Skin Care: Chemical Peels

Chemical peels are one of the most commonly used techniques for improving the appearance and texture of the skin. The procedure destroys parts of the skin in a controlled manner so that new skin can grow in its place. The types of chemical peels differ based on the type of chemical solution used and how deeply the chemical penetrates. There are three basic types of peels; superficial, medium and deep.

Superficial peels are the mildest type of chemical peel, can be used on all skin types, and can be done on the face or on other parts of the body. Superficial peels are used to improve the appearance of acne scars, mild sun damage, fine wrinkles, or the appearance of pigment changes in the skin. They may also be used to prepare the skin for a deeper peel.

First, the skin is cleaned. The chemical is then applied to the skin with a small brush, cotton-tipped applicators, or gauze. Superficial peels use a liquid containing mild acid, most often glycolic acid. Dry ice is also sometimes used. The chemical is left on the skin for two to seven minutes, depending on the type of chemical. Water is often used to neutralize the acid and end the chemical reaction, and then wiped off.

Superficial peels do not require anesthesia, are done on an outpatient basis, and cause only slight discomfort. The skin may turn pink, but heals quickly, allowing most people to return to their normal activities immediately. The results may not appear for some time, and when they do appear, may be minimal. In order to produce the desired effect, repeated peels are often needed.

Medium peels are most often used on the face and can be very effective in reducing fine wrinkles, signs of sun damage, and evening out pigment differences. This peel may also be used to treat precancerous lesions of the skin, as those usually caused by sun exposure.

The main peeling agent used for a medium peel is Trichloroacetic acid. The technique used is similar to that used for a superficial peel, but the 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 are absorbed deeper into the skin. Cool compresses and fans can be used to cool the stringing and burning caused by the chemical. A pain reliever and an oral sedative may be given to reduce pain and anxiety during the procedure, which usually takes about 20 minutes. Once the peel is finished, there is little or no pain.

Medium peels are usually done on an outpatient basis, but may require a few days off from work. A medium peel causes a second-degree burn of the skin which takes five to seven days to heal to a point where makeup may be used to hide the redness. There may be some swelling, especially if the area around the eyes is treated. The skin will turn reddish brown in two to three days, become crusty, and then flake and peel over the next several days. To produce the best effect, retreatment is often needed after three to six months.

Deep peels result in more dramatic effects as well as higher risks, increased pain, and longer healing time. They are done only on the face and are used to treat severe wrinkles, pronounced pigment changes, long-term sun damage, and lesions and growths of the skin. Deep peels are not done on darker skin types because they tend to bleach the skin.

Deep peels penetrate several layers of skin using a chemical called phenol. The procedure for a deep peel is also more complicated than for the other types of peels. An oral sedative and pain reliever, often in the form of a shot, may be given. Also, because phenol is toxic when absorbed into the body in large doses, a heart monitor and intravenous IV fluids may be necessary during the procedure. If only a small area is being peeled, this precautionary measure may not be necessary. Deep peels using phenol can rarely cause more severe complications during the procedure, including heart, liver, or kidney failure.

After the skin has been cleaned thoroughly, the chemical will be applied to one area of the face and allowed to penetrate. After one area is treated, there will be a 15 minute break before the next area is treated to avoid too much phenol being absorbed into the body. Depending on the size of the area being treated, the entire procedure may take 60 to 90 minutes.

A deep peel causes a second-degree burn of the skin. Some people have severe swelling, especially around the eye area. The skin remains extremely red and tender for up to three weeks with skin regrowth beginning within 10 to 14 days after the peel. Complete healing may take several months.

Oral pain relievers may be given after the peel, along with a short course of antiviral and antibiotic medications to prevent infection. Showering several times a day to reduce crusting may be recommended by your doctor, along with returning for office visits to have wounds cleaned and checked. In most cases, a deep peel can only be done once.

New skin is more susceptible to discoloration and damage from sunlight. During the early healing period after a chemical peel, avoid sun exposure. Once the skin has finished peeling and the early healing period has passed, wear sunscreen every day and limit sun exposure as much as possible.

Before you decide to have a chemical peel, talk to your doctor about the kind of results you can realistically expect to achieve. Your doctor can help you decide what depth of peel and what type of chemical solution is most appropriate for your skin type and the desired outcome. A small ‘test spot’ may be peeled to get a better idea of the results, especially for people with darker skin.