Chemical Peels

senior-beauty“Chemical peel” is a general classification for a number of chemical treatments used to exfoliate and rejuvenate the skin. Typically during a chemical peel nothing actually “peels” off. A chemical solution is applied to the skin, and works by dissolving the upper layers of the skin. As the tissue is dissolved, a wound is created on the skin which stimulates the body’s healing response, causing new tissue to emerge. The depth and strength of the ‘peel’ varies based upon the strength of the chemicals used and the length of time the solution is applied.

Some chemical peels are so strong as to be able to remove the whole surface of the skin, in a manner similar to CO2 or Erbium lasers. These are the deepest forms of chemical peeling. These forms of peels have generally been replaced by laser treatment as laser provides a greater and more precise level of control to the practitioner. Most peels today are less destructive and more superficial.

What are the different types of Peels?

There are a variety of different types of chemical skin peels, as there are a variety of chemicals used, each with their own properties. Phenol peels consist of a deeper solution which may remove the upper layers of the skin. TCA (trichloroacetic acid) peels are another common peel which can vary in concentration. Glycolic acid and alpha hydroxy acid peels are also quite common, often sold for in-home use in lesser-strength concentrations than you can receive from a physician.

What kind of results do I expect from a chemical peel?

With a chemical peel you get some tightening of the skin, you get improvements of pre-cancerous and brown spots, and a general resurfacing of the skin. Made from naturally occurring acids found in fruits and other foods, alpha hydroxy acid (AHA) peels–or, at least, the main ingredients in them–have been popular for removing dead cells on the surface of the skin (thus smoothing and rejuvenating the skin). The lactic acid from sour milk is one of the acids used in modern AHA peels. Other popular AHA peels used citric acid (from citrus fruit) and glycolic acid (from sugar cane).

You can buy AHA products in drugstores and department stores, but these products are not permitted to contain AHA concentrations of more than 10 percent–too low to have much effect on the skin. Also, over-the-counter products usually have a high pH, or acidity, level, which further dampens their effectiveness.

Stronger concentrations of up to 30 percent can be used only by trained professionals, including aestheticians–preferably in a physician-supervised setting. And physicians alone are permitted to use drugs with the highest AHA concentrations–up to 70 percent.

How do AHA Peels work?

AHA peels essentially work by exfoliating the skin. They loosen and remove the layer of dead cells (keratinocytes) on the skin’s surface (the stratum corneum), thus revealing the smoother, healthier-looking layer below. Regular treatments can help with fine lines, brown marks and dry spots (solar keratoses). They also can help minimize acne scarring–and even help with the treatment of acne by stripping away the plugs where acne bumps can form.

AHA peels can be done not only on the face, but on the neck, chest, arms and hands. They’re often combined with microdermabrasion for even greater results.

What is a treatment like?

chem-peelThese “lunchtime peels” generally take 15 to 20 minutes. Your skin will be cleansed with acetone or isopropyl alcohol, and then the peel will be applied and removed. During the application of the peel you may experience a numbing and/or stinging sensation, but this effect is usually very mild. No anesthesia is needed.

For a day or two afterwards, your skin will appear slightly red and some flaking may occur–effects similar to those of a mild sunburn. But you can return to your usual daily activities immediately. You should use a sunblock for several days after treatment, since your skin will be more sensitive to the sun–and thus more susceptible than usual to sunburn.

What are the Side Effects of Chemical Peels?

Too-frequent use of alpha hydroxy acid peels can cause skin to become irritated and inflamed, particularly when the concentration of the acid is too high or left on the skin too long. And some people should not have AHA peels. These include people who are using the acne medication Accutane or who have active cold sores, as well as women who are pregnant. For these reasons, it’s important to received AHA peels in a physician-supervised setting, where you’ll receive care from trained professionals who know what questions to ask and how to perform the treatment safely and effectively.

What are the different types of Chemical Peels?

