Chemical Peels

Posted by Audrey Kunin, MD There have been 4 comment(s)

Chemical Peels

Chemical peels are one of the most popular cosmetic procedures that patients avail themselves of today. Chemical peels can give your skin a healthy, "just refreshed" look, or can be aggressive, taking years off of your appearance.

What do chemical peels do? The outer portion of the skin (epidermis) is composed of multiple layers of epidermal cells. These cells provide a barrier against the environment, protecting deeper, more delicate tissues, maintain an even internal temperature and also prevent against dehydration.

Epidermal cells are anchored together in two ways. Microscopic fibers called tonofilaments run between individual cells, helping anchor them together. An extracellular surrounds each cell, acting as a sort of "glue" to further keep cells together. Over time, these cells are invisibly shed through the body's natural means of exfoliation. Speeding up this process can instantly restore a more youthful glow to the skin and address other subtle signs of the aging process.

Whereas microdermabrasion breaks the tonofilaments through the act of physical exfoliation, chemical peels work to dissolve the "glue." One of the most frequent questions is which procedure is better? The answer is that each works well, but neither provides a thorough exfoliation when used alone. That is why incorporating both treatments into a regimen can produce a much more satisfying result.

DERMAdoctor Physical Chemistry blends a chemical peel with microdermabrasion. The buffered glycolic, lactic, salicylic and azelaic acids dissolve the "glue" that hold the epidermal cells together. Calming, soothing anti-irritant botanicals reduce the redness and sensitivity typically associated with either a chemical peel or microdermabrasion. A self-destructing synthetic microdermabrasion particle breaks the microscopic fibers anchoring skin cells together. I favor synthetic particles as they are fully smooth and unlikely to abrade the skin. Natural particles; salt, sugar, ground pits or shells and mineral dusts are like snowflakes. Each is unique with tiny jagged edges that can scratch up or irritate the skin. It's a single step. Just apply it to dry or slightly damp skin, scrub and rinse. Please note that regardless of your chosen form of peel or microdermabrasion, exfoliation thins the epidermis, making it more vulnerable to sunburn. I always reccomend the use of a broad spectrum SPF 30 daily. DERMAdoctor Photodynamic Therapy each morning provides 3 benefits- SPF 30, daily moisturizer plus a cutting edge rejuvenating technology. It makes an ideal companion in your anti-aging skin renewing regimen.

Are you considering an in-office chemical peel? Just like other cosmetic procedures, there is a wide range of chemical combinations, strengths and techniques used that can make it overwhelming to decide which is best for you.

Physicians typically guide the patient to the most appropriate type and level of chemical peel to address the problem and yield a satisfying result. What's realistic? What isn't? What can you do for yourself? And finally, what should your doctor do that your aesthetician shouldn't? Let's find out.

Realistic Goals Of Chemical Peels

  • Chemical peels can correct actinic (sun) damage.
  • They can reduce mild scarring.
  • You can experience a reduction or eradication of your wrinkles.
  • Improvement of dark skin discoloration is possible.
  • Chemical peels can remove excessive / stubborn blackheads.
  • The peel may temporarily reduce excessive skin oils.

Unrealistic Goals Of Chemical Peels

  • It cannot remove or reduce the appearance of blood vessels on the skin.
  • It is impossible to truly change pore diameter. However, by removing blackheads, the pores may actually appear less pronounced after treatment.
  • This is not a procedure to get rid of keloidal types of scars.
  • Chemical peels are not a facelift.
  • This is typically not appropriate for improving dark skin discoloration in people of color (Asians, African Americans, Caucasians of Mediterranean extraction, Hispanics, etc.)

There are a variety of different chemicals used for the purpose of rejuvenating the skin in what are called "chemical peels." The main reason to select an active agent is based upon the desired depth of the chemical peel. If the skin concern is predominantly superficial, then a milder, less caustic ingredient is selected. If deeply placed conditions exist, then far stronger products with matching levels of potential complications may be necessary.

Chemical peeling agents that perform mild or moderate peels typically provide a safer peel that has less associated long-term side effects. These peels work on the epidermis and possibly the most superficial portion of the dermis (known as the papillary dermis).

Deeper peels go midway into the dermal layer (into the reticular dermis), almost invariably leaving a permanently lighter skin tone. Instead of being able to tan as in the past, this lighter skin often freckles instead. These deeper peels should not be undertaken lightly, and you need to make sure in advance that the peel technique will be feathered into the scalp line and performed down the neck, possibly even the decollettage, or you may find that you have a highly noticeable line demarcating your original skin tone and the new one that is on the face.

