Chemical Skin Peel: Light to Medium
(Photos Courtesy of The American Society Aesthetic Plastic Surgeons)

(Click here to read more about Deep Skin Peel)

Skin peeling involves an application of a chemical solution to sun-damaged, unevenly pigmented, and finely wrinkled facial areas. The procedure is meant to diminish imperfections by peeling away the skin’s top layers. It has proven to be a very popular nonsurgical cosmetic procedure; see current American Society for Aesthetic Plastic Surgery (ASAPS) statistics. Chemical peels vary according to their specific ingredients and their strength. Depth of peeling action may also depend on factors such as how long solutions remain on the skin and whether they are lightly applied, or more heavily or vigorously applied.

Technique:

The surgeon will select the best chemical or chemical mix for the individual patient. A solution is applied—using a sponge, cotton pad, cotton swab or brush—to the areas to be treated (or the entire face, avoiding the eyes, brows and lips). Generally, the most superficial peels are those using alpha hydroxy acids (AHA), such as glycolic, lactic or fruit acid. Various concentrations of an AHA may be applied weekly or at longer intervals to obtain the best result. A trichloroacetic acid (TCA) peel is stronger, and has a greater depth of peel compared to AHA’s.

Benefits:

AHA:

• No anesthesia or sedation is needed, and the patient will feel only a mild tingling or stinging sensation when the solution is applied.
   
• Sometimes a single treatment will give skin a healthier, radiant look.
   
• No downtime—patient can immediately resume normal activities.
   
• Can be mixed with a facial cream or wash in milder concentrations as part of a daily skin-care regimen.

TCA:

• TCA is especially effective in treating darker-skinned patients.
   
• Can possibly be used to achieve some effects of a deep peel, depending on the concentration and manner of application.
   
• Generally shorter recovery time than with a deep (phenol) peel.

Both:

• Short, safe procedure.
   
• No covering or after-peel ointment is necessary.

Other Considerations:

AHA:

• May require multiple treatments.

TCA:

• May require pretreatment with AHA or Retin-A creams.
   
• Repeat treatment may be required.
   
• Deeper TCA peel may result in 2-3 days of restricted activity.

Both:

• Sun block is strongly recommended, especially with TCA treatment. Skin pores may appear larger, and the skin may not tan evenly following a chemical peel.
   
• Some facial skin disorders do not respond to chemical peeling.

Chemical Skin Peel: Deep (Phenol) Peel

A deep chemical skin peel, or phenol peel, 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.

Technique:

A full-face deep chemical peel takes 1 to 2 hours to perform. A more limited procedure (such as treatment of wrinkling above the lip) will generally take less than a half-hour. A solution is applied to the area to be treated (avoiding the eyes, brows and lips). There is a slight burning sensation, but it is minimal since the solution also acts as an anesthetic. After the peel solution has worked on the skin, it is neutralized with water. Approximately one hour later, a thick coating of petroleum jelly is layered over the patient’s face, covering the protective crust which develops rapidly over the area. This stays in place for 1 to 2 days. In an alternative technique, the patient’s face is covered by a "mask," composed of strips of adhesive tape, with openings for the eyes and mouth (this is particularly effective in cases of severe wrinkling).

Some patients experience discomfort after a deep chemical peel, but this can be controlled with medication. A few days after the procedure, new skin with a bright pink color akin to sunburn will emerge; the pinkness will fade within a few days. Post-operative puffiness will also subside in a few days, but the skin will remain sensitive. Patients should avoid exposure to sunlight and continue to use sun block.

Benefits:

• Effects of a phenol chemical peel are long lasting, and in some cases are still readily apparent up to 20 years following the procedure. Improvements in the patient’s skin can be quite dramatic.
   
• Normal work schedule and other activities can be resumed after 1 to 2 weeks.
   
• Variants in the phenol peel formula can create a milder solution for broader use.

Other Considerations:

• Possible postoperative complications can include scarring, infection or abnormal pigmentation. Tends to have a bleaching effect, and patient may need to wear make-up to match treated and untreated areas.
   
• EKG monitoring is advised.
   
• Cannot be used on the neck or other parts of the patient’s body.
   
• Not as effective in treating individuals with dark, oily complexions.
   
• Some facial skin disorders do not respond to chemical peeling.
   
• Skin pores may appear larger, and the skin may not tan properly.
   
• Can activate latent cold sore infections.
   
• All forms of deep skin peels include the risk of delayed healing and scarring.

ASAPS Position:

The effectiveness of phenol chemical peeling has been proven in clinical studies over the last 30 years. Because they are serious procedures, it is ASAPS’ position that phenol chemical peels should only be performed under the direction of a qualified physician.