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Chemical Peel
 
As we age, the accumulated effects of sun exposure, pollutants, acne, and scarring can damage our skin and cause us to look older than we are. Such skin damage can be treated with a chemical peel, a non-invasive procedure designed to promote cell growth and produce smoother, clearer skin.

Chemical peels are also used to treat melasma (a skin condition characterized by irregularly shaped patches of brown skin commonly found on the face and neck), and pre-cancerous changes in the skin. Chemical peels can be performed on the face, neck, chest, arms, hands, and legs.

If you are considering a chemical peel, the following information will provide you with a good introduction to the procedure. For more detailed information about how the procedure may help you, we recommend that you consult a dermatologist who is board certified or has completed a residency program that includes instruction in this procedure.
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What are some of the most common benefits of this procedure?
A chemical peel can restore a more youthful appearance to wrinkled, unevenly pigmented, sun-damaged, or blotchy skin. But a peel cannot reverse the aging process or completely remove deep scars. Wrinkled skin that is loose and sagging may also require a face lift, laser resurfacing treatment, or combination of procedures for best results.
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How is a chemical peel performed?
All chemical peels involve applying a chemical solution to remove the outer layers of skin so that a smoother, more evenly pigmented, glowing layer of skin can appear. There are three basic categories of chemical peels. Each type works differently, and produces different results. Your doctor may choose from the following three types of chemical peel, or se/she may tailor the treatment to the needs of your skin. In general, the stronger the chemical, the deeper the peel, and the more impressive the results. However, the deeper the peel, the more pain you’re likely to experience and the longer the recovery time will be.

Light peels: Alphahydroxy acids (AHAs) Light or “lunch hour” peels are the mildest of the chemical peels. These peels include glycolic, lactic, and fruit acid peels. They burn off only the outer layers of the skin to smooth out fine wrinkles and/or rough, dry skin. AHA peels may also be used to improve the texture of sun-damaged skin, balance out skin pigmentation, or diminish some types of acne scars. These peels are often repeated to achieve the desired results.

The application of AHA peels is relatively fast and simple. These peels are generally performed in the doctor’s office. No sedation or anesthesia is required, since the patient only experiences a slight stinging when the solution is applied. The treatment usually takes about 10 to 15 minutes, but the doctor may vary the concentration of the chemical solution or the length of time of the treatment.

The doctor will begin by thoroughly cleansing the area to be treated. Next, he/she will apply the AHA solution, wait up to 15 minutes, and then remove it. After the procedure, no ointments or salves will be necessary to cover the treated area. Monthly or weekly repetition is common.

Recently AHA, incorporated with other acids and cosmeceutical ingredients, make up the Vitalize Peel from SkinMedica, which has become one of the safest, strongest half-hour chemical peels available. This achieves dramatic, more youthful and healthier results with a minimal amount of downtime.

Medium peels: Trichloroacetic acids (TCA) A TCA solution is used for medium depth peels. This is generally used to treat skin with moderate sun damage, surface wrinkles, and/or uneven tone or pigment abnormalities. Full-face TCA peels take approximately 15 minutes. Generally, TCA peels are performed in the doctor’s office or in a surgery center as an outpatient procedure.

Before applying the chemical solution, the doctor will thoroughly cleanse the area to be treated. A sedative may be given, but TCA peels often do not require anesthesia because the solution itself has a numbing effect on the skin. At first, the patient may feel a warm or burning sensation, followed by stinging. Sometimes two or more TCA peel treatments, at intervals of one to two months, are necessary to achieve the desired results.

Recently the Obagi Blue Peel has provided significant improvements to the TCA solution. The Obagi Blue Peel involves a blue solution mixed with the TCA solution and used to remove thin surface layers of aged and damaged skin. This combined solution allows the physician to control the chemical peel process and its depth. It can also allow physicians to tailor the process according to the problem, such as wrinkles, scars, and / or pigmentation problems.

Deep peels: Phenol acid Phenol acid is the strongest chemical peel solution, and it is used for the deepest possible chemical peel. Phenol peels are used to treat skin with coarse wrinkles and blotchiness. They may also be effectively used to treat patients with pre-cancerous growths.

Phenol peels should be used with caution because they can cause permanent lightening of the skin. For this reason, Phenol peels are not recommended for most patients with very dark skin tones.

Full-face Phenol peels take approximately one to two hours, but small-area phenol peels (such as on the upper lip) may take about 10 - 15 minutes. Generally, phenol peels are performed in the doctor’s office or in a surgery center as an outpatient procedure with anesthesia.

