Chemical peeling is a technique used to improve the appearance of the skin. A facial peel refers to the application of one or more chemicals to the skin with the intention of enhancing the skins appearance. Chemical peels are applied to the face and other sites such as the hands and chest. They may be used to treat damage caused by exposure to the sun (photo-ageing), to remove pigmentation such as freckles and melasma, to remove fine lines and wrinkles. This article aims to provide chemical peel patient information. This is not intended to be a substitute for a thorough consultation by a dermatologist.
A peel removes several layers of sun damaged skin cells, leaving fresh skin. The new skin has a more even surface and colour. New collagen formation will give an improved skin texture. Peels may result in superficial, moderate or deep skin rejuvenation. A skincare nurse or dermatologist may perform chemical peels. Peels can be repeated as necessary. Some people have superficial peels every few weeks. It is wise to wait three months before repeating a moderate depth peel.
Types of chemical peel
Alpha-hydroxy acid peels result in superficial skin injury and are well tolerated. This is also known as the “lunchtime” peel. They remove thin lesions on the skin surface, reducing pigment and surface dryness. The result of the first superficial peel may be underwhelming. However, following repeated superfical peels significant improvement is usual.
Trichloracetic acid (TCA) is the most common chemical used for a medium depth peel. The results usually depend on the concentration of TCA. Usually 20 – 35%. The treatment is painful and treated areas are swollen, red and crusted for a week or so. A TCA peel can lead to an impressive improvement in skin texture. There is often a reduction in blotchy pigmentation, freckling and sun damage (solar keratoses and dry sunspots). Fine wrinkles and some acne scars may be reduced. Note that a TCA peel has no effect on deep furrows.
Chemical peel consultation
During the consultation a detailed health history will be obtained and your dermatologist will assess your complexion, skin texture, thickness, degree of photo-ageing and severity of facial rhytids (wrinkles and fine lines), age related changes and of course your expectations. Details of previous aesthetic treatments will be explored. Based on these factors you will be advised on the best type of chemical peel that would be right for you.
Preparation before a chemical peel
It is often necessary to prime the skin three to six weeks before a peeling procedure. Skin priming helps to improve the skin tolerance and skin quality before the peel. Proper preparation will ensure that your skin responds well to the peels with a better eventual outcome. Pre-treatment creams may be prescribed by your dermatologist and may be used for several weeks prior to your peel. By preparing and exfoliating the skin are reducing pigmentation beforehand the results from the chemical peel will be improved. Careful preparation of your skin can also reduce the time needed for healing.
Creams recommended before a chemical peel may include:
- Alpha hydroxy acid eg. glycolic or lactic acid
- Hydroquinone for tanned or dark skinned people for for those with melasma
- Broad spectrum SPF 30+ sunscreen should also be used
The chemical peel
Superficial chemical peels are a minor procedure and no special arrangements are needed. For a deeper peel you may need painkillers. First the face is thoroughly washed to remove surface oil. The peeling agent is then applied for several minutes. A chemical peel stings. How badly and how long the sting lasts for depends on the chemical, the concentration and individual factors. A cooling fan can help alleviate the sting. The peel is then neutralised and the burning sensation is reduced.
Individual treatments may include peels with several agents on the same occasion. This approach may improve results and reduce risk. Antibiotic and antiviral agents may be recommended after deeper peels.
Care after a chemical peel
Superficial peels result in mild facial redness and occasional swelling which usually resolve within 48 hours. The peeling is similar to sunburn. Most people can continue their normal activities. A moisturiser will need to be applied regularly afterwards. Makeup can be applied a few hours after the procedure.
Moderate depth peels result in intense inflammation and swelling. This will usually resolve within a week. The peeling is more marked. Mild redness can persist for several weeks. Most people will want to take a week off work after a moderate depth peel.
Looking after your skin after a peel
- Keep treated areas cool using a water spray
- Do not pick! Picking delays healing and causes scarring
- Moisturise using light preparations after a superficial peel and thicker preparations after a deeper peel
- Protect your skin from the sun especially for the first six monts
- If recommended by your doctor continue to use tretinoin, glycolic acid and / or hydroquinone at night
Complications after a chemical peel are uncommon. However, the following risks should be noted:
- Comedones (blocked pores) or acne may result from the peel itsefl or from thick moisturisers used afterwards. Ask your dermatologist for treatment.
- Infection due to bacteria (Staphylococcus aureus), yeast (Candida albicans) or virus (Herpes simplex).
- Scarring may result from infection or picking – this may be permanent.
- Persistent solar keratoses may require treatment. Your dermatologist may choose cryotherapy, 5-fluorouracil cream or biopsy as needed.
- Discomfort – a warming or stinging sensation may be experienced during treatment
Chemical peel outcomes
The skin appears fresher and rejuvenated after the chemical peel. Chemical peels are often the treatment of choice for patients who have fine lines, pigment changes in the skin such as blemishes and other minor irregularities. Peels can also be used to treat scars such as acne scars and certain superficial skin cancers. Chemical peels can be used to enhance the results of a surgical procedure. Surgery alone may not be sufficient to obtain optimal aesthetic facial rejuvenation. In such cases the surgical procedures may need to be complemented with other resurfacing modalities such as chemical peels which have effects similar to laser resurfacing.
If you have questions or require information about chemical peels contact your local doctor who will arrange for you to see a dermatologist.