Types of Chemical Peels

Chemical peels are a type of facial rejuvenation procedure which uses a chemical, usually a type of acid, to remove the top layers of skin and promote new, healthy skin regrowth. Chemical peels are often referred to as trichloroacetic acid (TCA) or phenol peels since these are the most common type of chemicals used for facial rejuvenation. They are categorized by the depth at which the chemical penetrates the dermis in order to achieve the desired biological effect. There are light, medium, and deep depth peels. Each peel contains a different grade of acid and is used to treat various facial imperfections or degrees of aging.

Am I a Good Candidate for a Chemical Peel?

A GOOD CANDIDATE for a chemical peel includes:

• Male or female patients looking to reduce the natural signs of aging
• Lighter skin patients with mild to advanced signs of aging
• Patients with acne and those who wish to unclog their pores
• Patients with acne scarring or other skin imperfections
• Any patient with uneven skin tone, blotchiness and pigment abnormalities
• Patients with certain precancerous lesions may be suitable for a deep peel
• Any patient with rosacea and mild discoloration of the skin may benefit from a light peel
• Any patient who wishes to gain smoother skin and better texture without the need for surgery
• Patients in good health and with realistic expectations

The following patients are NOT GOOD CANDIDATES for certain types of chemical peels:

• Patients with facial warts or a history of cold sore outbreaks
• Any patient who is currently taking Accutane
• Patients who are prone to keloid scars
• Patients who have darker skin tones are not suitable for a medium or deep peel
• Patients who are unable to take the required time off for a lengthier recovery from deeper peels

How is a Chemical Peel Performed?

A chemical peel can be performed in an office, spa or hospital setting. The amount of time a peel takes to complete can range from 3 minutes to 2 hours depending on the type of peel chosen. The treatment area will be cleansed and a numbing cream may be applied to the face. The doctor will apply the chemical solution and the patient might experience a slight tingling for light to medium peels or a burning sensation for a deep peel. A fan is often used to help cool the skin during treatments and provide additional comfort.

The length of time the solution is left on the skin depends on the strength of the chemical and the patient’s goals. Some superficial or light peels are performed with 10% to 20% TCA while others use glycolic acid, salicylic acid and mandelic acid. Medium peels are 25%-35% TCA and a deep peel is 50% TCA. The stronger the solution, the deeper it penetrates the different layers of skin. The doctor will observe the changes in the skin’s appearance and neutralize the solution. The doctor may repeat the procedure for medium and deep peels until the desired level of improvement has been met. Ointment, or a thick coating of petroleum jelly, is applied to the treatment area after a medium or deep peel. Bandages or surgical dressing may be applied over the face after a deep peel.

Alternative Treatments

Alternative treatments may include microdermabrasion, microneedling and laser skin resurfacing. Each of these treatments varies with the degree of aggressiveness, recovery time and the number of treatments necessary to get the desired results.

• Microdermabrasion takes off dead skin by using a special tip to sand off the top layers of skin.
• Microneedling works by creating small controlled wounds and encouraging collagen production to smooth out wrinkles and blemishes.
• There are numerous types of laser resurfacing treatments which can be customized to treat a variety of skin imperfections at various depths. Most lasers provide the same outcome as chemical peels but fractionated lasers are less aggressive.

What is the Cost of the Different Types of Chemical Peels?

The cost of a chemical peel varies by the type of peel performed. A light peel can cost $100-$250 while a medium peel runs from $400-700. A deep peel can cost $700-$1000. The price also depends on any fees charged by the doctor or the facility and the geographic location of the treatment.

Recovery and Downtime

RECOVERY and DOWNTIME after a chemical peel is subject to the type of peel.

• Light peels are often called a lunchtime peel since it does not go beneath the dermis and there is no downtime. The patient will experience some redness or pinkness similar to sunburn. Patients can wear makeup directly after a light peel and there are no activity restrictions.
• After a medium or deep peel, patients can expect some redness, swelling and discomfort. Since a deep peel is more aggressive, patients may experience a higher degree of discomfort during the first few days but pain medications will be prescribed and should be taken as directed. The patient will need to cleanse the face and apply an ointment several times a day after the peels. The treatment area may crust and itch over the first few days. The face must be kept moist to prevent scabbing. Patients will not be permitted to wear makeup until peeling is completed. There is no downtime for a light peel and recovery for a medium peel is 1 week and a deep peel is 2-3 weeks. The pinkness can remain for up to 3 months. However, patients should feel comfortable enough to go out in public about 3-4 weeks after a deep peel.

With any kind of peel, patients should avoid direct and indirect sun exposure until any redness or pinkness has subsided. Patients who had treatment around the eyes should wear good quality sunglasses whenever going outdoors. Patients should protect the new skin with sunblock each time they go out since the skin will be more susceptible to burns.

Results

The results of a chemical peel depend on the type of peel. Patients can expect to see some results from a light peel after the redness has faded and the swelling has gone down. It can take up to 2 weeks for the redness to fade to pink and for the patient to see some results when the patient has undergone a medium to deep peel. However, it can take 2 to 3 months for the pinkness to fade and for the final results to be apparent after a deep peel.

Light chemical peels can be repeated yearly and the results of a medium depth peel can last 2 to 3 years. A deep peel should only be performed once and the results can last for up to 10 years before needing a touch-up procedure. To maintain longer lasting results, patients should apply sunscreen with an SPF of 30 or higher before going outside to protect the skin from the sun.

Limitations of Chemical Peels

• The limitations involved with the different types of chemical peels include:
• The recovery time needed for healing after a medium to deep peel may limit work and social activities
• Patients with darker skin tones are limited to only light peels since there is a greater risk of discoloration
• Patients with loose or sagging skin will be limited with what a chemical peel can do and may be better suited for a facelift
• Patients are limited to one deep peel treatment due to the risk of skin damage

Risks of Chemical Peels

• The risks involved with chemical peels include:
• Allergic reaction
• Infection
• Secondary infection
• Hot spots
• Delayed healing
• Changes in sensation
• Crusting and peeling
• Herpes outbreak
• Brown spots due to sun exposure
• Changes in skin color
• Demarcation lines
• Whiteheads
• Poor wound healing
• Scarring

Choose a Doctor Experienced in Performing Chemical Peels

Chemical peels can improve the texture of the skin by creating a controlled wound to remove the outer layers of skin and allow newer, fresher skin to regrow. However, the effectiveness of the peel depends on the training, judgment and experience of the doctor. The level of experience and training can lead to different results as well as increased risks in the hands of an inexperienced doctor. It is important to schedule an appointment with a doctor who is certified and adequately trained to perform the various types of chemical peels.

Written by Cosmetic Town Editorial Team - MA

Based on an exclusive interview with Mary Lupo, MD in New Orleans, LA