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Overview
Chemical peels use a chemical solution that causes the skin to blister and eventually peel off. The regenerated skin is usually smoother and less wrinkled than the old skin as it removes its damaged outer layers.
The deeper the peel, the greater and longer-lasting the benefits. This is especially for deeper wrinkles, however the deeper the peel, the longer the recovery time and the greater the potential problems. Deeper peels allow damaged cells to be removed and replaced by fresher new skin during healing.
Uses
Chemical peels are helpful for those individuals with wrinkles, ingrown hairs, rosacea, uneven skin pigmentation, sallow complexion and dry skin. Chemical peels may also remove pre-cancerous skin growths, soften acne facial scars and even control acne.
Chemical peels are most often performed on the face but may also be beneficial on the neck, chest, back, hands, arms and legs.
Types of Skin Peels
Azelaic acid is a naturally occurring saturated dicarboxylic acid that acts as a competitive inhibitor of tyrosinase. It has also been shown to be effective in various hyperpigmentation disorders including melasma and post inflammatory hyperpigmentation. Azelaic is also used regularly to treat acne. Azelaic acid is antibacterial, keratolytic and a scavenger of free radicals.
The acid should be used at a 10-20% concentration. It should be applied to the affected area initially daily, then if tolerated building up to a generous twice-daily application after thoroughly cleansing the skin. Azelaic Acid, when used twice a day produces minimal side effects and is therefore a popular alternative for patients with sensitive skin.
The Baker-Gordon formula of phenol penetrates further into the dermis than full-strength undiluted phenol because full-strength phenol causes an immediate coagulation of epidermal keratin proteins and self blocks further penetration. Dilution to approximately 50-55% in the Baker-Gordon formula causes keratolysis and keratocoagulation resulting in greater penetration.
A Baker-Gordon-Phenol peel penetrates deeply into the skin. New collagen and elastin are formed as the skin heals.
Glycolic acid penetrates the upper layers to detach them by destroying their connection with the rest of the tissue. Afterwards, the exfoliated cells can be easily removed with water or cleanser.
By removing damaged cells from the skin’s surface, glycolic acid also stimulates collagen production and speeds up the natural skin renewal process.
Glycolic acid preparations are recommended for those whose skin is showing signs of ageing. Fine lines, brown marks and solar keratoses can improve with regular applications or peels. Glycolic acid may also prove helpful for those prone to acne.
Jessner’s Solution is made from salicylic acid, lactic acid and resorcinol. It is used as a peeling agent with an outcome of epidermal exfoliation and regrowth. The solution is applied to the face, it will then burn slightly and you may need to apply several layers. A whitened look, known as “frosting” may develop that will dissipate within a few hours. Next the acid will be neutralised and removed with cool water. The patient will peel and flake for about 7 days and turn pink or brown afterwards. After healing, nice, smooth skin will be revealed.
Jessner’s peel is useful for mild photo-ageing textural changes. However it can produce post inflammatory hyperpigmentation, which limits its usefulness for melasma and dyschromias. This usually occurs within two to four days and is treated with mild cleansers, moisturising lotion, and sunscreen protection
Phenol is the strongest of chemical peels, and is reserved for individuals with deep wrinkles from sun exposure or is used to treat skin wrinkling around the lips and chin area. The procedure diminishes imperfections in sun-damaged, unevenly pigmented, or coarsely wrinkled facial areas by peeling away the skin’s top layers. It provides a relatively deep and predictable injury to the dermis. This is a serious peel, requires sedation and monitoring of your patients vital statistics. This peel is usually reserved for the face - and not the neck, arms, etc.
Unfortunately the most consistent side effect of phenol chemical peels is permanent lightening of the skin. Because of this, the procedure is not suggested for individuals with dark skin tones. Other serious side effects are possible including scarring and discomfort, with increased sun sensitivity.
Retinoic Acid lightens the skin not by suppressing tyrosinase, but by accelerating epidermal turnover. It replaces older skin with newer skin, and by slowing down the way the body removes skin cells that may have been harmed by the sun. However, it does not completely or permanently erase these skin problems or greatly improve more obvious changes in the skin, such as deep wrinkles caused by sun or the natural ageing process.
Applied once daily, Retinoic Acid cream can be used safely with minimal side effects.
Salicylic Acid Peels are effective in reducing the appearance of fine lines and wrinkles, and improving overall facial texture because it exfoliates both the skin surface and within pores, without irritation.
Salicylic Acid peels are particularly helpful in clearing clogged follicles and in promoting exfoliation. They are primarily used for acne, but can also be used to fade age or discolored spots.
Trichloroacetic acid creates a peel that offers less risk of scarring and pigmentation changes than the phenol chemical peel. It can make marked improvements in blotchy pigmentation, freckling, sun damage, fine wrinkles, and some types of acne scars. It consists of the application of one or several layers of medication to your skin to create a controlled chemical burn. There is normally a few minutes of stinging and burning after the medication is applied. During the next several days, the skin turns darker, feels tight, then cracks and peels off, leaving a new fresh layer of skin. There are no scabs, bleeding, or bandages.
The average peel takes 5 or 6 days to complete. Deeper peels, for heavily sun-damaged and wrinkled skin, may take 8 or 10 days. Your patient may have some swelling during the first 2 or 3 days after the peel, particularly if it is a medium or deep peel.
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