Chemical Peels

What are the benefits of chemical peels?
Individuals likely to benefit the most from chemical skin peels are from 25 to 50 years of age with photodamage (e.g, sun spots, age spots, fine wrinkles, irregular skin texture) on the face and hands. Fair-skinned, light-eyed individuals with a lot of sun damage or wrinkles at rest benefit the most from peels. It is very unusual to see significant photodamage before 25 years of age. After 50 years of age, other skin aging factors decrease the benefit of peels. In addition, chemical peels are often useful for patients with acne or actinic keratoses; however, the acne or any kind of dermatitis should be treated and under control before undergoing a peel. Patients that fail certain other topical therapies may also benefit from a peel.

Will my entire face respond to a chemical peel?
Fine wrinkles with skin motion, such as smiling, may respond to a peel but usually not as well as fine wrinkles seen only at rest. Deep wrinkles at rest such as those seen with intrinsically aging skin may require deeper peels or plastic surgery interventions. Dermal fillers are also an option for these lines. Deeper wrinkles that are muscle or motion induced will probably not respond to any peeling or resurfacing technique. Botox® can be a good option for these active wrinkles.

Do I actually peel? What takes place after I have a peel?
To produce peeling, a chemical such as glycolic acid, salicylic acid, or trichloroacetic acid is applied directly to the skin. Dermatologic or plastic surgeons also use phenol occasionally. These chemicals change the composition of the skin, delivering a controlled type of shallow or superficial tissue destruction or wound. As the wound heals, the outer layers of the skin peel or slough off. Deeper peels can also affect the lower collagen and elastin layers of the skin to remove deeper wrinkles. With mild peels, you may not see the peeling at all, but will still be benefiting from the rejuvenating actions.

After the peel, is there a healing process? Will I scab?
The minimal scabbing associated with a peel usually clears within 3 to 7 days. As the scabbing clears, the pigmentation of the skin is often removed. When the skin heals, the pigmentation should be more uniform, the texture should be smoother and the skin should be more youthful in appearance. Some mild glycolic acid (GA), salicylic acid (SA) or more moderate (TCA) peels may be repeated, whereas the deeper peels (e.g., phenol) usually do not require repeat treatment. Multiple applications of superficial-depth peels will usually produce the same results as the deeper peels, and it will not be as obvious to friends and family that you have had a peel. Multiple shallow peels may also be safer because they are better controlled than a single deep peel. Superficial-depth peels can be applied near the end of the week so that most of the peeling occurs over the weekend. By the next week, there is usually little or no sign that you have had a peel.

Whenever the skin is peeled or wounded, there is a risk of scarring and infection. There is also a risk of pigmentary augmentation that is both short term and long term and a slight risk of permanent pigmentary augmentation. Medium and deep peels increase the risk of all of these side effects and complications. Although rare, persistent hyperpigmentation can often be adequately treated with prescribed bleaching agents. If you are 1/32 Native American or more, you have a higher risk of a skin reaction and resulting hyperpigmentation with this procedure; therefore you need to inform the clinician of your heritage so that he/she can use precautions.

Can anyone have a peel?
If you are a smoker, have frequent fever blisters (e.g., herpes outbreaks), have had prior radiation therapy to the skin, or are taking hormones or using Accutane, inform your clinician because you may not be a good candidate for a chemical peel. Chemical peels are not really effective against the damage of persistent smoking. Your doctor may opt to prescribe antiviral therapy to take the day of your visit to prevent a herpes outbreak being triggered by the treatment.

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