NON SURGICAL CHEMICAL PEELING
What Conditions does a Chemical Peel Treat?
Chemical peels are performed on the face, neck, back or hands.
They can be used to:
Reduce fine lines under the eyes and around the mouth
Treat wrinkles caused by sun damage, aging and hereditary factors
Improve the appearance of mild scarring
Treat certain types of acne
Reduce age spots, freckles and dark patches due to pregnancy or taking birth control pills (melasma)
Improve the look and feel of skin that is dull in texture and colour
Areas of sun damage, which may contain pre-cancerous keratoses that appear as scaly spots, may improve after chemical peeling. Following treatment, new pre-cancerous lesions are less likely to appear.
However, sags, bulges and more severe wrinkles do not respond well to chemical peels. They may require other kinds of cosmetic surgical procedures, such as carbon dioxide laser resurfacing, a facelift, brow lift, eyelid lift or soft tissue filler (collagen or fat). A cosmetic surgeon can help determine the most appropriate type of treatment for each individual case.
Who Is a Good Candidate For a Chemical Peel?
Generally, fair-skinned and light-haired patients are ideal candidates for chemical peels. Darker skin types may also have good results, depending upon the type of problem being treated.
How Are Chemical Peels Performed?
A chemical peel can be performed in a doctor’s office or in a surgery centre as an outpatient procedure.
The skin is thoroughly cleansed with an agent that removes excess oils and the eyes and hair are protected.
One or more chemical solutions, such as glycolic acid, trichloroacetic acid, salicylic acid, lactic acid in various concentrations, are applied to small areas on the skin. These applications produce a controlled wound, enabling new, regenerated skin to appear.
Preparing for a Chemical Peel
Prior to the chemical peel, your doctor may ask you to stop taking certain drugs and prepare your skin with topical preconditioning medications such as Retin-A, kojic acid/hydroquinone, or glycolic acid. After the chemical peel, it’s important to use a broad-spectrum sunscreen every day.
During the procedure, most patients experience a warm to somewhat hot sensation that lasts about five to ten minutes, followed by a stinging sensation. Cool compresses may be applied to help alleviate this stinging. A deeper peel may require pain medication during or after the procedure.
Depending upon the type of chemical peel, a reaction similar to sunburn occurs following the procedure. Peeling usually involves redness, followed by scaling that ends within three to seven days. Mild peels may be repeated at 8-10 days intervals until the desired clinical effect is achieved.
Medium-depth and deep peeling may result in swelling, as well as the presence of water blisters that may break, crust, turn brown and peel off over a period of seven to 14 days. Medium-depth peels may be repeated in six to twelve months, if necessary.
You will work with your cosmetic surgeon to determine the depth of your peel. This joint decision can vary, depending upon the condition of your skin and the objectives of treatment.
It is important to avoid over-exposure to the sun after a chemical peel since the new skin is fragile and more susceptible to complications. The dermatological surgeon will prescribe the proper follow-up care to reduce the tendency to develop abnormal skin colour after peeling.
What Are the Possible Complications of Chemical Peels?
In certain skin types, there is a risk of developing a temporary or permanent colour change in the skin. Taking birth control pills, subsequent pregnancy or family history of brownish discoloration on the face may increase the possibility of developing abnormal pigmentation. Although low, there is a risk of scarring in certain areas of the face, and certain individuals may be more prone to scarring. If scarring does occur, it can usually be treated with good results. There is a small risk of reactivation of cold sores in patients with a history of herpes outbreaks. This problem is treated with medication as prescribed by the dermatologic surgeon. Your doctor may also choose to give you medication before or immediately after the peel in order to prevent a herpes outbreak. Prior to treatment, it is important for a patient to inform the physician of any past history of keloid (scar tissue overgrowth created at the site of a skin injury) or unusual scarring tendencies, as well as any history of x-rays treatments to the face or recurring cold sores.
Additional Information
Chemical peels are sometimes applied to other sites such as the hands. They may be used to treat damage caused by exposure to the sun (photo ageing), to remove pigmentation such as freckles and melasma and fine lines and wrinkles.
A peel removes several layers of sun damaged skin cells, leaving fresh skin which has a more even surface and colour. It may stimulate new collagen to be formed improving skin texture. Peels may result in superficial, moderate depth or deep skin injury.
Peels can be repeated as necessary; some people have superficial peels every few weeks. It is wise to wait 3 to 6 months before repeating a moderate depth peel.
Glycolic acid, salicylic acid and Jessner peels result in superficial skin injury and are well tolerated – the ‘lunchtime’ peel.
They remove thin lesions on the skin surface, reducing pigment and surface dryness. The result of the first peel may be disappointing, but after repeated peels, significant improvement is usually evident.
Trichloroacetic acid (TCA) is the most common chemical used for a medium depth peel. The results depend on its concentration, usually 20 to 35%. The treatment is painful and treated areas are swollen, red and crusted for the next week or so.
It can lead to an impressive improvement in skin texture with a reduction in blotchy pigmentation; freckling and solar keratoses (dry sunspots).
Although fine wrinkles and some acne scars are less obvious, the TCA peel has no effect on deep furrows
Before the peel
Pre-treatment creams are applied to the face at night for several weeks prior to the peel.
By exfoliating the skin and reducing pigmentation themselves, they improve the results seen from chemical peeling. They may also reduce the time needed for healing. The creams usually include one or more of the following:
Tretinoin
Alpha hydroxy acid e.g. glycolic or lactic acid
Hydroquinone for tanned or dark skinned patients or those with melasma
Broad spectrum SPF 30+ sunscreen should be used during the day.
The superficial chemical peels are a minor procedure and no special arrangements are needed. But you may need painkillers, sedation, local anaesthetic or even a general anaesthetic for deeper peels.
Individual treatments may include peels with several agents on the same occasion, with the aim of improving results and reducing risks.
Antibiotics and oral antiviral agents may be recommended after deeper peels.
Afterwards
Superficial peels result in mild facial redness and occasional swelling which usually resolve within 48 hours.
The peeling is similar to sunburn. Most people can continue their normal activities. Make-up can be applied a few hours after the procedure.
Moderate depth peels result in intense inflammation and swelling, which resolve within a week. The peeling is more marked.
Mild redness can persist for several weeks. Most people take a week off from work after a moderate depth peel.
Looking after the skin after the peel
Keep treated areas cool (use a water spray)
Do not pick! Picking delays healing and causes scarring
Moisturise – use light preparations after a superficial peel, thicker moisturisers after a deeper peel
Protect from the sun – especially for the first 6 months
If advised to do so, continue to use Tretinoin, glycolic acid and/or hydroquinone at night long term.