What is a chemical peel?
Chemical peels are a techniques used to improve the appearance of the skin on the face, neck or hands, by applying chemicals to make it blister, after which the skin will peel off. The goal of this action is to stimulate new skin growth and collagen with more evenly distributed melanin which is smoother and less wrinkled than the old skin.
Who is this for?
Chemical peels can be done on the face, neck, or hands. This procedure is used to reduce the appearance of:
- Acne, and acne scars
- Aging skin, as well as wrinkles caused by sun damage
- Crow’s feet
- Age spots, freckles, and dark patches due to pregnancy or taking birth control pills
- Sun damaged skin
- Sagging skin
A chemical peel is not ideal for dark-skinned patients, or for people with infections, active skin disease, cut or broken skin, sunburns or active Herpes simplex 1 sores. There are also other people that should avoid this treatment, they are:
- People that are pregnant or nursing
- People that have been on Accutane for about six months
- People that have eczema, psoriasis, dermatitis or rosacea
- And people that have used Retin-A, Renova, skin products that contain ascorbic acid, bleaching or skin-lightening agents or other acid-based products in the last 48 hours.
What are the procedure?
There are 3 types of peels, namely the superficial, medium, and deep peels. These are grouped according to the depth of action taken. Using the correct depth chemical peel is a critical component for success.
With superficial peel a mild acid, like Alpha-hydroxy acid, is used to penetrate the outer layer of the skin only. With the medium peel the middle layers are targeted with acids such as glycolic or trichloroacetic acid. This treatment is more intense and is aimed at treating age spots, fine lines and wrinkles, freckles and moderate skin discoloration. If, however, a stronger treatment is needed, Tricholoracetic acid or phenol is applied as part of the deep peel treatment.
What are the risks?
Superficial peels are safe and tolerated with mild discomfort, such as transient burning, irritation, and erythema. Scarring is rare in superficial peels, as are PIH and infection.
Pain and burning is commonly encountered during a peel procedure in sensitive skin. It can persist up to 2-5 days after the peel till re-epithelialization is completed.
In medium and deep peels, lines of demarcation that are technique related can occur. Care should be taken to feather peel solution at junctions with non-peeled skin to avoid this effect. Side effects of deeper peels can also include pigmentary changes (e.g., PIH for dark-skinned individuals), infections, allergic reactions, improper healing, hypersensivity, disease exacerbation, and those due to improper application.
Care must also be taken to prophylactically treat patients with a history of herpes simplex infections. Herpetic episodes, usually on the lip or above the vermilion border, may be prevented with prophylactic oral acyclovir, valacyclovir hydrochloride, or famciclovir.
Antiviral agents are especially useful in patients who indicate a strong history of multiple herpetic lesions each year.
The best way to prevent complications is to identify patients at risk and maintain an appropriate peel depth that balances efficacy with known adverse events. Patients at risk include those with PIH, keloid formation, heavy occupational sun exposure, a history of intolerability to sunscreens, and uncooperative patients.
In medium and deep peels, a common location of scarring is on the lower part of the face, due perhaps to greater tissue movement or more aggressive treatment. Other rare causes of scarring include infections and premature peeling, making post-peel monitoring an essential component of management. Delayed healing and persistent redness are early warning signs, and treatment with topical antibiotics and potent topical corticosteroids should be initiated as soon as possible to minimize scarring. Resistant scars may be treated with dermabrasion or pulsed dye laser followed by silicone sheeting therapy.
Acneiform eruptions may occur during or after peeling, presenting as erythematous follicular papules. These eruptions respond to oral antibiotics used in acne treatment.
Milia usually appear 2 to 4 months after peels in up to 20 percent of patients undergoing medium and deep peels and may be treated with extraction or electrosurgery.
Although rare, complications may occur including persistent erythema, milia, and scarring.
Persistent erythema, Pruritus, edema, blistering, ectropion of the lower eyelids, hyperpigmentation, Skin depigmentation, Lines of demarcation, Millia, texture changes, atrophy
After a chemical peel, skin is temporarily more sensitive to the sun, so wear sunscreen every day.