Chemical Peel Overview
In a chemical peel, a chemical solution is applied to the skin and allowed to soak in. Over the next 1 to 14 days, depending on how deeply the chemical penetrated the skin, the layers of the skin peel and slough off. This procedure dissolves layers of the skin in a controlled way so that new skin can grow in its place. The chemicals used are sometimes called exfoliating or wounding agents.
The types of chemical peels differ based on how deeply the chemical penetrates and what type of chemical solution is used. Factors that may affect the depth of a peel include the acid concentration in the peeling agent, the number of layers that are applied, and the amount of time allowed before the acid is neutralized. Deeper peels result in more dramatic effects as well as higher risks, increased pain, and longer healing time. There are three basic levels of peels:
· Level 1 - Superficial peels are the mildest type of chemical peel and can be used on all skin types. Superficial peels usually use liquid containing a mild (dilute) acid, most often glycolic, lactic or salicylic acid.
· Level 2 - Medium peels penetrate the skin more deeply than superficial peels and cause a second-degree burn of the skin. Trichloroacetic acid (TCA) is the main peeling agent used for medium peels, though the peel may also be done in several steps using a different chemical solution followed by TCA.
· Level 3 - Deep peels penetrate several layers of skin and cause a second-degree burn of the skin. They are used only on the face. A chemical called phenol is usually used for a deep peel. Deep peels may not be used on darker skin types because they tend to bleach the skin (hypopigmentation). Even in lighter-skinned people, phenol peels-or any type of deep resurfacing-may hypopigment the skin. A deep peel is only done with prior consultation and proper skin preparation.
Before the peel
A consultation will help your esthetician decide what depth of peel and what type of chemical solution is most appropriate, based on your skin type, which areas you want peeled, what kind of results you want, how much risk you are willing to take, and other issues. A small "test spot" may be peeled to get a better idea of the results, especially for people with darker skin.
One to three weeks before the peel, you will need to begin preparing your skin by cleansing it twice a day, applying a special moisturizer or cream once or twice a day, and using sunscreen every day. In some cases, daily use of Retinol (vitamin A), or a topical acne medicine is also recommended and may speed healing. Your esthetician recommended home care regimen will help the skin peel more evenly, speed healing after the peel, and may reduce the chance of infection and other complications, especially uneven color changes in the skin.
For medium and deep peels of the face, you may need a short course of medicine (such as acyclovir) to prevent viral infection. This is especially likely if you have had cold sores before, and the peel will be in the areas near the mouth or eyes.
How a Level 1 superficial peel is done
Right before the peel, the skin is cleaned. The chemical (usually a liquid or paste) is then applied to the skin with a small brush, gauze, or cotton-tipped applicators. The chemical is left on the skin for several minutes, depending on the type of chemical used. Water or alcohol may be used to neutralize the acid and end the chemical reaction, then it is wiped off. You may feel a little itching or slight burning while the chemical is on your skin. A handheld fan can help cool the skin and relieve any discomfort.
How a Level 2 medium peel is done
The technique used to do a medium peel is similar to that used for a superficial peel, but the chemical may be left on longer and multiple layers are applied. The esthetician may choose to increase the effectiveness of the peel by performing pre-exfoliation with another peel or microdermabrasion. Medium peels can be more painful than superficial peels, because the chemicals are stronger and they soak deeper into the skin. You may be asked to take a mild pain reliever and an oral sedative to reduce pain and anxiety before the procedure. Cool compresses and fans are used to cool the stinging caused by the chemical. There is little or no pain after the peel is finished. Home care products to speed up healing and reduce inflammation are highly recommended for best results.
How a deep peel is done
Deep peels take the most time and will require some downtime after the peel and you will have a substantial amount of peeling or shedding of the skin. It is impossible to tell how much a patient will peel but 5-7 days is the average. Most deep peel solutions contain a numbing agent and the peel is virtually pain free. Some mild stinging may occur when the peeling solution is applied. This type of peel is NOT neutralized and it is left on the skin. Immediately after the peel you may have swelling, redness and/or irritation. A mild pain reliever or anti-inflammatory may be taken 30 minutes before the peel.
Estheticians who perform our deep peels have gone through extensive training and will have many years of experience performing chemical peels. The procedure for a deep peel using phenol can be more complicated than other types of peels. Only experienced professionals should perform this type of peel.
What To Expect After a Peel
Recovery time after a chemical peel depends on what kind of peel was done and how deep it was. With all types of peels, proper care of the skin after the peel is very important to speed healing, help results last longer, prevent infection, and avoid color changes in the treated area of the skin. Proper skin care after a peel is very similar to the care used to prepare for a peel and typically involves:
· Cleansing morning and night with a gentle skin cleanser recommended by your skincare professional.
· Frequently applying a healing ointment on the skin (for medium and deep peels).
· Moisturizing the skin morning and night with a recommended product.
· Avoiding any sun exposure until peeling has stopped and frequently apply a non-irritating sunscreen. New skin is more susceptible to sun damage.
· Avoid picking and peeling the skin during the healing as if my cause skin damage and pigmentation.
Superficial peels are done quickly with little or no down time and cause only slight discomfort afterwards. Most people can return to their normal activities immediately. The skin heals quickly after a superficial peel. The skin may turn pink, and only minimal peeling may or may not occur.