Active ingredients used alone or in combination for mild to moderate strength chemical peels

  • Glycolic Acid(AHA)
  • Salicylic Acid (BHA)
  • Lactic Acid
  • Jessner's Peel (a combination of salicyclic acid, resorcinol and lactic acid mixed in ethanol)
  • Resorcinol
  • TCA (Trichloracetic Acid)

Active ingredients used in deep chemical peels

  • Baker's Phenol

THE FOUR LEVELS OF PEELING

The ingredient and concentration obviously play a very big role in determining the ultimate depth of the chemical peel. However, other variables can make a difference such as whether a pre-peel de-fatting prep was performed, the amount of chemical applied, and the length of time the chemical was allowed to stay on the skin.

Another important factor is which area will be treated. The variations in skin thickness can affect the ultimate peel outcome. For instance, the face usually heals far more rapidly and typically experiences far fewer complications (such as discoloration, scar formation and infection) than areas such as the backs of the hands or neck. And regardless of what type or depth of peel used, exfoliation always increases one's sun sensitivity. Always wear a broad spectrum SPF 30 when using any type of chemical or physical exfoliation.

Very Superficial:

This really isn't a true peel, more of an exfoliation. The most superficial layers of the stratum corneum (at the top of the epidermis) is removed or thinned during exfoliation. Most chemical peels have a preoperative regimen of using exfoliating agents such as Renova, Tazorac or a strong glycolic acid cream for 2-4 weeks prior to the actual procedure. This helps the chemical peeling agents penetrate more deeply and evenly. The use of these exfoliants also has the obvious benefit of smoothing out thickened rough areas, helping self tanners go on more evenly and helping other skin rejuvenation products reach deeper tissues. Additionally, there has been good evidence that vitamin A exfoliants can help stimulate collagen deposition.

Superficial:

Superficial chemical peels remove skin through a portion or all of the epidermal layer. These are the "refreshing" forms of skin peels. They can also help with reducing the appearance of very mild blotchy skin discoloration, remnant acne discoloration and help cleanse the pores. This is the most common form of peel that you would find performed in a spa or by an aesthetician. And typically they would only utilize glycolic, AHA blends or BHA as the active ingredients. True peels with higher levels of glycolic acid (30% or higher) or those containing TCA, resorcinol or Jessner's ideally would be performed in a medical setting.

Examples of chemicals used for a superficial peel include: TCA 10-20%, Resorcin, Jessner's Solution, Salicylic Acid, Solid CO2 (also known as dry ice), AHAs (Glycolic and Lactic Acid).

Home peel kits tend to fall somewhere between very superficial and superficial. They can be excellent for helping freshen skin, eliminate blackheads, improve symptoms of oiliness and/or acne and renew texture. Home peels usually rely upon very low levels of glycolic acid (AHA) or blend with salicylic acid (BHA). Guestimate that total levels of actives will fall somewhere in the 4-12% total acid level range when looking at an average do-it-yourself products. Certainly chemical peels for home use in the 30+ range should be approached with care. Glycolic acid at 30% enters into potential medium level peel, particularly if misused.

Acid is acid, so anytime a peel regimen is used at home, it is important to follow the directions. Acids are neutralized during the routine to stop their action. This prevents inflammation, discoloration or chemical burns from occurring. Most mainstream brands have been thoroughly tested and have well proven safety records. But "rogue" peels without any major brand behind them may be suspect. DERMAdoctor has periodically received frantic consumer calls about problems experienced with "no-name" chemical peels purchased online or through an infomercial. So it always boils down to buyer beware and use with care.

While fun to try, I have personally found that using a multi-step system doesn't fit in with my hectic lifestyle. Between the kids, the job, the house and the husband, somehow there is just no time for me. Add in the fact that a chemical peel does not provide a thorough exfoliation, and my medical inclination is to combine both chemical peel with microdermabrasion.

Medium:

Here's my personal cut off point that distinguishes medically performed peels from those offered in a spa, by an aesthetician or facialist. A medium strength chemical peel allows the acid to penetrate through the epidermis, down into the upper most portion of the dermis known as the papillary dermis. A medium strength peel will be far more likely to be associated with complications, both temporary and permanent.

In addition to the pre-peel use of exfoliants, the use of a skin bleaching agent, such as 4% hydroquinone, and a broad-spectrum sunscreen a month prior to the procedure, may be added for more aggressive forms of these peels, or for patients who already suffer from some form of skin discoloration. Inflammation from this level peel may temporarily produce an increase in skin tone. Medium peels are typically not appropriate for people with darker skin tones or of ethnic background, again due to the risk of irregular pigmentation following the procedure.

Dealing with infection preventatively is key here. For non-buffered glycolic acid and more commonly TCA peels, the use of antiviral medication (herpes cold sore prevention) started before the peel is performed is very helpful. The use of antibiotics is sometimes also used. It is absolutely CRUCIAL that you not pick at the peeling skin during the healing phase. This is a sure way to end up with an infection and long lasting problems such as scarring or skin discoloration.

