Chemical Peels

Chemical Peels

Chemical peels involve applying a type of "chemical agent" to the skin for the purposes of exfoliating sun damaged or thickened surface skin while stimulating the growth of healthier skin. The popularity of chemical peels took a back seat for a period time when lasers were becoming the accepted method for treating wrinkles. In balance, depending on the amount of wrinkling present and desired results, chemical peels can play a significant role in skin resurfacing.

Peel solutions most typically contain alpha hydroxy acids (glycolic acid), beta hydroxy acid (salicylic acid), tricholoracetic acid (TCA), or phenol as the exfoliating agent. Each of these is categorized by the concentration and the resulting depth of the peel on the skin which can range from superficial (also known as micro or light peels) to medium or deep peels.

Results are closely linked to the depth of peel performed. Superficial peels (typically those using low concentrations of AHA or BHA) offer far less dramatic improvement than medium or deep peels (usually TCA or phenol-based) do. Overall, you can expect minor to major improvement in fine lines and wrinkles, skin discolorations, skin texture, rebuilding of collagen, removal of blackheads, and a temporary reduction in excessive oil production.

On the other hand, chemical peels in any form cannot remove or reduce the appearance of blood vessels on the skin, they cannot change the appearance of enlarged pores, they do not have an effect on keloidal scarring, they do not work as a facelift, and they have limited benefit for improving skin discoloration for those with darker skin color. There are definite drawbacks to consider with these procedures, but this is largely dependent on the depth of peel.

• Superficial peels have few associated risks but also offer less noticeable results. Some redness, swelling, and increased skin sensitivity can occur with superficial peels. When significant results are desired, complications increase proportionately.
• Medium and deep peel complications can include scarring, infection, temporary or permanent changes in skin color (this is especially true for deeper peels), and cold sore breakouts for those with a history of cold sores.

Chemical peels are performed by the application of the specific solution that actually dissolves the skin’s top layers, either over the entire face or on specific areas. Often, several shallow to medium-depth peels can achieve similar results to one deep-peel treatment, with less post-procedure risk and a shorter recovery time.

• Alpha hydroxy acid peels (AHA) use glycolic, malic and lactic acid as the peeling ingredient and these are considered superficial to medium peels depending on the concentration utilized. Typically the concentrations range from 20% to 90%. AHA peels are effective in improving skin texture, causing some collagen and elastin rebuilding, minimally reducing the appearance of acne scarring, and reducing the appearance of skin discolorations. Repeated treatments are necessary for all concentrations to maintain results. Important Note: AHA peels are not medical procedures and as a result are not regulated by the FDA. A physician usually performs higher-concentration peels (more than 30%), but this is not always the case. Lower-concentration peels (20% to 30%), often performed by aestheticians, require repeated treatments to achieve and maintain the results seen immediately after the peel is performed.
   
• Beta hydroxy acid (BHA) or salicylic acid peels are not as popular as AHA peels, yet they can be equally effective and have specific advantages for some skin types. A salicylic acid solution can work in a way that is similar to a glycolic acid peel, but irritation may be reduced. Salicylic acid is a compound closely related to aspirin (acetylsalicylic acid), and it retains its aspirin-like anti-inflammatory properties. A deep BHA peel can be superior for many skin types because the irritation and inflammation are kept to a minimum due to the analgesic action of the BHA compound. Salicylic acid is also lipid soluble; therefore, it is a good peeling agent for blemish-prone skin with blackheads. The most common concentrations used today are 20% to 30%.
   
• Trichloroacetic acid (TCA) peels (as seen in South Africa in ranges such as Environ) in concentrations up to 50% are superficial to medium peels and have been around for years with a history of being effective and safe. It can be used for peeling the face, neck, hands, and other areas of the body. It has less bleaching effect than phenol (see the next paragraph) and is excellent for "spot" peeling of specific areas. TCA peels are best for fine lines but are minimally effective on deeper wrinkling. Jessner’s peel is a medium peel containing 14% salicylic acid, 14% lactic acid, and 14% resorcinol. Though considered effective and easy to use, there is little research on this method.
   
• Phenol is sometimes, though rarely, used for full-face peeling when sun damage or wrinkling is severe. It can also be used to treat limited areas of the face, such as deep wrinkles around the mouth, but it may permanently bleach the skin, leaving a line of demarcation between the treated and untreated areas that must be covered with makeup. Although phenol produces the most remarkable resolution of actinic damage and wrinkling among the various [chemical peels]… it also possesses some of the more significant [serious side effects]. Many have abandoned phenol in favor of other agents or laser resurfacing. Hypopigmentation may occur in all skin types, noticeably lightening patients with darker skin and making lighter-skinned patients appear waxy or pale. A clear line of demarcation may be present between treated and untreated skin. Buffered phenol offers yet another option for severely sun-damaged skin. One such formula uses olive oil, among other ingredients, to diminish the strength of the phenol solution. Another, slightly milder formula uses glycerin. A buffered phenol peel may be more comfortable for patients, and the skin heals faster than with a standard phenol peel, but it is still a risky procedure that can depigment the skin.