Chemical Peels

Chemical peels first gained popularity in the 1960s when skin-care options were few and far between. Chemical peel treatments have remained a favorite because they can resurface and refresh the skin by diminishing the appearance of fine lines, wrinkles, sun damage, enlarged pores, hyperpigmentation and acne scars.

Today, chemical peels are used for various skin concerns across all ages, and are often coupled with other skin-enhancing treatments for maximum benefits.

The process of a chemical peel is relatively simple. “Most acid peels work by disrupting the bonds between dead skin cells. The speed and depth of exfoliation is determined by the specific acid used, its acidity (or pH), the concentration of the solution, and the amount of time it’s left on the skin,” explains Barrington, IL, dermatologist David Van Dam, MD. Once the skin is injured by the peel (in a controlled and safe way), the skin begins to naturally repair itself. The dead skin flakes away to reveal new, fresh skin.

It’s extremely important that the person administering these treatments is an experienced skin practitioner—if the peel isn’t left on long enough there will be no effect on the skin; if it’s left on for too long, it can cause damage to the living cells.

Chemical skin peels can range from superficial (often called micro-resurfacing) to medium or deep. Superficial peels are generally recommended in a series of at least six, while a deeper peel may be a one-time treatment. You may be able to return to your regular activities immediately after a light peel (with mild redness); deeper peels may require significant downtime. Deeper chemical peels, laser resurfacing and Dermabrasion are all cosmetic skin treatments that remove the outer layers of the skin, leaving you with fresh, pink, healthier-looking skin once healing is complete.

Chemical peel agents include:

• Glycolic Acid Peels (one of many alphahydroxy acids) – a light peel that provides subtle results in the treatment of faint hyperpigmentation, acne and wrinkles.
• Salicylic Acid Peels (an ingredient also found in a Jessner's Peel) – a light to medium peel.
• TCA-based Peels (Obagi Blue Peel) – a medium peel. Trichloroacetic acid (TCA) peels treat pronounced blemishes, lines and pigmentation, yielding softer, refined complexions, but these come with a recovery period that ranges from seven to 10 days or more.
• Phenols (croton oil-based) – a deep peel.

Glycolic acid peels (formulated from sugar cane) are virtually downtime-free skin treatments, which come with mild redness or irritation as the only likely after-effect. Glycolic acid chemical peels are ideal for people who suffer from excess sebum, and these treatments may rejuvenate the skin without much downtime. Glycolic acid peels, in particular, contain alphahydroxy acids (AHAs) that gently exfoliate the skin to unclog oil-filled sebaceous glands. Peels that utilize AHAs penetrate the skin and help remove layers of dull, dry skin. The skin renewal cycle is roughly 28 to 32 days without any exfoliation assistance, but AHA peels can speed up the process. A series of five in-office peels (spaced three weeks apart) can be effective for alleviating minor skin spots and blemishing.

Alphahydroxy acids (AHAs) in concentrations of 30 percent or more are applied for two to five minutes (or more) to slough away the upper layer of dead skin cells as well as penetrate into the upper layers of the dermis to soften fine lines, promote a rosy glow, encourage better penetration of other skin-care products or even dry an acne flare up.

Chemical exfoliation can also help improve the appearance of excess pigment by exfoliating the upper layers of the skin where some pigment resides. Your dermatologist or plastic surgeon can recommend the best course of treatment based on your skin tone and specific pigment problem, but St. Louis, MO, dermatologist, Roberta Sengelmann finds that a series of two to six, 30 percent to 70 percent glycolic acid peel treatments coupled with Jessner’s solution is especially beneficial for minimizing melasma.

For optimal results, Dr. Roberta Sengelmann also prescribes a retinoid (or another peeling agent) for at-home use between peels. While using these high-strength treatments, diligent sun protection with an SPF of at least 30 every day is necessary for two reasons: First, sun exposure can trigger production of the pigment you are trying to eliminate, and second, chemical peels and topicals such as retinoids increase sun sensitivity. Dr. Roberta Sengelmann stresses that anyone with a darker skin tone may have a higher complication rate with these peels.

In addition to glycolic acid and AHAs, other acids used as agents in light chemical peels known for mild exfoliating are citric acid, (from lemons, oranges, limes and pineapples), lactic acid (from milk or bilberries), malic acid (from apples) and tartaric acid (from grapes).

“Lactic acid peels have similar effects to glycolic peels, although lactic acid is generally milder,” explains Barrington, IL, dermatologist David Van Dam, MD. Plus, lactic acid peels, which are derived from sour milk, offer up a subtle lightening effect. If your skin is sensitive or if you suffer from a condition like rosacea, talk to your aesthetician about a lactic acid peel.

