Chemical Peels

A chemical peel is one type of a skin resurfacing procedure for the face. With all types of skin resurfacing, the top layer of skin is removed and heals into a younger looking, more even toned and smooth skin. Other forms of skin resurfacing include dermabrasion and laser resurfacing.

 A chemical peel can be used to treat sun-damaged, wrinkled, blemished, acne scarred, or blotchy skin to its original youthful appearance. It can also be used to remove precancerous skin lesions called actinic keratoses. The results after healing are usually a smoother, more even-toned textured skin. Peels can be done on just one section of skin, such as the area around the mouth or The skin will look younger, tighter, and fresher than before. These peels can be done not only on the face, but also on the neck, chest, back, arms or hands or anywhere you wish to rejuvenate or improve your skin.

However, a chemical peel cannot remove all cosmetic facial flaws. Deeper lines, wrinkles, deep acne scars, and other flaws may require additional treatments or techniques.

The idea of a chemical peel is actually an old one, Milk baths and facial masks that contained vinegar or lemon juice are actually very mild chemical exfoliators. Cleopatra was said to have bathed in ass's milk to keep her skin young. 

There are many variations on a chemical peel. You can have a very minimal layer of skin removed or you can go deeper. The doctor or technician can use any of several acids or other chemicals on the skin and can divide the treatment into two or more sessions. Deeper and more extensive treatments may require sedation and anesthesia.

The acid normally used in chemical peels are trichloracetic acid (TCA), for more superficial lines and blemishes, or phenol (a stronger acid for a more serious peel) for deeper wrinkles, flaws, or discolorations. 

Having a chemical peel is serious business and your face will be red and even crusty and scabbing for several days to 2 weeks after your treatment. You may need to keep out of the public eye for that length of time. Be prepared for this down time during your recovery.        

In some states, no medical license or other training is required to perform a chemical peel. Some states have more stringent regulations and stipulate that only physicians may apply chemicals with stronger concentratons. In many states, trained aestheticians can perform some lighter chemical peels in skin care clinics that are under the supervision of a physician. Still, it is best to get the advice of a physician who is experienced in skin care before having a chemical peel.

Your Options in Chemical Peels

To understand a chemical peel, let's study the skin a bit. The skin is made up of three basic layers: the epidermis, dermis, and subcutis. The epidermis—the top layer of the skin—is made up of the stratum corneum (which is mostly dead skin cells called keratinocytes and is also called the horny layer), a layer of  live keratinocytes, and the basal layer, which make the keratinocytes that live and die as they gradually move up through the stratum corneum and get sloughed off. The epidermis also contains the melanocytes, the pigment-containing skin cells that give our skin its color. The dermis, the middle layer, is mostly made up skin cells, hair follicles, sweat glands, and is mostly held together by collagen, which is made by skin cells called fibroblasts.

There are several types of chemical peel, ranging from very minor peels to deeper, more serious, peels that require sedation and extensive recovery time.  You need to understand your options so that you may make an informed decision.

Here is a list of the most commonly used acids or chemicals. A dermatologist or aesthetician/skin technician can determine which is best for your individual needs.

Alphahydroxy Acids (AHAs): Chemical peels that use AHAs help eliminate finel wrinkles, sun damage, unevenness, pimples, and splotchiness. These peels can also improve dryness.  However, they are not  very invasive and only provide mild resurfacing results. They produce a mild rejuvenation without the extended downtime of a more invasive peel. Some of these peels are very weak.

          • Fruit Acids: There are five main fruit acids: citric acids (from citrus fruit), glycolic (from sugar cane), lactic acid (although derived from milk, this is still considered a fruit acid), malic (from apples), and tartaric (from grapes). Sounds like a nice fruit salad with some yogurt, huh?

Citric acid peels are simple and effective, although not incredibly invasive or capable of significant improvement with one treatment. Glycolic acid peels are mildly exfoliating and work by loosening and exfoliating the superficial top layer of skin. This peel also stimulates collagen growth. Lactic acid peel, usually at a 70% concentration or less, can remove dead skin cells, and promote softer and more radiant skin. Malic acid peel can open up the pores, allowing them to expel sebum and reduce acne. Tartaric acid peels are similar to the other fruit acids.

These peels can be reapplied at 2-week intervals. AHA peels are the mildest. There are some skin products containing low concentrations of AHAs that can be used on a daily basis to improve skin texture and tone.

