Treatment
What are chemical peels and how do they work?
The procedure known as chemical peeling (or chemexfoliation to give it its proper name) involves the application of a chemical solution to the surface of the skin to produce the careful removal of its outer layers. The amount of skin removed will depend on the type of chemical used, the strength of this product and how long it is left on the skin.
Chemical peels are usually described according to how deep they work on the skin. Below are some examples of the type of peels and the kind of language you can expect to hear used when discussing chemical peels.
Look at the diagram below to see where the different layers are and where different types of peels act on the skin.
SUPERFICIAL PEELS
Remove the outer layer of the skin or the “epidermal layers”.
MEDIUM DEPTH PEELS
Remove both the epidermal layers and upper dermal layers. These are the next layers down as you can see on the diagram.
DEEP PEELS
Peeling extends deeper into the lower dermal layer of the skin.
No matter how deep the peel, your skin will re-grow and should heal fully.
If you choose to have a deeper peel – maybe to get rid of wrinkles or acne scars – when the skin re-grows, it will not “remember” the blemishes that were there before. As the new skin develops, a new band of collagen in the dermis will grow along with a thicker epidermis. Hence, your skin will appear smoother and more perfect than before the treatment.
The deeper the peel, the greater potential for improvement to the skin. However, a minority of people can experience some side effects with deeper peels.
What skin problems can chemical peels treat?
Chemical peels can be used on most areas of the body, but the commonest use is to improve the appearance of sun damaged skin on the face, or the backs of the hands.
They can also be used to improve certain skin spots, blemishes or lesions such as acne and actinic keratosis. If you are considering having a chemical peel, you must go to an experienced practitioner as the success of the treatment depends on a variety of factors. Your skin type and the problem which requires attention both need to be investigated fully by you and your practitioner.
Below is a list of the treatments and the type of skin problems which they can reduce.
SUPERFICIAL PEELS
Can help to lessen rough skin texture, dry or flaking skin, fine lines due to sun damage, mild acne marks, “age spots” (brownish patches which can be caused by sun damage) and balancing irregular skin tones (i.e. skin which may be uneven in colour.)
MEDIUM DEPTH PEELS
Can reduce small wrinkle lines, some acne scars, and certain pigmentation problems (again, making different coloured skin more even.)
DEEP PEELS
Can help to reduce the appearance of deeper lines, wrinkles and scars.
PLEASE BE AWARE: chemical peels cannot change your pore size, improve loose skin (saggy skin generally needs to be treated by surgery), or deal with deep scarring.
What are the different types of peels used?
All the terms and descriptions below are words which your practitioner may use when talking to you about your chemical peel, so it might be a good idea to read up on them now. However, don’t worry, if it all seems mind-bogglingly technical! You will be given good guidance about which product and treatment is best for you if you go to see an experienced practitioner in this area.
You do need to be familiar with two terms in particular:
HYPERPIGMENTATION: where the skin has too much pigment and that can lead to brownish spots or blotches on the skin.
HYPOPIGMENTATION: the opposite of the above when the skin can look white or bleached.
SUPERFICIAL PEELS
These are the commonest types of peel used and most often contain some form of hydroxy acid, which is a family of chemicals known to cause exfoliation (removing the top layer of dead skin cells in the epidermis), when applied to the surface of the skin. A superficial peel is like a mild “sandpapering” of the facial skin and it will give your face a healthy glow. You might want to have a peel prior to a special occasion when you want your face to look alive and glowing.
Different forms of hydroxy acid are available on the market. These include alpha hydroxy acids, such as the naturally occurring lactic acid (sour milk) and tartaric acid (from grape skins). Salicylic acid, is a beta hydroxy acid and is unique amongst the hydroxy acids in that it can penetrate deeper into the oil glands causing exfoliation even in the oily areas of the face and scalp. For this reason it has been used for years by dermatologists (skin specialists) to help treat comedonal acne in people who have very oily skins.
Glycolic acid : This product comes in different strengths (30% – 90%) and different pH levels (levels of acidity).
Sometimes combinations of different hydroxy acids are used, such as Jessner’s Solution which contains a combination of lactic acid and salicylic acid.