Glycolic acid, which is derived from sugar cane, is probably the most popular grade of alpha hydroxy acid (AHA) used by physicians for facial peels. Glycolic acid peels are effective, yet they tend to produce the minimum of side effects. Most of the glycolic acid formulations used by physicians contain acid concentrations of 50 percent or higher. (By comparison, over-the-counter cosmetic AHA products contain only 3 to 10 percent glycolic acid, percentages with questionable usefulness.)

How does a Glycolic Acid Peels work?

What should you expect from a glycolic acid peel?

Like other AHA peels, glycolic acid peels removes the top layer of dead cells on your skin, revealing a new layer that is smoother-textured and more vibrant-looking. These peels help with fine lines, minor skin discolorations (such as “age” spots), and dry patches known as solar keratoses. They’re also useful for treating acne and for removing or minimizing old acne scars. Glycolic acid peels are also believed to stimulate the growth of collagen, a protein that helps give skin its structure. The loss of collagen due to aging and sun exposure is one of the factors involved in the formation of lines and wrinkles. To increase the effectiveness of the peel, your physician may recommend that you combine it with another treatment that removes the top micro-layer of skin: microdermabrasion.

Trichloracetic acid (TCA)

How Does a TCA Peel Work?

Who is the treatment with TCA performed?

What are the Side Effects of TCA peels?

Trichloracetic acid (TCA) peels are considered medium-depth peels. They reach slightly deeper into the skin than alpha hydroxy acid (AHA) peels–and thus often produce stronger results.

These peels also have the advantage of being suitable for most skin types, including darker-toned skin. To avoid discoloration, however, people with dark brown skin need to follow a pre-treatment protocol that may include treating the skin with alpha hydroxy acids (AHAs) first. (Dr. Bolourian will explain this process to you during your consultation.)

Phenol Peel

How do Phenol Peels Work?

A Phenol peel is usually the strongest type of peel offered. It is generally used on very deep wrinkles and severely aged skin. There is also a risk of hyperpigmentation with phenol peels. Recovery times with a phenol peel are usually the longest of any peel, sometimes a week or longer. It is usually used on the face. The results with a phenol peel are similar to those of CO2 laser resurfacing.

What is the recovery time for chemical peels?

The recovery time for a patient who has had a chemical peel will depend on the type and strength of the peel they’ve had. For example, the common alpha-hydroxy and glycolic acid peels have little or no recovery time. There may be some slight pinkness to the skin, but that usually fades rapidly.

With the higher concentration peels, such as TCA or Phenol peels, you can have some peeling and irritation for a few days afterward. Very aggressive peels with very high concentrations can be more problematic. The post-treatment effects and recovery times can be similar to a total skin resurfacing with a carbon dioxide laser. Recovery from an extremely powerful chemical peel can take more than a week, requiring wound care. So the recovery time will vary depending on the type of peel, ranging from no recovery or downtime, to a week or more of downtime. You will have to discuss the strength of the peel and recovery time with Dr. Bolourian prior to treatment.

chem-peelAHA & Glycolic Peels

There is a risk of certain side effects from any chemical peel. AHA peels tend to be milder and the risk of side effects is usually just some mild redness and irritation following the treatment. If someone is using Retin-A or Retin-A like medications it will make a glycolic peel have a stronger effect, so you should tell your practitioner if you are using them.

TCA Peels

TCA peels will increase sensitivity to sunlight and avoidance of sun exposure is usually advisable for several months after the treatment. Wearing sunscreen is highly advisable following any chemical peel. There is also a risk of hypo and hyperpigmentation with TCA Peels, either a lightening or darkening of the skin.

As with everything in life, the greatest risks offer the greatest rewards. Phenol peels prove the point. Phenol peels offer great results for patients with high-levels of sun damage and wrinkling, however the risks are substantial. Scarring may result from a phenol peel, especially on parts of the body other than the face. In addition, pigmentation changes may also result. Risks such as infections, scarring, prolonged sun sensitivity and irritation are also possible. In addition, there are cardiac risks as well. As a result of their high level of risk, many physicians have largely replaced phenol peels with laser or other alternative treatment options, though some highly experienced providers still offer the treatment