Also known as light chemical peels and deep chemical peels
As we age, dead skin cells do not slough off as easily as when we are younger, causing the skin to appear dull. Light, medium and deep chemical peels are a popular nonsurgical cosmetic procedure used to peel away the skin’s top layer to improve sun-damaged, unevenly pigmented and wrinkled skin. Improving the evenness of color and texture in your skin creates a youthful look and restores a healthy, luminous and radiant appearance.
When to Consider Chemical Peels
- If you have wrinkles or sun-damaged skin.
- If you have skin discolorations, blotchiness or brown spots.
- If you have scars that have made the surface of your skin uneven.
- If you have certain precancerous skin growths.
Most often, your treatment will be performed by a licensed skincare professional in your plastic surgeon's office or medical spa. Peels involve the application of a chemical solution to your entire face or just to certain regions, such as the crow's feet area around your eyes or the vertical wrinkles around your mouth.
The chemical solution is either applied lightly or rubbed more vigorously onto the skin being treated using a sponge, cotton pad, swab, or brush (avoiding your brows, eyes and lips). During peel application, you may experience a slight tingling (light to medium peels) or a burning sensation (deep peels). These sensations are usually minimal for light and medium peels but are more severe for deep peels. The length of time the solution is allowed to work is determined by carefully observing the changes in the appearance of your skin. With certain types of chemical peels, the solution may be "neutralized" after an appropriate amount of time has elapsed.
The different types of chemical peels vary according to their specific ingredients and their strength. The depth of their peeling action may also be determined by factors such as how long they remain on the skin and how they are applied onto the skin.
No covering or after-peel ointment is necessary after a light or medium peel and you can expect little to no downtime. However, after a deep peel, a thick coating of petroleum jelly or other protective ointment is layered over the face, covering the protective crust that develops rapidly over the area. This stays in place for one to two days. In some cases, dressings, tape or a bandage may be applied (this is particularly effective in cases of severe wrinkling). A deep peel requires a longer recuperation period.
Chemical peels exfoliate dead cells and can improve texture, acne, sun damage and congested pores. Deeper peels can address wrinkles and uneven skin tone.
Your surgeon will provide thorough pretreatment instructions, answer any questions that you may have, take a detailed medical history, and perform a physical exam to determine your fitness for treatment.
Depending on the depth of your chemical peel treatment, you may be placed on a pretreatment program during which you will apply special creams, lotions or gels to your skin for a few weeks or longer. If you have a history of herpes infections around your mouth, your doctor will prescribe an antiviral medication before and after treatment to prevent viral infection. You may also be given certain oral medications that you should begin taking prior to your treatment.
In advance of your procedure, your surgeon will ask you to:
- Stop smoking at least six weeks before undergoing the chemical peel to promote better healing.
- Avoid taking aspirin, certain anti-inflammatory drugs, and some herbal medications that can cause increased bleeding.
- Regardless of the type of treatment to be performed, hydration is very important before and after surgery for safe recovery.
Chemical peels are usually performed on an outpatient basis. If you have a deep peel be sure to arrange for someone to drive you home after treatment and to stay with you at least the first night following treatment.
*What can I expect on the day of a chemical peel treatment?
Light to Medium Peels
A light or medium chemical peels is often performed in an office-based setting. Generally the procedure takes about 30 minutes to an hour. No sedation or anesthesia is needed.
A deep chemical peel may be performed in an accredited hospital, free-standing ambulatory facility or office-based surgical suite. Most chemical peel procedures take at least 30 minutes to two hours to complete but may take longer.
- Medications are administered for your comfort during the procedure.
- Depending on the type of chemical peel chosen and the area treated, local anesthesia may be adequate; however, for larger areas, sedation or general anesthesia may be recommended.
- For your safety during the treatment, various monitors will be used to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood.
- Your surgeon will follow the treatment plan discussed with you.
- After your procedure is completed, you will be taken into a recovery area where you will continue to be closely monitored.
You will be permitted to go home after a short observation period unless you and your plastic surgeon have made other plans for your immediate post-treatment recovery.
Your options will depend on the treatment depth you require and your surgeon will recommend an approach based upon your aesthetic goals. The amount of time you can allow for recovery may be an important factor to consider when selecting a particular chemical peel or determining the extent of treatment.
Light to Medium Peels
Glycolic (AHA) peel
Generally, the most superficial peels are those using alpha hydroxy acids (AHA), such as glycolic, lactic or fruit acid. AHA peels can reduce the effects of aging and sun damage including fine wrinkling and brown spots. Sometimes a single treatment with an AHA peel will give your skin a fresher, healthier appearance and a radiant glow. No anesthesia is needed and you will only feel a tingling or mild stinging sensation when the solution is applied. Immediately after the procedure, you generally will be able to wear makeup and you can drive yourself home or back to work. Various concentrations of an AHA may be applied weekly or at longer intervals to further improve the texture of your skin. Your surgeon may recommend a maintenance program using AHA products that you can apply at home on a regular basis.
Trichloracetic (TCA) acid peel
A TCA peel is a stronger, medium depth peel. TCA peels are often used for the treatment of wrinkles, skin pigment changes and blemishes. Many patients can benefit from having TCA applied not only on the face but also on the neck and other parts of the body that have been exposed to the sun. For spot peeling of limited areas such as around the mouth or eyes, TCA formulas are often preferred because they have a reduced bleaching effect compared to solutions containing phenol, another popular peeling agent. Some surgeons have found TCA to be effective in treating darker-skinned patients. Milder TCA peels can be repeated frequently in order to achieve cumulative effects or TCA can be used to achieve a medium or even a deep peel, depending on the acid concentration and manner of application.