Alpha hydroxy acid peel brands include:
MD Forte® and Neo Strata
Lower strength TCA (Trichloroacetic acid) may also be used to obtain a superficial peel.
MEDIUM DEPTH PEELS
These involve the use of stronger peeling solutions. The commonest of these is higher strength T.C.A.. Trichloroacetic acid acid can be used on it’s own at up to 50% strength, but it is more commonly used in concentrations around 25% – 35% to help reduce possible side effects.
T.C.A. can also be used in combination with glycolic acid or other solutions to help achieve a more controlled and even peel to the correct depth.
Medium depth peel brands include:
Skintech Peels and Obagi Blue Peel
DEEP PEELS
These are generally performed using phenol, or 40% TCA. Although deeper peels can be very effective for the right patient, there are a number of potential complications associated with this procedure. Consequently, you will find fewer trained practitioners offering deep peels in the U.K. than those who can give you a medium or superficial treatment.
What happens during the treatment and how long will it take to recover?
At your first consultation with a practitioner, you should explain what you expect from the treatment and how you would like to look afterwards. He or she should tell you exactly what the treatment will involve and how long it will take for you to recover from it. A medical history should be taken by the practitioner, to ensure that there are no reasons why you shouldn’t have the treatment. Once this is established, you would normally be asked to read some detailed information and sign a consent form indicating that you have understood the potential benefits and risks associated with the peel procedure recommended.
Photographs may also be taken by the practitioner, for use as a “before and after” comparison at a later date.
Depending on the depth of peel and combination of peels used, different treatment procedures are recommended.
You would normally be asked to avoid any changes in your normal skincare routine 1 – 2 weeks prior to peel treatment. Things to avoid include electrolysis (facial hair removal), an exfoliating facial, sunbathing, tanning beds, or the use of any new creams as these could alter your response to the peeling agent. What happens next depends on the type of peel used.
SUPERFICIAL PEELS
For one of the commonest peeling agents used, glycolic acid, the procedure is generally quick and easy to perform. The face is cleansed to strip the skin temporarily of its natural oils and allow the glycolic acid to be absorbed into the skin. The peel is then quickly painted onto the area to be treated and is left for between 2 – 10 minutes, depending upon the strength and type of glycolic peel used, before it is washed off and neutralised.
Repeat procedure
This mild peel generally needs to be repeated weekly for 4-6 weeks to obtain a good result, which can then be maintained with monthly peels.
Recovery time
In general, most patients can return immediately back to work after this procedure.
MEDIUM DEPTH PEELS
The skin is again thoroughly cleansed before application of the peel. An even layer of the peeling agent is applied to the area to be treated, which makes the skin slowly becomes whitish – grey, or “frosted”. A fan is sometimes used to help cool the face. Once frosting has occurred, which may take several minutes, cool saline compresses (pads soaked in a salt water solution) may be applied to the face to neutralise the peel.
Repeat procedure
This type of peel may be repeated monthly until the desired effect is achieved. Thereafter, maintenance peels every 6 – 12 months should keep your skin looking good.
Recovery time
This can take a week or so depending on how well you heal, your age (older skin tends to heal less quickly) and any post-treatment complications.
DEEP PEELS USING PHENOL
Phenol is a strong chemical which is why it produces such dramatic results. A local anaesthetic block may be used prior to a phenol peel, this “freezes” your face and ensures that you do not experience any pain during the treatment. The “freezing” is very similar to that used by the dentist when you go for a filling. You may also be given a sedative whilst undergoing a phenol peel.
Continuous heart monitoring is also required as phenol has the potential to cause irregular heartbeats in some patients.
The skin is thoroughly cleansed and phenol is applied to the area to be treated whereupon the skin immediately turns white or “frosted” in appearance. For full face phenol peels, half of the face is treated first (this usually takes around 30 minutes), with half the peel being removed before the other half is treated. For some areas of the face, the practitioner many apply two or three layers of waterproof tape after phenol has been applied. The tape helps to the peel to work more effectively, and is removed 48 hours later. In some cases petroleum jelly (Vaseline) is used instead of tape.
Repeat procedure
Just one phenol peel treatment can produce dramatic improvement in patients with sun damaged skin. These effects can last for 10 years or more.
Recovery time
This can take several weeks depending on how well you heal and any post-treatment complications.