Medium-strength Trichloroacetic acid (TCA) peels are best for those with fair skin (since post-inflammatory hyperpigmentation is possible) looking to tackle extreme pigment problems like melasma. Similarly, peels containing salicylic acid more readily aid in the sloughing of dead skin cells. Patients looking for a more aggressive sebum-reducing treatment, however, should consider a TCA skin peel, which alters the skin’s acidity levels to halt bacteria and oil overgrowth. “TCA peels should only be performed by an experienced physician, since the concentration of acid and duration of contact are critical in determining the peel’s effect,” notes Barrington, IL, dermatologist David Van Dam, MD. In higher concentrations, well-trained doctors use TCA in lieu of laser resurfacing to soften acne scarring and erase wrinkles deeper wrinkles.

Since TCA peels are medium strength, they always cause stinging and redness. “Stronger concentrations of TCA can penetrate into the dermis and create significant peeling and redness that may last for more than a week,” he says.

“There are a variety of peels that are effective for brown spots, such as the Obagi Blue Peel, which can only be found in doctors’ offices,” says Kirkland, WA, dermatologist, Dr. Julie Voss. One of the better-known types of TCA peels is the Obagi Blue Peel, which requires one cycle of pre-peel prepping to prevent hyperpigmentation from occurring during the actual peel. The Obagi Blue Peel (your doctor will let you know if you require a single treatment or a series), which is a TCA peel in mask form, is suitable for all skin types and works to correct fine lines, scars and pigmentation problems. Obagi Blue chemical peels are good for reducing fine lines, improving skin texture and even softening sun-damaged skin. The peel is designed to prevent over-exfoliation of the skin using a special blue tint that usually washes off in 12 to 24 hours.

Most TCA-based peels are a one-time treatment and require one to two weeks of downtime until crusting heals to reveal smoother, younger, clearer pink skin. (There is no downtime with lighter concentrations of TCA peels.)

While treatments vary, the skin’s surface must be rejuvenated to get rid of the sun-damaged cells and stimulate the body to make more collagen. To help resurface the skin and eliminate excess pigment, your dermatologist or plastic surgeon may prescribe Tri-Luma, which contains hydroquinone to lighten pigment, as well as a retinoid to speed skin-cell turnover and a steroid to prevent inflammation. “This should work within two months on irregular brown patches,” says Dr. Julie Voss.

What Trichloroacetic Acid Treats

TCA peels can also treat deeper acne scars and hyperpigmentation.

Usually just one TCA peel, which takes about 10 to 15 minutes, will reduce medium to deep discoloration—but in some cases, more than one treatment is needed to achieve the desired results.

Before the peel, your doctor will probably apply a topical anesthetic; otherwise you may feel some stinging. Post-peel, your skin will crust or scab and your face may be swollen for a few days. And while the results are not permanent, once your skin is fully healed (within about seven to 10 days after the treatment), it will still be able to produce pigment. To prevent hyperpigmentation from returning, make sure to stay out of the sun for the first few months after your peel and wear an SPF daily.

Can TCA Peels Prevent Skin Cancer?

A study published in the Archives of Dermatology compared the outcomes of a 30 percent TCA peel, CO₂ laser skin resurfacing and the topical cream fluorouracil to treat precancerous skin lesions. After three months, all patients saw a reduction in the number of actinic keratosis lesions, but those receiving TCA peels experienced a “markedly lower” or 40-fold reduction in non-melanoma skin cancer. The sample size of the study was small, but the authors believe the results warrant additional studies with larger patient populations.

While the study demonstrated that TCA peels were effective for preventing non-melanoma skin cancers, Dr. David Van Dam says, “In order for a TCA peel to prevent skin cancer, it would have to be a deeper, more aggressive peel, not a light, ‘freshening’ version.” It’s important to note that the TCA peel used in this study requires 10 to 14 days for recovery, and you can expect the uppermost layers of the skin to shed for up to three days.

Jessner's Solution (or Jessner’s Peel) is the common name often used for a deeper chemical peel solution made from resorcinol and lactic and salicylic acids. Salicylic peels (a betahydroxy acid) are often applied after a glycolic peel of 30 to 50 percent concentration.

Although not appropriate for anyone with an active breakout, this type of peel can also provide rejuvenating benefits such as the reduction of fine lines and discoloration, and can stimulate new collagen production (depending on the strength). Although TCA varies in concentration, it is most often a deeper peel that requires about two full weeks of downtime and diligent sun protection both during and after treatment.

Named after New York dermatologist Max Jessner, MD, who invented it, Jessner's Solution is layered on the skin to treat uneven pigmentation, acne, acne scarring and other skin irregularities. You can expect aggressive peeling and occasional crusting forms within two to four days after the peel has been applied. Redness and swelling may last a week or more. Results are visible with new, clearer skin within seven to 10 days, but redness or other pigment changes may persist for several weeks.

