CHEMICAL PEELS – The Whole Story
Preface and Disclaimer.
I compiled this page from the very good and authoritive information on the websites of American Society of Plastic Surgeons (ASPS) and Australian Society of Plastic Surgeons’ procedures website : The Australian Foundation for Plastic Surgery
After reading this you are welcome to find more about chemical peels from the link here, but you must not decide on any action until after you have consulted a medical professional. The source sites all say this, and I repeat, that information here is not personal medical advice for you. That can only come from a medical professional after consultation with you.
All About Cosmetic Chemical Peels
Chemical peel is a cosmetic treatment that uses various chemical solutions of differing strengths to correct facial blemishes, wrinkles and uneven skin pigmentation. The damaged outer layers of skin on the face is removed to improve and smooth the skin’s texture. The depth of the removal (ie “peel”) depends on the strength of the applied chemical.
Chemical peels are used mostly on the face, but they can also be used to improve the skin on your neck and hands. A chemical peel is sometimes done with facelift surgery to increase the rejuvenation.
A chemical peel – what can it do?
A chemical peel may help remove or reduce :
- Pre-cancerous skin growths
- Acne or acne scars
- Fine lines and wrinkles
- Irregular skin pigmentation
- Rough skin and scaly patches
- Sun damaged skin
- Uneven tone or spotting from no other reason than ageing
Chemical peel – what won’t it do?
A chemical peel is a surface surface treatment and it won’t
- Treat deep facial lines
- Tighten loose or sagging skin
- Remove broken capillaries
- Change pore size
- Remove deep scars
Chemical Peel – is it suitable for me?
Chemical peel is a highly individualised procedure and may not be suitable for everyone. Always talk to your Specialist Plastic Surgeon before making a decision. Your surgeon will assess your condition and general health, and plan the treatment that is best suited to you.
Firstly it maybe good for you if
- You are physically healthy;
- You have realistic expectations of what skin rejuvenation can accomplish;
- You are a non-smoker or have stopped smoking.
And of course, less good for you if not, but also note….
You may not be a good candidate for chemical peeling if you have:
- A history of abnormal skin scarring
- Abnormal pigmentation
- Afro-Caribbean or Asian skin
- Facial warts
- Red hair and pale freckled skin
- Used certain acne treatments within the last year
Chemical Peel – Some Important Things to Consider
- Effects are variable It is not always possible to predict the outcome of chemical peel.
- Sometimes, improvements are minimal . Deep wrinkles may appear less obvious after chemical peel, but they may not disappear.
- Chemical peel cannot stop the ageing process or the effects of ageing
- Chemical peel cannot result in “perfect skin”
The types of Chemical Peel
There are three different types of chemical peels each with a different strength chemical.
The chemicals used are alphahydroxy acids , trichloroacetic acid, and phenol .
The treatments with these chemicals are respectively light, medium, deep chemical peels.
The formula used by your doctor will be adjusted to meet your particular needs.
Light chemical peel
Alphahydroxy acids (AHAs), such as glycolic, lactic, or fruit acids, are the mildest of the peel formulas and produce light peels. AHA peels may be used to treat fine wrinkling, areas of dryness, uneven pigmentation and acne.
You will see subtle improvements at first, but that healthy glow will increase with more treatments.
A light chemical peel might be the right choice if you have uneven pigment, dryness, acne or fine wrinkling.
This kind of peel removes just the outer layer of skin (epidermis) in a light exfoliation and results in a healthier glow.
The procedure and recovery details are mentioned below.
Your health care provider will use a combination of alphahydroxy acids and beta hydroxy acids, such as glycolic acid, lactic acid, salicylic acid and maleic acid. All of these chemicals are the mildest choices. You can repeat these treatments to achieve your desired results.
Medium chemical peel
Trichloroacetic acid (TCA) can be used in many concentrations, but is most commonly used for medium-depth peeling. Acne scars, somewhat deeper surface wrinkles, superficial blemishes and uneven skin colour problems are commonly treated with TCA.
The chemicals used for this type of peel will remove skin cells from both the outer layer of skin (epidermis) and upper part of your middle layer of skin (dermis).
Your treatment provider will sometimes use glycolic acid in combination with trichloroacetic acid. See below for more about the procedure and recovery details.
Deep chemical peel
Phenol is the strongest of the chemical solutions and produces a deep peel. It is used mainly to treat patients with coarse facial wrinkles, areas of blotchy or damaged skin caused by sun exposure, harsh climate, or pre-cancerous growths.
Results are dramatic, but recovery takes the longest. One treatment with a deep chemical peel will produce long-lasting and dramatic results that can last up to 10 years.