Medium peels may need to take a few days off work to recover. A medium peel causes a second-degree burn of the skin depending on the layers of the peel applied. The skin usually takes 5 to 7 days to heal and may consist of mild to moderate peeling and some redness. There is little or no pain after the peel, but there may be some swelling, especially if the area around the eyes is treated. The skin will turn reddish brown in 2 to 3 days, become crusty, and then flake and peel over the next few days.
A deep peel causes a deeper second-degree burn of the skin. Skin regrowth takes between 10 to 14 days after a deep peel. The skin can remain extremely red for up to 2 weeks for some people. Most people take about 5-7 days off from work. Complete healing of the skin may take several weeks.
· Oral pain relievers may be taken to reduce pain and swelling after the peel.
· Some people have severe swelling, especially around the eye area. Elevating the head may reduce the swelling to some extent, and corticosteroids may be used for more severe swelling.
· Proper wound care is extremely important after a deep peel to speed healing and prevent infection of the wound. You may be asked to apply a healing ointment several times a day to reduce crusting and speed up the healing. It’s important to return for a follow up hydrating or deep cleansing treament 1-2 weeks after the peel to make sure the skin is healing properly and to treat any conditions that may come up.
When is a chemical peel NOT recommended
A chemical peel may not be done if:
· Recently used isotretinoin or Accutane (drugs used to treat acne) in the past 6 months.
· Are pregnant or lactating. AHA’s may be ok in the 3rd trimester with your doctor’s clearance.
· Had recent facial surgery or facial radiation therapy. This can make regrowth of the skin more difficult.
· An active herpes infection affecting the area to be treated.
· An impaired immune system. This can delay healing and increase the risk of infection and skin color changes after the peel.
· Known allergies to certain medicines.
What are Realistic Results
The results of a chemical peel depend in part on the depth of the peel and the care of the skin afterwards. We recommended at least a series of 3 peels to achieve a significant difference in the skin’s appearance.
It is important that your skincare professional understand what you hope to achieve and that you understand what results you can realistically expect. Even with realistic expectations, you may not see results for several weeks or months after a chemical peel.
· A superficial peel may slightly reduce but does not eliminate sun damage and signs of aging. The results may not appear for some time, and when they do appear, they may be minimal. Repeated peels and a series of 6 or more over several months or years are often needed to produce the desired results.
· A medium peel can be very effective in evening out pigment differences and in reducing fine wrinkles and signs of sun damage. Retreatment may be needed after 2 to 4 weeks to produce the best effect.
· A deep peel can help eliminate wrinkles and significantly tighten the skin. The effects are often dramatic and increase over time as the skin produces more collagen with the wound healing. In general, a person can have repeated deep phenol series of peels only 1-2 times a year.
Your skin type, skin care before and after the peel, and your lifestyle after the procedure can also affect the results. Some types of skin problems respond better to chemical peeling than others. People with lighter skin who limit their sun exposure after the procedure tend to have better results than those with darker skin and those who continue to spend lots of time in the sun.
Before you decide to have a chemical peel, talk to your skincare professional about the kind of results you can expect and if those expectations are reasonable and achievable. You may be referred to a plastic surgeon if the wrinkle depth or scarring will not have the desired effect by a chemical peel.
Changes in the color and texture of the skin caused by aging and sun exposure may continue to develop after a chemical peel. Chemical peels are not a permanent solution for these problems and the skin requires ongoing maintenance for skin rejuvenation.
What are the Risks
In general, the deeper the peel, the greater the risk of side effects and complications.
· Redness (erythema). Expect some redness of the skin after a chemical peel. With deeper peels or with certain skin types, redness can be severe. It may fade within a few days, or it may last several weeks.
· Color changes in the skin. Treated areas may be darker or lighter than the surrounding skin.
· Crusting and scaling.
· Swelling (edema), especially around the eyes.
· Allergic reaction to the chemical.
· Infection. People who have a history of herpes outbreaks are especially prone to infection after a chemical peel.
· Increased sensitivity to sunlight.
Sun Protection and Caution
During the early healing period after a chemical peel (before the skin has finished peeling), you will need to completely avoid direct sun exposure, especially after a deep peel. After the early healing period has passed, you will need to wear sunscreen every day and limit sun exposure as much as possible. New skin is more susceptible to damage and discoloration from sunlight.
The skin will absorb all sunscreen after 2 hours, so it is important to reapply sun protection frequently after a peel. We recommend a high quality mineral makeup such as Colorscience or Jane Iredale to reapply throughout the day for adequate protection.
Other options for skin resurfacing
Chemical peel, microdermabrasion, and laser resurfacing are the most commonly used techniques for improving the texture and appearance of the skin. Although these techniques use different methods, they have basically the same effect on the skin-they destroy and remove the upper layers of skin to allow for skin regrowth.
No one technique is necessarily better than the others. When done by an experienced surgeon, laser resurfacing may be slightly deeper than chemical peeling or dermabrasion but can be painful, extremely expensive and requires several treatments. It has higher risks and can have adverse affects and may cause more pigmentation and scarring, especially in ethnic or darker skin types.
But the choice of technique is based on the site you want to treat, your skin type and condition, your preferences, and other factors. Some people may get the best results using a combination of techniques.
Questions? give us a call (562.427.1025) or email us at skinspa@live