Jessner's Peel: This is a medium-depth chemical peel designed to remove more of the skin than AHAs can. It contains a mixture of salicylic acid (a beta hydroxy acid), lactic acid (an alpha hydroxy acid), and resorcinol. 

Your surgeon or skin technician will apply a glycolic cleanser to the area to be treated. This is done to fully remove skin oils and the top layer of dead skin cells so that the Jessner's solution will penetrate properly. When the Jessner's is applied, it will burn slightly (although this can be relieved by blowing cool air on your treatment area). You may have several layers applied depending on how deep a peel is wanted. You may develop a whitened look, known as frosting, which will dissipate within a few hours. After about 10 minutes, the technician will neutralize the acid and remove everything with cool water.  Your technician may apply a calming mask to help sooth your skin and you will be sent home. Your skin will peel and flake for about 7 days and then turn pink or brown afterward and then nice, smooth skin will be revealed.

This peel may be reapplied at 2-3 week intervals.

Obagi blue peel: This peel is a trichloracetic acid (TCA) peel done in-office and can correct fine lines, superficial scars, minimal laxity and pigmentation problems. It can be done on people of all skin types, but more invasive peels are suitable to only those of European descent. 

One to four layers of the blue solution are applied and are left on the skin for 25 to 30 minutes. You may feel a slight burning or stinging sensation as each layer is applied. This can be relieved by a cooling fan. The blue tint will darken and show the technician when the peel is finished.  The blue tinge that you get from this peel may last for up to 10 days in some people, which may make you stay home for several days. 

This peel can be reapplied at 4 week intervals.

Phenol: Chemical peeling with phenol can be used to improve sun damage as well as moderate wrinkling. It is considered a deep peel, and requires sedation and monitoring of your vital signs. Phenol provides a relatively deep and predictable peel. The solution most commonly used is the Baker/Gordon formula, in which the phenol is diluted to a concentration varying from 45% to 55% and which contain other ingredients to aid in penetration. One of the drawbacks of a phenol peel is that it leaches your skin and leaves a distinct demarcation line around the edge of where it was used.  It is very possible that your skin will never regain its ability to tan after a very deep phenol peel, so consider this before committing to it. You should discuss with your doctor whether some other form of skin resurfacing may be a better choice for you. A phenol peel is usually reserved for the face and is not used elsewhere on the body. It is reported that scarring can result when used on nonfacial areas.

Are You a Candidate for a Chemical Peel?

You may be a candidate for one if you have slight wrinkles, hyperpigmentations, splotchiness, unevenness in tone, acne, acne scars, black heads, or sun damaged skin. Because solutions can be tailored to individuals, there may be a chemical peel right for you.

However, many people may not be good candidates for chemical peels. You may not be a candidate if you have herpes (which includes recurrent cold sores or fever blisters) because the viral infection can spread in the treated skin and cause large sores that can scar. You may be asked to take antiviral medications, which will decrease your risk of an outbreak. Deeper peels may not be suitable for you if you are prone to keloids, excessive scarring, warts, or hyperpigmentation and hypopigmentation problems. You may not be a good candidate if you have any autoimmune disorders.

You should not have a chemical peel if you've used Accutane (isotretinoin) in the last year because it can increase your chances of excessive scarring. You should put off having a peel if you have had recent radiation or chemotherapy treatments, have sunburn, windburn or broken skin, or have recently waxed or have recently used a depilatory.

For deeper peels, which require sedation or extensive recovery, you must be in good health, not have any active diseases or pre-existing medical conditions. You also have to have a good idea of what a chemical peel can do for you and what it cannot. Discuss you goals with your doctor so that you may reach an understanding with what can realistically be achieved.

You must be mentally and emotionally stable to undergo a deep chemical peel. Recovery take some time and you will be uncomfortable. Your face will be red, scabby and peeling. You may experience a period of depression after a deeper peel and if there is already a pre-existing emotional condition, this low period can develop into a more serious issue.  Please consider this before committing to this procedure.

You should not have a chemical peel if you will continue to have excessive sun exposure.

What to Expect at Your Consultation

Ask around for the names of health professionals who specialize in skin care and peels. Make an appointment for a consultation with two or three of them.  This is when you will discuss your goals and what you want to achieve. You both will discuss your concerns and discuss the how much your skin can be improved. Your doctor will explain the technique and options that may be most appropriate for you. He or she should also discuss the risks associated with chemical peel with you.

For a deeper peel, you will also discuss what type of anesthesia will be used. Most deeper chemical procedures are performed under either oral sedation or light sleep sedation. Lighter peels pay require no anesthesia or sedation at all.