If you have deeper facial wrinkles, skin that’s damaged by the sun, scars, areas that appear blotchy, or even pre-cancerous growths, deep facial chemical peels might be the right choice for you.
Your physician will use the strongest chemical called phenol to penetrate down to the lower dermal layer of your skin. For this type of peel, you may need a local anesthetic and a sedative to manage any discomfort.
A deep chemical peel usually involves some sort of pretreatment for up to eight weeks. This will prepare your skin for the peel and speed the healing process. There are details about the procedure and recovery below.
Will I need anaesthetics for a Chemical Peel?
No anaesthesia is needed for Light AHA peels since they cause only a slight stinging sensation during application, and anaesthesia isn’t required for Medium TCA and Deep phenol peels because the chemical solution itself acts as an anaesthetic. However, sedation may be used before and during the procedure to relax you and keep you comfortable.
Chemical peels – what are the risks?
You should understand that all chemical peels carry some risks and uncertainties. A chemical peel is usually a very safe procedure when performed by a qualified and experienced plastic surgeon but does have the potential for risks and complications to occur.
Further treatment may be necessary to correct any complications. Some risks and complications associated with chemical peel may include but are not limited to:
- Stinging, redness, irritation and crusting skin.
- A risk of reactivation of cold sores (herpes) if you have suffered from them in the past. Be sure to ask your doctor to prescribe medication to try and avoid an outbreak.
- Infection. It happens infrequently, but you could develop an infection or scarring from chemical peels.
- Keloids. Tell your treating plastic surgeon if you have a history of keloids (scar tissue overgrowth) or any unusual scarring tendencies.
- Uneven skin colour. New skin loses its ability to make pigment. This is particularly common after a phenol peel. Dark pigmentation may occur when the newly treated skin is exposed to the sun, even if a strong sunscreen is used and also there may be areas that stay pale. For people with certain skin types, or ethnicities, there is a risk of developing a temporary or permanent color change in the skin either lightening or darkening. Use of hormone medications or a family history of brownish discoloration on the face may increase the possibility of developing abnormal pigmentation.
- Skin sensitivity to allergens
- Heart problem. Phenol may pose a special risk for patients with a history of heart disease.
Chemical peel – your consultation
During your chemical peel consultation be prepared to discuss:
- Your goals
- Medical conditions, drug allergies, medical treatments and smoking history
- Current medications, vitamins, herbal supplements, alcohol, tobacco and drug use
- Previous surgeries.
Your surgeon will also determine your general health status and any pre-existing health conditions or risk factors and discuss with you likely outcomes and any risks or potential complications. At this time be sure to ask any questions about any aspect. It is very important to understand all aspects of your chemical peel. It’s natural to feel some anxiety, whether it’s excitement for your anticipated new look or a bit of stress. Don’t be shy about discussing these feelings with your plastic surgeon.
Chemical Peel – Questions to ask your plastic surgeon
- Do you have top level accreditation and membership of Australian Society of Plastic Surgeons (or equivalent in your country) ?
- Were you specifically trained in the field of plastic surgery?
- Where and how will you perform my procedure or treatment?
- If you are not going to do the treatment yourself, is the person who is doing it specifically trained and qualified in this procedure?
- Is the your clinic facility accredited by a state-recognized accrediting agency, and is it Medicare-certified?
- Am I a good candidate for a chemical peel?
- What will be expected of me to get the best results?
- What results are reasonable for me? and how can I expect to look over time?
- How long of a recovery period can I expect?
- What are the risks and possible complications associated with my procedure?
- Do you have before-and-after photos of patients having this procedure that I can look at?
Chemical Peel – What you need to do beforehand
Before undergoing the procedure, it is important that you:
- Be as fit as possible to help the recovery process
- Stop smoking
- Do not wear makeup, mascara, contact lenses or hairspray on the day of treatment
- Prepare a “recovery area” in your home. This may include pillows, ice packs, a thermometer and a telephone within easy reach.
- Make sure you arrange for a relative or friend to drive you to and from the hospital or clinic. Someone should also stay with you for at least 24 hours after you return home.
- Arrange for a relative or friend to drive you home after the procedure. If you have a phenol peel, someone should also stay with you for at least the first day after the operation and preferably for a few days.
Your surgeon should give detailed instructions to prepare for the procedure. Follow them carefully. Your plastic surgeon may prescribe medication, such as Retin A, as pre-treatment to the chemical peel. This is designed to thin out the skin’s surface layer to allow the solution to penetrate more deeply and evenly.
