Chemical Peels

As we age, are skin goes through several changes.  Our ability to produce youthful collagen diminishes resulting in fine lines, wrinkles and skin sagging.   The affects of sun damage sustained during our youth start to manifest as adults in the form of hyperpigmented skin spots and uneven skin tone.   Also, the ability of the skin cells to replicate and turn-over diminishes resulting in a rougher skin texture.  There is not one dermatologic procedure that can address all these factors, but there are dermatologic procedures that can address each of these factors independently.

What are Chemical Peels

A chemical peel is a skin exfoliation procedure that addresses fine lines, uneven skin tone, and rough skin texture.  Chemical Peels involve the use of a chemical solution (alpha-hydroxy acid or beta-hydroxy acid) to be applied to the skin which results in a chemical exfoliation of old skin cell layers.  Depending on the strength of the chemical solution used, chemical peels can be mild and lead to a gentle exfoliation (aka superficial or lunchtime peel).  They can be medium-strength peels (i.e., Jessner Peels), which lead to penetration to middle skin cell layers.  These are ideal for improving fine lines and wrinkles, and skin discoloration.  Or they can be deep peels (TCA or phenol peels), which penetrate even further into the skin layers helping to improve deeper lines and deeper facial scars. 

What conditions are treated with Chemical Peels

Chemical Peels can be used to improve the appearance of acne scars, pigmented lesions (sun spots), fine lines and wrinkes, and aging skin. 

How is the procedure performed

The patient’s face is thoroughly cleansed and a degreasing astringent may also be used to wipe away residual facial oils.  The appropriate superficial or medium depth peel is selected based on the patient’s specific needs.  A cotton gauze is moistened with the chemical acidic solution and then the affected areas of the facial skin are wiped with the solution.  There may be a slight burning sensation after the chemical peel is applied, but it is usually tolerable.  Sometimes a fan is used to cool the skin if the burning sensation becomes uncomfortable.  One or more coats may be required for the solution to penetrate the desired skin depths. 

Is there social downtime?

For superficial chemical peels, there is typically mild redness and irritation after the procedure, but this sensation usually disappears after a few hours.  There is typically no downtime associated with superficial peels and this is why many superficial peels have been given the nickname “lunchtime peels.”  Patient’s that undergo superficial peels can typically get back to normal activities without interruption. 

For medium-grade chemical peels, there may be moderate discomfort during the procedure because of the strength of the peel and because more than one layer of chemical solution is used to get to the desired depth in the skin.  A hand-held electric fan is sometimes used to cool the skin as the chemical saturates into the skin.  After the procedure, one can expect moderate redness, some skin flaking, and sometimes mild facial swelling.  For the first 2-4 days, the skin may appear as if it was severely sunburned.  On the third to fourth day, the skin typically starts to peel, again, like a severe sunburn injury.  Because of these expected events, we tell patients that there may be “social downtime” in which they should not plan to be at events such as parties, weddings, job interviews, etc. for approximately 10 days.  Medium-grade chemical peels lead to delayed gratification because under the old skin that has peeled-off is a more youthful softer skin with more even skin tone.

Who are good candidates for chemical peels?

Chemical peels typically work better on patients with lighter skin tones than dark skin tones.

Who are not candidates for chemical peels?

Individuals who have chronic skin conditions such as facial eczema, psoriasis, and skin cancer.  Also individuals with acute skin conditions such as acute facial trauma/laceration, skin infection (i.e., herpes lesions or bacterial infection), or active sun burn or recent sun tan.  Other conditions in which someone should not undergo a chemical peel include recent (within 6 months) use of Accutane, pregnancy, or nursing. 

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