What Light Chemical Peels Treat

Betahydroxy acid peels are good for oily skin, acne, uneven skin tone, fine lines and wrinkles. Salicylic acid peels, which are similar to low-strength alphahydroxy acid peels, are best for fighting blackheads, whiteheads, clogged pores, fine lines, wrinkles and uneven skin tone.

“Salicylic acid peels have effects limited to the epidermis because the acid does not penetrate deep within the skin no matter how long it’s left on for,” says Barrington, IL, dermatologist David Van Dam, MD. If your skin is dry or normal, a salicylic acid peel, which is the main type of betahydroxy acid peel, may be too harsh for you. You should always use sunscreen with a high SPF after a betahydroxy peel, since it increases sun sensitivity.

Chemical peels exfoliate the top layer of skin, causing the natural cell turnover process to speed up. Salicylic and glycolic acids are two of the most commonly used ingredients in light peels. They refresh the skin by removing discolored skin cells. Plus, they work wonders on acne-prone skin—oil production is minimized, pores are unplugged, and blemishes, blackheads and whiteheads shrink in size. Unlike microdermabrasion, chemical peels can be a little more intense, depending upon the percentage of acid used.

Salicylic or glycolic peel can be mildly uncomfortable and burn or sting. It’s also normal for skin to be red and dry and peel for a few days after the treatment.

Phenol peels are the strongest type of chemical skin peel available. They penetrate deep within the skin to treat severe wrinkles, sun damage and lines and wrinkles around the lips and chin. “Even though this is a major treatment, it offers profound benefits for wrinkles and uneven pigment,” says Barrington, IL, dermatologist David Van Dam, MD.

Phenol peels offer the most dramatic results because the skin is forced into creating new, thicker collagen. But because deep peels are so strong (they are always performed with anesthesia and your doctor will prescribe pain medication to take at home after your peel), they usually are only used on the face since they can cause scarring on the neck and other parts of the body. Keep in mind that phenol peels, which are generally performed only once, can cause a demarcation line on your skin, regardless of your skin type, and require a healing time of at least two weeks.

The phenol effect is due to the croton oil agent, but croton oil is not the only phenol agent found in phenol skin peels. Effects of phenol skin peels are long lasting with patients seeing dramatic improvements.

There are some risks associated with phenol peels. Always consult with your doctor to achieve a complete understanding of any side effects or complications from its use.

What Deep Peels Treat

Phenol peels are good for treating deep wrinkles, lines and sun damage.

Whether performed by your dermatologist or plastic surgeon, a medium to deep chemical peel can literally erase away past skin damage. The acids used in chemical peels force the skin to shed the outermost damaged layers. “Chemical peels are a long-tested procedure proven to improve wrinkles,” says Miami facial plastic surgeon Julio Gallo, MD. “However, I find chemical peels to be a little less precise and variable in their results as opposed to a computer-controlled laser,” he adds. Regardless of the type of peel that you eventually decide on with your doctor, your skin may appear red and irritated for a few days after the treatment and will peel for at least one week (if not more) before fresh, new skin is revealed. Any deep peel or laser may produce permanent pigment changes in some patients.

Your doctor will determine which peel is best for your concerns and your lifestyle, since some of these do require downtime and diligent post-procedure care.

Similar to chemical peels, there’s a wide range of resurfacing options that can be used to bring new, fresh skin cells to the surface. “Patients with deep wrinkles around the eyes and mouth are candidates for CO₂ laser or erbium laser skin resurfacing at the time of their facelift,” explains Salt Lake City plastic surgeon Renato Saltz, MD.

When it comes to treating acne in those with darker skin, Boca Raton, FL, dermatologist Marta Rendon, MD, says, “The options such as chemical peels and laser treatments may be more limited. The safest option for darker skin is a light salicylic acid peel, which does not carry the risk of pigment changes.” Dr. Marta Rendon approves of using retinoids to help keep skin clear, although it can take a few months to see results. Retinoid creams tend to leave a white residue, so clear retinoid gel formulas may be better for darker skin.

For gentle exfoliation that won’t irritate the skin, ask your dermatologist or plastic surgeon about an in-office lactic acid peel.

Deep chemical peels and laser resurfacing, such as CO₂ resurfacing, often cause pigmentation problems including a loss of pigment (hyperpigmentation) or skin whitening, and should be avoided by people with darker skin.

Chemical peels—whether light, medium or deep—all involve the removal of the upper layers of the skin, which is known as an ablative skin procedure. You’ll also experience swelling, redness, flaking and peeling, so you must keep skin hydrated for the first few days following treatment.

Once healing is complete, you’ll see overall improvement in the texture and color of your skin.

These days, more medi-spas are offering medical-grade procedures like chemical skin peels and light-based skin resurfacing treatments that were once reserved for the doctor’s office. These spas can be a great way to optimize your well-being and appearance, as long as they meet safety and other medical criteria.

