skin and decrease the risk of post-operative pigmentation changes. You will be asked to limit your sun exposure at least a month before the peel. Here are some general guidelines to follow:

• You should wear loose clothing that to put on over your head.
• You should refrain from wearing makeup, wearing any perfume, and shaving on the day of treatment.
• Avoid aspirin, any aspirin containing medication or any other non-steroidal anti-inflammatories (NSAID), such as Motrin® or Advil®, for two weeks prior to treatment. Because aspirin thins the blood, it can interfere with normal blood clotting and increase the risk of bleeding and bruising.
• Smoking inhibits the healing process, so stop smoking before your procedure and if you start again, make sure it is after you are completely healed. Besides, smoking increases muscle activity and can contribute significantly to wrinkles.

Are there alternatives to this procedure?

Alternatives to chemical peels include dermabrasion, laser skin resurfacing , and injectable fillers like collagen, etc.. Although chemical peels can have a rejuvenating effect on the skin only a surgical procedure like facelift, eyelid lift or a brow lift can actually tighten sagging skin. Finally, vitamin A, glycolic acid and other topical treatments, known as “skin polishers”, stimulate generation of new skin from underneath and promote filling in of wrinkles and depressed acne scars. These preparations are often used to pre-treat the skin before administering a peel or other resurfacing treatment.

Anything else you need to know?

A “Parisian Peel” is not a chemical peel at all. In fact, it is a brand of microdemabrassion which uses fine crystals, sprayed on in a very fine stream to exfoliate the outer layers of skin, which are vacuumed away. Although it has some effects on skin texture they are very subtle compared to a peel. This is not considered as having any lasting or permanent results and must be repeated frequently.

Another peel which is known by a brand name is the Obagi Blue Peel. This is a TCA-type peel formulated by dermatologist Zein E. Obagi, M.D. A blue coloring is added to the chemical solution to allow for even distribution, slower release of the solution to help reduce irritation, and slower penetration of the chemicals resulting in less of a burning sensation. For deeper exfoliation, an additional number of coats of the chemical can be applied during the procedure. The Blue Peel procedure can be repeated every four to six weeks.

The BioMedic MicroPeel is a type of light AHA peel in a three-step process that takes around 20 minutes. The treatment involves exfoliation of the skin then the alpha hydroxy acid is applied and last carbon dioxide is applied to cool the skin.