Often the use of emollients during the first few days are incorporated in addition to the continued use of sunscreen such as DERMAdoctor Ain't Misbehavin' spf 30, and a very mild cleansing agent such as DERMAdoctor Wrinkle Revenge 1 facial cleanser. Make-up is often avoided until the skin has fully peeled away.

Buffered glycolic acid chemical peels that range from 70-99% do not cause the type of significant noticeable peeling that you can see with TCA peels such as AccuPeel. However, a series of 6-12 buffered glycolic acid peels compared to usually 1 of the AccuPeel is typically performed. Skin sensitivity, degree of skin concerns, time down, and cost will determine which form of peel should be chosen.

A variety of acid compounds can be used for a medium peel: Glycolic Acid 70%+ (non-buffered), TCA 35-70%, combination peels such as solid CO2, (also called dry ice), followed by medium strength TCA, and glycolic acid followed by TCA.

Deep:

This peel goes through the epidermis, papillary dermis and into the deeper portion of the dermis known as the reticular dermis. These peels are not a simple procedure. Absorption of the active ingredient, phenol, has been known to cause cardiac arrest and even death. Patients who undergo phenol peels should be placed under general anesthesia and on full cardiac and pulmonary monitoring.

A phenol peel unquestionably requires a medical setting where emergency back-up is available should anything go wrong. An anesthesiologist should be present, and preferably have this procedure done in a surgical setting, not just a room adjacent to the doctor's office. The down time from this procedure is obviously the longest, 2-3 weeks is generally required before you want to be seen in public. Due to the depth of the peel leaving deeper tissue exposed, there is an increase in photosensitivity to the sun.

Examples of ingredients used in deep peels include: Baker's phenol alone or under occlusion by tape. The tape drives the phenol deeper into the skin.

Chemical peels can truly retexturize the skin, restore radiance and a youthful appearance. Whether looking for magic or simply the ideal home treatment to maximize your rejuvenation routine, chemical peels are undoubtedly here to stay. Whatever the reason, always follow the directions. Doing so will help get the most from your treatment and minimize problems down the road.

Thank you for taking the time to read my newsletter. As always, I hope you have found it informative.

Audrey Kunin, M.D.

This content is sponsored by DERMAdoctor. The author receives compensation for its creation. All content is the legal copyright of DERMAdoctor, Inc, and it may not be used, reprinted, or published without written consent.

The information provided is for entertainment purposes only and is not intended to provide medical, legal or other professional advice.


This post was posted in Anti-Aging, Articles, Discoloration, Exfoliation, Rejuvenation and was tagged with chemical peels, chemical peel, glycolic acid, microdermabrasion

4 Responses to Chemical Peels

  • Kay says:

    I have acne scarring and would like to do my own deep chemical peels at home.I am 36 and still have breakouts. I was on acutane 5yrs ago which helped with the breakouts for many years but now Im getting breakouts again. I had 2 fraxel laser procedures 2 yrs ago which worked a little with my scarring but now since I am experiencing breakouts again i incurred some more scarring. What would you reccomend I use for my breakouts and what chemical peel should i use?

    Posted on October 22, 2012 at 7:48 pm

  • I have been done with my chemo for about 4 months, I am 55yrs old,now my skin looks so aged, what do you recommend for me to use to have my skin look better?.

    Posted on August 20, 2012 at 1:31 pm

  • Hi Summer!

    You can do many things to help improve facial discoloration. Not knowing how deep your natural skin tone it, if you have large well defined patches of discoloration, this may be something your dermatologist can treat with IPL or prescription bleaches. Should you want to try improve the discoloration on your own, you want to both work to remove pigment already present and turn off further dark pigment formation.
    Step 1 - wear a broad spectrum SPF 30 daily such as DERMAdoctor Body Guard. No matter what you do to lighten your discoloration, the sun will work to darken it back up. DERMAdoctor Immaculate Correction is a hydroquinone-free skin brightener to be used on the dark spots. DERMAdoctor Poetry in Lotion used no more than every other night can help even out skin tone.

    All My Best!
    Dr. Audrey Kunin

    The information contained in this response is intended for educational purposes only and is not meant to be used as a diagnosis or treatment plan. If you have a medical concern, please contact your physician.

    Posted on April 20, 2012 at 4:32 pm

  • summer says:

    good day Dr.

    If chemical peel isnt ideal for removing discoloration in Asians (Im Filipina) then what should be the best treatment?
    I have discoloration on my face and noticed that since i spent long hours in front of the computer,my discoloration increased.
    what must I do>Pls help me,Dr.
    Many Thanks and Good luck!!

    Posted on April 18, 2012 at 11:45 am

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