Chemical peel – what to watch for afterwards
If you experience any of the following symptoms, notify your Specialist Plastic Surgeon immediately:
- Temperature higher than 38°C or chills
- Persistent bleeding around the treated area
- Increasing pain or redness in the treated area
After an light chemical AHA peel, it is common to experience some temporary flaking or scaling, redness and dryness of the skin. However, these conditions will disappear as the skin adjusts to treatment.
After a medium TCA or deep phenol chemical peel, you may experience significant swelling to the point where your eyes may be swollen shut temporarily. Tape may be applied to cover your face to help with the swelling.
It is normal to feel pain, tingling and throbbing after the procedure. Your surgeon may prescribe mild pain medication to help with the discomfort. After the tape is removed a crust or scab will form on the treated area.
Depending on the extent of your procedure, you may need to take a few weeks off work to rest. Avoid heavy lifting, strenuous exercise, swimming and strenuous sports until advised by your surgeon.
Make sure you protect your skin from the sun, including the regular use of sunscreen when outdoors.
Your surgeon will give you specific instructions on post-procedural care. Be sure to follow them carefully.
Light Chemical Peel
Light chemical peel – the procedure
Your face will be cleansed.
The chemical solution is brushed onto your skin and left on for a few minutes. You may feel some mild stinging.
The chemical peel is then washed off and neutralized.
Light chemical peel – the risks and recovery
Other light chemical peel risks include:
You are likely to experience some redness, stinging, skin flaking, and irritation from a light chemical peel.
(After repeated treatments, these side effects will likely subside.)
Hyperpigmentation (brown blotches). Avoid this by always using a high-factor sunscreen.
Medium Chemical Peel
Medium chemical peel – the procedure
Your face will be cleansed.
The chemical solution is brushed onto your skin and left for just a few minutes. You may feel some burning or stinging.
The treated area may turn a whitish grey color.
The chemicals are neutralized with a cool saline compress.
Your skin may turn red or brown in the days just after the peel. It may take up to six weeks for your skin to look normal.
You may repeat a medium chemical peel every few months to maintain your new glowing skin.
Medium chemical peel – the risks and recovery
When trichloroacetic acid is used in a medium chemical peel, you’ll experience some redness, stinging and skin crusting just like a light chemical peel.
Although these chemicals won’t bleach your skin, you may see some color changes. You’re advised to avoid the sun for several months to protect that fresh new layer of skin.
Other medium chemical peel risks include:
- Hyperpigmentation (brown blotches from uneven tanning) may result even if you use sunscreen.
- Permanent scarring is another infrequent risk.
- Redness, which occurs in everyone after the peel, may last longer than a few months for some people.
Pretreatment may include use of a retinoic acid cream or gel – a prescription medication that’s derived from vitamin A. This works to thin out the skin’s surface layer, allowing the chemical solution to penetrate more evenly and deeply.
Deep Chemical Peel
Deep chemical peel – the procedure
You will be given a sedative to relax along with a local anesthetic to numb your face.
Your face will be cleansed.
Phenol is brushed onto the area after an appropriate time interval.
The chemical is neutralized with water.
A thick coat of ointment is smoothed over your skin, to prevent dryness and pain. The ointment must stay in place. Sometimes your surgeon will cover your skin with strips of tape or medicated gauze rather than ointment.
Deep chemical peel – the risks
The chemical used in a deep chemical peel, phenol, can lighten the skin that’s treated. With this kind of peel, your new skin often loses its ability to make pigment, meaning to tan. You will always need to protect your skin from the sun.
Phenol also can pose a special risk for people with heart disease. Be sure to tell your surgeon about any heart problems and include it in your medical history.
Deep chemical peel – the recovery
A deep chemical peel requires that you have an adequate recovery time.
You may return to work and some of your normal activities two weeks after treatment. At that point, your skin will be healed enough for you to wear makeup.
Deep chemical facial peels will result in peeling, crusting, skin redness and discomfort for several days.
Your doctor will provide painkillers to keep you comfortable. Although the swelling is likely to disappear in about two weeks, your skin may remain red for up to three months.
Chemical Peels – More Information
descriptive Illustrated PDF
To see a good descriptive illustrated PDFs prepared for American Society of Plastic Surgery all the various chemical peels – light, medium and deep – (and copy them if you like)look here on the downloads page. Choose either “light” “medium” or “deep” chemical peel.
Chemical peel – Videos
For 3D animations of deep, medium and light chemical peel treatments go to this page and select the treatment you want to see.
Other chemical peel videos :
Chemical peel risks
chemical peel overview
Chemical peel results
Chemical peel recovery
Chemical peel costs