In a chemical peel, a chemical solution is applied to the skin and allowed to soak in. Over the next 1 to 14 days, depending on how deeply the chemical penetrates the skin, the skin peels off. This procedure destroys parts of the skin in a controlled way so that new skin can grow in its place. The chemicals used are sometimes called exfoliating or wounding agents. The types of peels differ based on how deeply the chemical penetrates and what type of solution is used. Things that may affect the depth of a peel include the acid concentration in the peeling agent, the number of coats that are applied, and the amount of time allowed before the acid is neutralized. Deeper peels result in more dramatic effects as well as higher risks, increased pain, and longer healing time. There are three basic types of peels:
- Superficial peels are the mildest type of chemical peel and can be used on all skin types. Superficial peels usually use liquid containing a mild (dilute) acid, most often glycolic acid. Superficial peels are done on an outpatient basis, do not require anesthesia, and cause only slight discomfort afterwards. Most people can return to their normal activities immediately. The skin heals quickly after treatment. The skin may turn pink, and usually only minimal peeling occurs.
- Medium peels penetrate the skin deeper than superficial peels. Trichloroacetic acid (TCA) is the main peeling agent used for medium peels, though the peel may also be done in several steps using a different chemical solution followed by TCA. Medium peels are usually done on an outpatient basis, but you may need to take a few days off work to recover. The skin usually takes 5 to 7 days to heal. There is little or no pain after the peel, but there may be some swelling. The skin will turn reddish brown in 2 to 3 days, become crusty, and then flake and peel.
- Deep peels penetrate several layers of skin and cause a second-degree burn. They are used only on the face. A chemical called phenol is usually used for a deep peel. Deep peels may not be used on darker skin types, because they tend to bleach the skin (due to hypopigmentation). Skin regrowth takes between 10 to 14 days after a deep peel. The skin remains extremely red for 3 to 8 weeks. Complete recovery may take several months. A deep peel can be done only once in most cases.
Which type of peel is right for you?
Your dermatologist can help you decide what depth of peel and what type of chemical solution is most appropriate, based on your skin type, which areas you want peeled, what kind of results you want, how much risk you are willing to take, and other issues. A small “test spot” may be peeled to get a better idea of the results, especially for people who have darker skin. Two to three weeks before the peel, you will need to begin preparing your skin by cleansing it twice a day, applying a special moisturizer or cream once or twice a day, and using sunscreen every day. In some cases, daily use of tretinoin (Retin-A), a topical medicine usually used to treat acne, is also recommended and may speed healing. This skin care regimen will help the skin peel more evenly, speed healing after the peel, and may reduce the chance of infection and other complications, especially uneven color changes in the skin.
Details of the procedure
The skin is thoroughly cleaned right before the procedure. The technique used to do a medium peel is similar to that used for a superficial peel, but the applied chemical may be left on for a longer period of time. Medium peels are more painful than superficial peels, because the chemicals are stronger and they soak deeper into the skin. You may be given a pain reliever and an oral sedative to reduce pain and anxiety during the procedure. Cool compresses and fans can be used to cool the stinging and burning caused by the chemical. The procedure takes about 40 minutes. There is little or no pain after the peel is finished.
Deep peels take the most time and are the most painful type of chemical peel. The procedure for a deep peel using phenol is also more complicated than for other types of peels. These types of peels should only be performed by specialized surgeons.
Recovery time after a chemical peel depends on the kind and depth of the peel performed. With all types of peels, proper skin care after the peel is very important to speed healing, help results last longer, prevent infection, and avoid color changes in the treated area caused by sun exposure. The daily regimen includes:
- Cleansing the skin frequently with water or a special wash.
- Changing the dressing or ointment on the wound (for medium and deep peels).
- Moisturizing the skin daily.
- Avoiding any sun exposure until peeling has stopped and sunscreen can be used. After peeling has stopped, sunscreen should be used every day. New skin is more susceptible to sun damage.
The results of a chemical peel depend mainly on the depth of the peel:
- A superficial peel may slightly reduce but does not eliminate sun damage and signs of aging. The results may not appear for some time, and when they do appear, they may be minimal. Repeated peels are often needed to produce the effect the person wants.
- A medium peel can be very effective in evening out pigment differences and in reducing fine wrinkles and signs of sun damage. Re-treatment may be needed after 3 to 6 months to produce the best effect.
- A single deep peel eliminates wrinkles and may tighten the skin. The effects are often dramatic. In general, a person cannot have repeated deep phenol peels.
Your skin type, skin care before and after the peel, the doctor’s level of experience, and your lifestyle after the procedure can also affect the results. Some types of skin problems respond better to chemical peeling than others. People with lighter skin who limit their sun exposure after the procedure tend to have better results than those who have darker skin and those who continue to spend lots of time in the sun. Changes in the color and texture of the skin caused by aging and sun exposure may continue to develop after a chemical peel. Chemical peels are not a permanent solution for these problems.
Which are the other existing options for skin resurfacing and how to make the right choice?
Chemical peel, dermabrasion, and laser resurfacing are the most commonly used techniques for improving the texture and appearance of the skin. Although these techniques use different methods, they have basically the same effect on the skin—they destroy and remove the upper layers of skin to allow for skin regrowth.
Neither one of these techniques is necessarily superior to the others. The choice of which technique to use is based on the site you want to treat, your skin type and condition, the doctor’s experience and your individual preferences. In my practice a combined approach, utilizing multiple procedures at once, has proven to achieve the best results. Clients that have strictly adhered to my treatment plan before and after the procedure, claim that the results we achieved are better than what they attained through surgery with less risk and downtime.