Chemical Peels: What Can They Do For Your Skin?
Reviewed by Yael Halaas, MD
Chemical peels have been around for eons. In fact, the earliest peels date back to Ancient Egypt when Cleopatra and her crowd turned to the active ingredient in sour milk to exfoliate and rejuvenate their skin. In the Middle Ages, people applied wine to derive the same benefits.
Chemical peels have evolved and become rather sophisticated since the days of yore, but their main mode of action remains the same. Chemical peels use a chemical solution (whether lactic acid from sour milk or another solution) to remove the damaged outer layers of your skin and improve its texture.
While results vary based on the type and strength of your peel, a chemical peel can:
- Reduce fine lines, especially under the eyes and around the mouth.
- Correct mild scarring.
- Treat certain types of acne.
- Diminish sun spots, age spots, liver spots, freckles, or blotchiness.
- Refresh and rejuvenate skin texture and color.
A chemical peel cannot, however, tighten loose or sagging skin, remove deep scars, change pore size or remove broken blood vessels.
Chemical peels can be individually formulated based on your skin and your aesthetic goals. There are several types of chemical peels, ranging from very minor peels to deeper peels that may require sedation and extensive recovery time. They can be done on just one area of your face, such as around your mouth, or on your entire face. Peels can also be used on your neck, chest, back, arms or hands.
Types of Chemical Peels
Decisions, decisions! If you have ever stepped into a medi-spa, you have likely been handed a menu listing your options. Some are mild (meaning a very minimal layer of skin is moved) while others go much deeper. In general, the deeper the peel, the more significant the results and the more significant the downtime.
Trichloracetic acid (TCA) is the mildest of available peel formulas. They can be used in higher strengths for more significant results. TCA peels can help treat fine surface wrinkles, superficial lines and blemishes, age spots or pigment problems, and some skin precancers. Sometimes pretreatment with Retin A can help the TCA better penetrate the skin, improving the results. Other bleaching agents may also have a role in pretreatment. Talk to your doctor to find out how you can maximize the results of your TCA peel.
Alphahydroxy Acids (AHA) is the umbrella term for a family of peels that includes several types of fruit acid peels, including glycolic and lactic acid peels. Best for mild skin problems such as dryness and minor sun damage, AHA peels help eliminate fine wrinkles, pimples and splotches. There are even some skin care products containing low concentrations of AHAs that can be used on a daily basis to improve skin texture and tone.
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).
Each type of fruit acid peel has its own set of strengths and weaknesses. Citric acid peels are simple and good for very minor skin problems. Glycolic acid peels are mildly exfoliating, removing the superficial top layer of skin. This peel may also stimulate collagen growth. Collagen is the main structural protein found in the skin, and its supply dwindles with advancing age. A lactic acid peel, usually at a 70 percent concentration or less, can help remove dead skin cells and promote softer and more radiant skin. Malic acid peels can open up the pores, which may help banish acne. Tartaric acid peels are similar to the other fruit acids.
Phenol is a stronger chemical peel solution. It is best suited for deeper wrinkles, or discolorations caused by mask of pregnancy (melasma), sun damage, medication or illness. Phenol is only used on the face because it may cause scarring elsewhere. Only fair-skinned individuals are candidates for this harsh peel as darker skin may be more prone to unfavorable scarring. That said, newer phenol formulations can take some of the sting and risk out of phenol peels, and these may be options for darker-skinned individuals. Talk to your doctor.
Your Chemical Peel: What to Expect
A chemical peel takes anywhere from 10 minutes to two hours. They are always done on an outpatient basis when they are performed as standalone procedures. If a chemical peel is done in conjunction with another facial rejuvenation procedure such as a facelift, there may be a hospital stay involved. Some deeper peels may involve local anesthesia, local anesthesia with twilight sedation or even general anesthesia.
The procedure starts with a thorough cleaning of the skin to get rid of any excess oil. The qualified technician, aesthetician or physician next applies the peel to the designated location, where it produces a controlled wound-healing process that enables new, regenerated skin to appear. Warning: it may hurt a little. Most people report a warm to hot sensation that lasts about five to 10 minutes and is followed some stinging. A deeper peel can be more painful and may require medication during or after the procedure. Your face will be red, scabby and peeling for several days to two weeks after your treatment.
Your skin will also crack after treatment. Follow the advice of your aesthetician or doctor regarding how to care for cracked, healing skin. Scarring is possible if you do not adhere to your post-peel instructions. Many doctors recommend using a broad-spectrum (blocks ultraviolet A and ultraviolet B rays) sunscreen with a sun protection factor of 15 or higher every day to help keep your skin looking refreshed.
Peels may be reapplied at two to three week intervals, but treatment plans are individualized based on the strength of peel and the skin condition it is designed to treat.
Chemical Peels: Risks and Complications
Serious complications rarely occur with chemical peels, especially when they are performed by a qualified professional. Risks may include infection, unplanned pigment changes and scarring.
Not everyone is a candidate for chemical peels. If you have oral herpes (cold sores or fever blisters) and have an outbreak before your peel is completely healed, the virus can infect the treated area, causing severe scarring. Talk to your primary physician about a prescription for an oral antiviral drug if you have herpes. Taking an antiviral product can significantly decrease your chances of an outbreak. 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. Other factors that may affect your candidacy include recent radiation or chemotherapy to treat cancer; sunburn, windburn or broken skin in the treatment area; and/or recent waxing or depilatory use in the treatment area. If you plan to tan, skip the peel.
Chemical Peel Cost
Chemical peels cost anywhere from $100 to $900 based upon the strength of the peel. Insurance rarely covers the cost of solely cosmetic procedures. If you are having the chemical peel done to treat a medical condition such as acne or to remove a precancerous skin lesion, ask your insurance provider about their policy in advance. The costs will be higher if you are having the chemical peel done in conjunction with another facial plastic surgery procedure. Ask about financing options if the chemical peel cost is prohibitive.
Choosing a Chemical Peel Provider
Choosing a qualified provider is the best way to minimize your risk for complications and maximize your results. You may be uncertain whom to trust for a procedure with the potential to cause some pain as well as a significant recovery. To put your mind at ease, All About Facial Rejuvenation has compiled a directory that only includes highly skilled and respected facial plastic surgeons with years of experience performing a wide range of procedures.