The doctor will thoroughly cleanse the face before applying the chemical solution. You may feel a warm or burning sensation as the solution is applied, followed by some slight stinging or numbing. You’ll probably be given a sedative before the procedure. The doctor may administer pain medication during the procedure as well.

After completing the procedure, the doctor may apply petroleum jelly or a waterproof dressing tape to the treated area. This covering will be left on for a day or two. Unlike AHA and TCA peels, Phenol peels are only used once, and create dramatic results.
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How long does it take?
AHA and TCA peels for the full face generally take 10 - 15 minutes. Full-face Phenol peels may take between one and two hours. Phenol peels for small portions of the face, such as the upper lip, may take only 10 to 15 minutes.
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Where will the procedure be performed?
Generally, AHA peels are performed in the doctor’s office. TCA peels may be performed in the doctor’s office or in an outpatient surgery center. Phenol peels are typically performed in an outpatient surgical center. If performed in conjunction with another procedure, such as a facelift, the chemical peel may be performed in the hospital.
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How much pain is there?
During the procedure, most people feel a brief burning sensation, followed by a feeling of numbness or stinging. The sensation will vary depending on the type of peel as well as the possible of pain medications in the case of deep peels. The AHA, BHA, and TCA peels are uncomfortable only during treatment. The phenol peel may have discomfort after the procedure.
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What can I expect after the procedure?
After the procedure, most people experience some facial swelling and reddening. Your doctor may advise you to keep your head elevated.

After a Phenol peel, the eyes often swell shut. And, after a Phenol peel, a petroleum jelly or waterproof dressing may be applied to the treated area. This covering is left on for a day or two. After Phenol and deep TCA peels, you’ll need to arrange for someone to drive you home. Ride arrangements do not need to be made after having an AHA or a light TCA peel.

The recovery period is different for each type of peel.

Light peels: Alphahydroxy acids (AHAs) AHA peels generally cause some flaking, redness and dryness, or skin irritation. These side effects diminish over time. Once the body heals itself naturally, the outer layer of skin will fall away. Patients are usually able to engage in normal public activities the day after an AHA peel.

Medium peels: Trichloroacetic acids (TCA) TCA peels may cause significant swelling, depending on the potency of the chemical solution that was used. Swelling should diminish after the first week. The skin will heal sufficiently to resume normal activities in approximately 7-10 days.

After TCA peels, some patients also have outbreaks of small whiteheads, called milia, which are formed in obstructed facial glands. Generally, these disappear with washing, but in some cases a doctor will need to remove them.

Deep peels: Phenol acid After a Phenol peel, your doctor may prescribe a mild pain medication to relieve any discomfort. If a waterproof adhesive is applied to the treated area, it will be removed in 1-2 days, and you’ll be instructed to cover the area with antiseptic powder several times a day. A scab will form and, within 7-10 days, new skin will form. While the skin will be red at first, the color will lighten over a few weeks to a few months.

After any peel, it is critically important that the skin be protected from the sun. Ask your doctor to recommend a sun block with both UVA and UVB protection, and apply it daily.

After the procedure, the doctor may recommend that the patient stop smoking for at least a week. Smoking decreases circulation of the blood in the skin, which can slow your recovery.
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Ideal candidate:
In general, the best candidates for chemical peels are people:
  • In good physical health.
  • Psychologically stable.
  • Who understand the procedure.
  • Who do not smoke.
  • Wanting to look younger and more refreshed.
  • Unhappy with the appearance of wrinkles or brown spots, especially around mouth or eyes.
  • Free of active skin infections, including most kinds of acne.
  • Informed about the appropriate skin tone for the type of peel used.
  • Not taking Accutane, nor have taken it for the previous 18 months.
  • Free from large or unusual scar formations, such as keloids.
  • Realistic in their expectations.
  • Willing to accept the limitations involved in the healing process.
The above is only a partial list of the criteria that your doctor will consider in determining whether or not this procedure is appropriate for you. Be sure to ask your doctor if he / she considers you an ideal candidate for a chemical peel.
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Other important information:
Partial-face chemical peels are frequently combined with a face-lift, because face-lifts can correct loose and sagging skin, while chemical peels improve the texture of the skin. Aging skin may require both kinds of corrections in order to achieve a healthier, more youthful appearance.

