How do Chemical Peels work?
Chemical peels come in many different types and strengths, but the main action of peels is to remove the top layer of the skin, and allow the bottom layers to rejuvenate and grow in.
The components of the skin from the top to bottom include the stratun corneum, which is the top, dead layer, the epidermis, which is the first living layer and the layer most visible to the eye, the dermis, which is the middle, structure-bearing layer, and the deeper subcutaneous fatty tissue. Light chemical peels usually remove the stratum corneum. Deeper peels can penetrate into the epidermis. The risk of penetrating too deeply into the dermis is possible permanent scarring.
Some publications have reported that chemical peeling can actually stimulate new collagen growth in the dermis. Peeling can remove excess stratum corneum, which can appear as dry lusterless skin. Peeling can also remove excess dead skin from plugged up hair follicles. Uneven pigment in the epidermis, such as from sun damage, can be peeled away along with the epidermis, to allow a more uniform epidermis to grow in.
Types of Chemical Peels
You should discuss with your practitioner your goals for skin improvement. Depending upon your skin type and desires, the proper treatment plan can be suggested. We offer several types of chemical peels, including:
Glycolic acid is an alpha-hydroxy acid derived from sugar cane. Peels can be performed with glycolic acid ranges from 20 to 70 percent. Peels are applied to the skin, and are usually left on for anywhere between 1 to 10 minutes, and patients experience mild to moderate stinging and burning. These peels can penetrate into the stratum corneum and epidermis, depending upon strength and application. Directly after the peel, there is usually light redness, and peeling skin for the next few days. Patients can usually resume their normal activities upon leaving the office. These peels generally do not achieve the desired goal after only 1 treatment. Usually, glycolic acid peels are done in a series, such as every 1 to 4 weeks, for about 6 total treatments. Your practitioner will discuss the appropriate plan with you. Your practitioner may ask you to use home products containing glycolic acid and/or hydroquinone to treat the skin before and/or after the peels. Prior to the peels, you may be asked to discontinue use of certain medications such as Retin-A. These peels can improve skin texture, skin pigment, acne, mild acne scarring, and mild sun damage.
Salicylic Acid Peels
There are several brands of peels which use salicylic acid, a beta-hydroxy acid. The application of the peel is similar to the description of the glycolic acid peel, except that this peel is not timed. The patient experiences mild to moderate tingling and burning, which stops by itself after approximately 3 to 5 minutes. These peels can be done for the same conditions as for glycolic acid peels. Because the beta-hydroxy acid penetrates well into the hair follicles, it is useful to treat the plugged pores in acne.
Tri-chloro-acetic Acid (TCA) Peels
Tri-chloro-acetic acid (TCA) peels can range from light peels similar to glycolic acid peels, to deeper peels similar to resurfacing treatments. 20% TCA peels can be performed for skin rejuvenation, pigment irregularity, and skin roughness. At this lower strength, the peels can be similar to or slightly deeper than the glycolic acid peel. In addition to redness and peeling, there may be some superficial erosions and crusts. One way to deliver the 20% TCA peel is in a series of three, one week apart. Each subsequent peel goes deeper, because of the skin removed at the prior week’s peel. Deeper TCA peels can be done at concentrations greater than 20%. The goal of the deeper peel is generally to treat moderately to severely sun damaged skin, or some acne scars. Deeper peels can also treat some early actinic keratoses (precancers). The deeper peel is usually performed once. The patient experiences moderate to intense burning during the treatment, which lasts approximately 5 minutes. Afterwards, the skin is red and has a whitish frost from the peeled skin. The patient can expect some swelling, crusting, and drainage for about 1 to 2 weeks, during which time ointment dressings are being applied. Patients generally will take some time off from their schedules for this treatment. After the skin has healed, there may be some light redness for the next few months. Patients may be prescribed antibiotics to take during the healing period. Usually, prior to treating the complete area, your practitioner will perform some test spots first. The deeper TCA peel may not be suitable for some patients with darker skin types, due to risk of pigmentation changes.
For all types of peels, it is important not to have excessive sun exposure for a few weeks before and after the treatment. After the peel, it will be important for you to use careful daily sun protection. Be sure to discuss your current topical medicines and creams. If you are using Retin-A, Differin, or Tazorac, you may be asked to stop 1 week before the peel. Be sure to tell your practitioner if you have had Accutane pills in the past (a medication for severe acne), as this treatment may cause difficulty with skin healing for up to 1 year after the last pill. Also tell your practitioner if you have had cold sores (Herpes blisters), so that a treatment may be prescribed to prevent an outbreak after the peel.
What are the risks of Chemical Peels?
Risks for all types of peels include light or dark discoloration (pigmentation), absence of desired effect, persistent redness, scarring, infection, and irritation to the eyes if they are exposed. Risks generally are greater for the deeper peels. Your practitioner will try to minimize the risks by carefully choosing the correct peel for you. Some patients with darker skin may have higher risk of pigment side effects.