Your Preoperative Appointment

You may not have a preoperative appointment, especially not with a lighter peel. For a deep peel with anesthesia, you may have one and you can ask more questions. You will also go over your preoperative and recovery period instructions. You may be given prescriptions for antibiotics and antiviral drugs and pain relievers.

Preparing for Your Chemical Peel

In the days before your treatment, you will usually be asked to closely follow a skin care regimen that may include the use of AHAs, Retin A, and other products to prepare your skin and even out your skin tone.  This will make the peel more effective and reduces the chances of hyperpigmentation problems.

You will be instructed to buy or will be given high-quality moisturizer, skin preparation lotions, and strong sunblock to use as you heal afterwards to protect the newly uncovered skin from the sun.  After your peel, do not ever go outside without putting sunblock on the treated area.

After your treatment, your skin will crack and you may be told to cover it with a thin layer of lotion or antibacterial ointment or you may be instructed to allow it to dry, crack and let the crusts fall away naturally.

For some types of peels, you will be told not to moisturize the treated area, but your may be encouraged to do so for other types of peels. This advice may also be based onyour dermatologist's or skin care specialist's preferences. If anything here is different than what you are told by your physician or skin care specialist, follow their instructions and not these. 

How This Procedure Is Performed

Depending upon the peel, peel depth and the skin type - you may be anesthetized.  If so please read our Anesthesia Page.   If not, you will have your skin cleansed and prepared either by exfoliation, treatment with special solutions, or whatever is needed. One or more layers of acid will be applied and a timer will be set to time the treatment. You may experience a warm or tingling sensation or, depending upon the strength of the peel, a stinging sensation.  Your physician or the aesthetician may place a fan on low speed to blow cool air on you and help with any discomfort. 

When the timer dings, the acid will be removed with a neutralizing lotion and perhaps you will have a moisturizer applied to your face. You may or may not have dressings places on your face, unless this is a superficial peel.

Please consult with your physician for specific details of your procedure as many treatments are carried out differently and are very individual.

The Road to Recovery

You will feel as though your skin has a windburn or sunburn and your skin will feel tight.  Do not make excessive or widely exaggerated facial expressions.  This can result in tearing of the skin and bleeding, and possibly scarring. 

Just let your skin heal naturally. Do not peel or tug on any skin or scabs or crust on your face. You can cause excessive damage and severe scarring if you do this.

You will usually be told to cleanse your face as usual, but to use a gentle formulated cleanser. You may or may not be instructed to use a special moisturizing cream or lotion.

Do not apply any type of glycolic acid or exfoliation products because this can severely damage or irritate the skin. Avoid sun exposure. Use a high SPF sunscreen whenever you are outdoors.

Let your surgeon or skin care specialist know immediately if you come down with a herpes break out, such as a cold sore or fever blister. This could spread into the peeled skin and result in serious scarring.

You will start noticing pink fresh skin emerging from under the peeling damaged skin.  Do not help the peel along by pulling or rubbing this old skin off.  Within a few weeks, the pinkness will fade for most, light peels. For deeper peels, you may have lingering pinkness tat may look like a mild sunburn or flushed appearance.  Your physician will go over what to expect for the depth of the peel you undergo.

Risks and Complications of Chemical Peels

If you have oral herpes (cold sores or fever blisters), and have an outbreak before your peel is completely healed, there is the chance that the virus can infect the treated area, which can cause severe scarring. Before having a chemical peel, get the approval of your primary physician and a prescription for an oral antiviral drug.  This is very important!  Taking an antiviral product can significantly decrease your chances of a break out. 

Be aware of any excessive crusting or weeping Ask your skin care specialist for specifics about what to look for. With a typical AHA peel, you should feel and look normal within 3 to 4 days. For deeper peels, your recovery time may take weeks and even months for complete recovery.

If you experience painful areas of the face, contact your surgeon or skin care specialist immediately, especially if you are prone to cold sores.  Call them immediately if you see any blisters in the treated area. 

Hyperpigmentations (dark spots) and hypopigmentation (pale or white spots) can be a problem after a peel. These may occur if you have darker skin, are of certain types of ethnicity, if you have failed to reveal any skin problems, or ifyou did not take proper care after your peel. Infection is uncommon with chemical peels, but they are possible so keep an eye out for redness and pain. 

Scarring is possible if you do not adhere to your post-peel instructions.