Chemical Peels
Chemical peels are a wonderful way to improve and rejuvenate the skin of the face, hands, neck and upper chest.
What Is A Chemical Peel?
What Does The Procedure Involve?
A chemical peel is the application of certain chemicals in a controlled fashion to the skin requiring improvement. Usually these chemicals are mild acids which actually burn the skin to a variable depth depending on the strength of the acid applied and how long it is left on the skin. The layers of skin so treated actually peel away and new skin replaces it. In the deeper layers of the skin treated by a chemical peel, collagen is stimulated to form. It is the new collagen that reduces overlying wrinkles, depressions and scars.
A chemical peel is very simple procedure. Usually no anesthesia is used. The skin is first cleaned with acetone or alcohol. The chemical peeling agent is then wiped on with gauze or cotton tipped applicators and left on for a specified period of time. Some chemical peeling agents require the application of a neutralizing agent. Others such as TCA (trichloracetic acid), our preferred chemical peeling agent, are self-neutralized by the proteins in the skin. After the chemical peel is complete, some sort of cream or ointment is applied to the skin. There is usually a specific post-peel protocol to follow and antibiotics to take after deeper peels.
What Kinds Of Skin Conditions
Do Chemical Peels Improve?
Chemical peels can be used to effectively treat wrinkles, more superficial acne and other scars, skin pigmentation, sun damage, age spots, and other skin blemishes. In some cases a proper depth chemical peel can actually control and improve active acne.
What Different Types Of Chemical
Peels Are Commonly Used?
Chemical peels can be divided into superficial, medium-depth, and deep peels. The most common superficial peel is glycolic acid (45-70%), a naturally occurring acid found in certain fruits. This peel can be applied by a non physician and usually has a very short recovery time. As with any superficial peel, it is the least effective in correcting the above mentioned skin problems and must be repeated for sustained improvement. In our practice we do not do glycolic acid peels.
Medium-depth peels are the chemical peels we feel give the best results with the least expense and recovery time. We use a combination of two peels- an initial application of Jessner’s solution followed by 25-35% TCA – to achieve a medium-depth peel. Phenol peels are deepest of any peels available. Phenol achieves depths that exceed even the CO2 laser. As can be expected, phenol peels while offering the most dramatic results also have the longest recovery times and greatest complication rates. We do not perform Phenol peels.
Do Chemical Peels Hurt? Is Anesthesia Required?
Superficial and medium-depth peels burn intensely for a few minutes prior to neutralization. As the duration of discomfort is very short and well tolerated, they are usually done with no anesthetic other than our cooling device and /or pre-peel oral analgesic such as Advil. Our medium-depth TCA peel with Jessner’s solution burns for about 3-4 minutes before the TCA self-neutralizes. Deeper peels require formal local or other anesthesia.
What Is The Recovery Time After A Chemical Peel?
Recovery time varies with the depth of the peel. Our medium-depth 25-35% TCA peels with Jessner’s solution require about five days to heal to the point of being able to go out in public with make-up. Immediate post-peel care is minimal. Patients take antibiotics for four to five days, wash their faces and apply Vaseline to their skin four times a day for about two days. Afterwards, they have only to keep their treated areas moist with over-the-counter moisturizers.
Are There Any Complications With Chemical Peels?
The deeper the peel, the greater the greater is the potential for complications. Our TCA peels with Jessner’s solution are very safe and have few complications. The more common complications include persistent redness for as long as several months following the peel and increased pigmentation which almost always resolves. Infection, scarring and lose of pigment in the skin (hypopigmentation) while possible are exceedingly rare with peels. They are far more common with CO2 laser peels (CSR) and phenol peels.
What Are The Advantages And
Disadvantages Of Chemical Peels?
Our medium depth TCA peels are far less expensive, far less time consuming, far easier on the patient to undergo, and achieve in many cases nearly the same results as the CO2 laser. They also are much less demanding to heal than the laser. The CO2 laser cannot be used to rejuvenate the skin of the hands, neck, and upper chest without severe complications. The TCA peel can be used safely and effectively in these areas. TCA peels can be combined with our FotoFacial/RF treatments for wonderful skin rejuvenation.
Deeper wrinkles are not satisfactorily addressed with the medium-depth peel. And, as we consider the deeper chemical peel (Phenol) not worth the risks, we will often combine the TCA peel with Laser Skin Resurfacing to achieve the results we want. For instance, for many women, the wrinkles around the mouth are the deepest and most unsightly on the face. We will resurface the mouth area with the CO2 laser and use our TCA peel for the rest of the face. In doing so, we achieve desirable results with the minimum of healing time, expense, and complications.
Richard D. Fisher, MD