Alternative procedures include dermabrasion, laser resurfacing, and injectable fillers. In addition, Retin-A (a prescription medication derived from Vitamin A) is often used to pre-treat the skin by thinning the skin’s outer layer. This pre-treatment allows for deeper penetration of the chemical solution. The pre-treatment period may take up to a month before the chemical peel is actually performed.
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Risks and limitations:
Significant complications with chemical peels are infrequent, but potential complications include:
  • Scarring
  • Infection
  • Temporary or permanent changes in skin tone or uneven tone (especially with Phenol peels).
  • Hyperpigmentation (a darkening of the skin, treatable in most cases with current bleaching techniques)
  • Hypopigmentation (a lightening of the skin, more difficult to treat)
  • Cold sore breakouts in patients who have a history of recurring blisters and cold sores, like herpes and shingles. (An anti-viral medication before the procedure can help prevent this.)
  • Risks for those with a family history of heart disease> (Phenol peel only)
You can help minimize certain risks by following the advice and instructions of your doctor, both before and after the chemical peel. Pre-existing conditions may also put you at risk. If you have a history of heart disease or herpes, or you have a tendency to form large or unusual scars, be sure to discuss this with your doctor before you have a chemical peel. Also tell your doctor if you have undergone considerable amounts of radiation or facial x-rays.
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Costs:
The national average of 2007 doctor fees for a chemical peel was $744 (Source: American Society of Plastic Surgeons). Regional averages: New England states: $741 Middle Atlantic states: $728 North Central states: $837 South Central states: $653 and Mountain/Pacific states: $753. These fees do not include anesthesia, operating room facility, hospital stay, and other related expenses.
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Choosing a doctor:
It is very important that you select a physician adequately trained and experienced in this procedure. We strongly recommend that you consider choosing a doctor who is board certified by the American Board of Medical Specialties. See our Physician Locator feature to find a dermatologist in your area, including detailed profile information for many of the listed doctors. Also read How to Select a Dermatologist for a more detailed discussion on choosing the right doctor.
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Questions to ask your doctor:
It is important to select an adequately trained, and experienced physician. The following questions should help you to select your doctor, and better understand the procedure.
  1. Are the desired results that I described realistic?
  2. Where is the procedure performed? How long will it take?
  3. What kind of anesthesia is used?
  4. How much does it cost?
  5. Which chemical solution will you be using and why?
  6. How long have you been performing chemical peels? (How long has he/she performed this procedure, and how many has he/she performed in the past year?)
  7. What percentages of patients have had significant complications with this procedure? (The doctor should disclose this information to you.)
  8. Will you repeat or correct the procedure if it does not meet agreed upon goals? And if the procedure must be repeated / corrected, will I be charged again? (The physician should provide you with his/her policy on this issue.)
  9. May I see “before and after” photos of recent patients? The doctor should provide many photos of recent patients.
  10. May I have the names and contact information for several recent chemical peel patients? (Follow up to get first-hand information on the procedures and the doctor.)
  11. Could I observe the exact procedure I am considering before I decide to have the procedure? (Either on videotape or in real life.)
  12. What should I expect after the chemical peel in terms of soreness, what to watch for, medication, bathing, and level of activity?
  13. Who will be assisting during the procedure? What are their qualifications? (Does the doctor perform the whole procedure?)
  14. Have you ever had your malpractice insurance coverage denied, revoked, or suspended?
  15. Do you offer patient financing?
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Be sure to:
  • Tell your doctor if you have a history of heart disease, recurring fever blisters or cold sores (such as herpes or shingles), or a tendency to scar. Also let him/her know if you have undergone considerable amounts of radiation or facial x-rays.
  • Ask a friend or family member to drive you home after a Phenol or deep TCA peel. This should not be necessary after an AHA or a light TCA peel.
  • Use sunscreen. After any peel, it is critical that you protect your skin from sun exposure. Ask your doctor to recommend a sun block that has UVA and UVB protection, and apply it daily.
The information on this web site is only intended as an introduction to this procedure and should not be used to determine whether you will have the procedure performed nor as a guarantee of the result. The best method of determining your options is to consult qualified dermatologists who are able to answer specific questions related to your situation.
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Related Articles
Please review the following articles for more information on this procedure.
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How do I finance this procedure?
Did you know that 29% of all Americans have considered having an elective procedure? Of those, 60% would schedule a procedure immediately if financing was available. With iEnchance's patient financing options, money no longer has to be the barrier between you and your new image. By filling out our on-line application you can qualify for a loan in as little as 30 seconds.
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Facts:

*Top 5 Surgical Cosmetic Procedures in 2008:

1. Breast Augmentation: 356,000
2. Liposuction: 341,000
3. Blepharoplasty: 195,000
4. Rhinoplasty: 152,000
5. Abdominoplasty: 147,000

*Top 5 Non-Surgical Cosmetic Procedures in 2008:

1. Botox: 2,464,000
2. Laser Hair Removal: 1,281,000
3. Juvederm/Restylane: 1,263,000
4. Chemical Peel: 592,000
5. Laser Skin Resurfacing: 571,000

* Data collected from the American Society of Plastic Surgeons (ASPS)
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