Despite the fact that both deep chemical peels and laser resurfacing treatments offer up similar results, it’s important to talk to your doctor about your skin type and skin concerns to determine which treatment is best for you. Both options focus on regenerating the skin, and improving fine lines, wrinkles and texture, but the way each works is quite different. “Laser resurfacing has a fixed penetration and the effect is enhanced by the number of passes, whereas the effect and penetration of chemical peels has to do with their concentration and the amount of time they are left in contact with the skin,” says New York plastic surgeon A. Peter Salas, MD. “The most important factor with both treatments is the comfort level and experience of the surgeon,” he says. Your doctor will also take into consideration your skin tone and thickness, as well as the depth and elevation of your wrinkles, to make an accurate recommendation.

It's important to know the difference between microdermabrasion and chemical peels. Rancho Mirage, CA, dermatologist, Wendy E. Roberts, MD says, "In a chemical peel, exfoliation is accomplished with chemical agents [and] there is usually longer downtime." With microdermabrasion, "exfoliation is accomplished by sanding with minimal to no downtime."

When it comes to how long you should wait between a chemical peel and microdermabrasion, Dr. Wendy E. Roberts says, it's, "all about what you want to achieve and why you are [getting] your peel. Chemical peels vary in strength and depth so the safest recommendation is to wait two weeks between because your skin will be completely re-epithelialized (repaired)." Assuming that you had a "deeper peel." She adds, "In the optimal clinical circumstances, a peel can be done on the same day as a microdermabrasion with wonderful results, but in the wrong circumstances this could be a prelude to scarring and discoloration. So judgement and experience is crucial to the planning and execution of the peel."

If you're wondering whether too many chemical peels can thin the skin, Dr. Wendy E. Roberts says, "No. The layers of skin get thin by sun damage and aging." She also adds that, chemical peels can be done every week or every two weeks, or in just one session.

The type of peel that you’re having dictates if you’ll need just one or a series of treatments. Light peels are usually performed in a series, spaced about a month apart, but they can also be performed on their own (like after a facial) to combat breakouts. However, single treatments won’t offer your skin the long-term benefits that a series can. Medium peels can be performed just once or as part of a regimen, depending on what your dermatologist or plastic surgeon feels is best for your skin concerns. And deep peels are generally only performed once since they offer up dramatic results and carry the risk of serious pigment changes.

Skin that has been exposed to medical-grade chemical peels needs intense hydration to promote healthy healing and prevent excessive peeling, redness and dryness.

Keep in mind that any derma peeling treatment can also leave your skin red for days (and in some cases weeks). “Post-procedure redness occurs when the skin tissues have been traumatized or stressed,” says West Palm Beach, FL, aesthetician Tammy Fender. After a noninvasive procedure, like a light peel, your skin may be slightly red for a few hours to a few days.

You’ll experience sunburn-like redness for the first few days, during which you’ll need to keep the skin moist with an ointment. You should be able to start wearing makeup on day three, and the skin should begin to peel at this time, as well.

“Fortifying the skin before going out into the sun can prevent inflammation,” says Virginia Beach, VA, licensed master aesthetician Saphonia Gee, who strongly advises against getting any type of chemical peel two weeks before traveling to a warm destination, since it will thin out the skin, leaving it vulnerable to the sun.

In the case of full-face chemical peels or resurfacing, your doctor may recommend a hydrocortisone cream since its creamy texture may be better suited for full-face use than ointment. Again, every doctor provides his or her patients with different post-procedure instructions, so be sure to follow the directions and recommendations given to you.

• Most medical facials are coupled with a chemical peel to speed up the natural process of skin shedding, which may cause some redness and dryness.
• Peptides are believed to encourage collagen synthesis to enhance cell metabolism for more elastic, youthful skin. And, peptide-rich skin-care products can even be used nightly and after dermatological procedures like chemical peels and laser resurfacing treatments because they don’t cause irritation.
• Don’t plan to get a peel of any strength before a cosmetic procedure. It’s best to wait a few months—especially with medium and deep peels—before any surgery is performed to ensure that the skin is completely healed.
• It’s important not to smoke before or after your peel since the constant pursing of the lips can cause a reaction between the chemicals in the smoke and the peel. Plus, smoking deprives your skin of the oxygen it needs to heal.
• Alphahydroxy acid peels are not considered medical procedures and are not regulated by the Food and Drug Administration (FDA). Peels with an AHA concentration of less than 30 percent can be performed by an aesthetician, while a physician should administer peels with a concentration higher than 30 percent.
• Mild to extreme burning is common with chemical skin peels, although any discomfort usually subsides once the peel is neutralized. Try taking ibuprofen about one hour before the treatment to lessen the burning, tingling and stinging effects.