Chemical Peel
Chemical peels,
also known as chemical resurfacing, are chemical treatments to produce
an improved appearance of the face. Chemical peels are used for
the treatment of photoaging (from sun damage), wrinkles, scarring,
acne, precancerous lesions, and discoloration (or dyschromia). Chemical
peels produce controlled injury to the skin that promotes the growth
of new skin with an improved appearance.
Many different chemicals are
used including glycolic acid, trichloroacetic acid (TCA), salicylic
acid, “Jessners” solution, and phenol. The different
chemical solutions produce different degrees of injury to the skin.
There are two layers of the skin; the outer layer is called the
epidermis and the inner layer, the dermis. Superficial peels (e.g.
glycolic acid) produce very superficial injury confined to the epidermis.
Superficial peels can help improve conditions such as acne and dyschromia.
Deeper peels (e.g. phenol peels) produce injury within the dermis
and can reverse moderate-to-severe photoaging and wrinkles. In general,
the deeper peels offer the most dramatic results but require longer
recovery periods and carry a higher risk of complications.
Chemical peels have actually been
used for hundreds of years and have a proven safety record in the
proper hands. However, chemical peels are not for everyone. For
example, people who are in poor general health should not get peels.
Also, active infections and certain medications (i.e. isotretinoin
(Accutane)) may preclude the use of certain types of chemical peels,
especially medium and deep. Sometimes, people with abnormal scarring,
certain skin diseases, or recent surgeries should not have a chemical
peel. You and your physician should decide if chemical peels are
safe for you.
Chemical Peel Procedure:
Chemical peels usually begin with
vigorous cleansing of the skin. The depth of the peel depends on
the chemical used. Very light peels (e.g. low potency glycolic acid,
10-20% TCA) only penetrate the dead skin cells that sit atop the
epidermis and produce almost no injury. Sometimes, this level of
peel is called “exfoliation”. Light peels (70% glycolic
acid, 25-35% TCA) injure the entire epidermis and stimulate the
regeneration of a new epidermis. This level of chemical peel may
produce a burning sensation during the procedure. Recovery from
light peels is quick- hence the name “lunchtime peel”.
Improvement in the appearance of photoaged skin and scarring is
usually subtle at best. Medium depth peels involve injury to the
upper level of the dermis. Injury to the dermis stimulates the formation
of collagen and “plumps” up the skin. Usually 35% TCA,
in combination with another chemical such as glycolic acid, is used
safely with minimal discomfort. Burning is the most common complaint
during the procedure and this is usually well controlled with cool
compresses or topical anesthetics. Deep peels involve injury to
the mid dermis and are usually performed using a phenol solution.
A deep chemical peel may offer dramatic results such as elimination
of deep furrows and scars. However, complications such as scarring,
permanent textural changes, darkening and redness of the skin can
occur. Furthermore, during a deep peel, anesthesia must be used
and vital signs must be monitored throughout the procedure. Recovery
from a deep peel requires occlusive bandages and can take up to
a month under normal circumstances. The phenol peel should only
be performed by qualified physicians with proper monitoring equipment.
Chemical Peels Related News & Articles
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All photos courtesy of S. Zimmet, MD and P. Bitter Jr., MD
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