A phenol peel is a deep peel that is sometimes recommended for treating severe wrinkles (from fine lines to deep creases), sun damage, uneven skin tone and texture and may be used in the treatment of precancerous skin conditions. Phenol is particularly useful for minimizing the vertical lines that often form around the mouth as a result of aging. Deep peels take longer to perform and will leave a healing crust on the skin that must be covered with protective ointment and limited from sun exposure. There is a burning sensation, but it is relieved somewhat because the solution also acts as an anesthetic. Phenol often has a significant bleaching effect and you may need to wear makeup in order for the treated portions of your skin to more closely match the skin color of the surrounding areas. Phenol cannot be used on your neck or other parts of your body.
The effectiveness of phenol chemical peeling has been proven in clinical studies over the last 30 years. Because this is a serious procedure, it is ASAPS' position that phenol chemical peels should only be performed under the direction of a qualified physician.
Croton oil peels
Croton oil enhances the penetration of phenol and the depth of the peel. Croton oil peels are used to treat severe wrinkles caused by sun damage and extensive acne damage. The ideal patient has fair, dry skin. The application of this peel is painful, and intravenous sedation or general anesthesia is usually necessary. Patients are usually pain free the following morning.
What are the brand names for chemical peels?
A variety of chemical treatments can be used to exfoliate and rejuvenate the skin. Depending on the depth of treatment required, your surgeon may choose one of the following peels:
- Alpha-hydroxy acid peel (AHA)
- Trichloroacetic acid peel (TCA)
- Phenol peel
- Croton oil peel
It's important to choose your surgeon based on:
- Education, training and certification
- Experience with chemical peels
- Your comfort level with him or her
After finding a board-certified plastic surgeon in your area who is experienced in performing chemical peels, you will need to make an office appointment to set up your consultation. Generally, because of the in-depth nature of the consultation, there is a cost associated with the initial visit.
During your initial consultation, you will have the opportunity to discuss your cosmetic goals. Your surgeon will evaluate you as a candidate for a chemical peel and clarify what it can do for you. Understanding your goals and medical condition, both alternative and additional treatments may be considered.
You should come to the consultation prepared to discuss your complete medical history. This will include information about:
- Previous surgeries
- Past and present medical conditions
- Allergies and current medications
Additionally, it is important to tell your surgeon if you have ever had x-ray treatments of your facial skin, such as those used in the treatment of acne or if you have had a chemical peeling procedure. Current or past use of Accutane (isotretinoin), as well as Retin-A (tretinoin) and other topical skin preparations, must be reported to your surgeon.
Based on your goals, physical characteristics and the surgeon's training and experience, your surgeon will share recommendations and information with you, including:
- An approach to your treatment, including the type of procedure or combination of procedures.
- The outcomes that you can anticipate.
- Your financial investment for the procedure.
- Associated risks and complications.
- Options for anesthesia and treatment location.
- What you need to prepare for your treatment.
- What you can expect to experience after treatment.
- Show before and after photos of cases similar to yours and answer any questions.
We developed these questions to help you:
- Make the most informed and intelligent decisions about your procedure.
- Confirm that you have the right surgeon for your procedure.
- Make your initial consultation as rewarding as possible.
- Understand your options, potential outcomes and risks.
It is important for you to take an active role in your treatment, so please use this list of questions as a starting point for your initial consultation.
- Am I a good candidate for a chemical peel?
- Are the results I am seeking reasonable and realistic?
- Do you have before-and-after photos I can look at for the procedure I am undergoing?
- Will I have any scarring?
- What kind of anesthesia do you recommend for me?
- What will be the costs associated with my treatment?
- What will you expect of me to get the best results?
- What kind of recovery period can I expect and when can I resume normal activities?
- What are the risks and complications associated with my procedure?
- How are complications handled?
- What are my options if the cosmetic outcome of my treatment does not meet the goals we agreed on?
Your surgeon will discuss how long it will be before you can return to your normal level of activity and work. After surgery, you and your caregiver will receive detailed instructions about your postsurgical care, including information about:
- Normal symptoms you will experience
- Potential signs of complications
Following all chemical peel treatments, it is important to avoid direct or indirect sun exposure until all the redness or pinkness of your skin has subsided. Even after that, it is advisable to protect your skin by regular use of sunscreen and, whenever possible, a wide-brimmed hat. This is particularly important if you have had a phenol peel which eliminates your skin's ability to tan. If the area around your eyes has been treated, you should wear good quality sunglasses when outdoors. After some types of chemical peel treatments, you may need to be careful about exposing your skin to chlorinated water.
Immediately after a chemical peel
For deep peels, your treated skin may be covered with petroleum jelly or other protective ointment and, in some cases, dressings may be applied.
You may have some pain, particularly with the deeper peels. If the pain is extreme or long-lasting, contact your physician. You will also have some redness and swelling after the surgery. Contact your surgeon to find out if your pain, redness and swelling are normal or a sign of a problem.
Recovery time frame after chemical peels
Your recovery will depend on the technique and depth of treatment.
A more superficial treatment will have no down time and you can return to your normal activities immediately.
Medium to Deep Peels
A deeper peel will involve a more prolonged healing period. You will be advised about cleansing your skin and if you should apply any ointments. For men who have undergone resurfacing procedures, shaving must be delayed for a while.
It is vitally important that you follow all patient care instructions provided by your surgeon. Your surgeon will also provide detailed instructions about the normal symptoms you will experience and any potential signs of complications. It is important to realize that the amount of time it takes for recovery varies greatly among individuals.
The first two weeks
- Depending on the post-treatment regimen selected by your surgeon, a scab may or may not form over the treated area in medium and deep peels.
- For deeper peels, your wounded skin may be moist and ooze serous ("clear watery") fluid.
- Depending on the depth of the peel you might have, swelling and redness will gradually change to pink, signalling that your new skin has begun to form.
Week two to eight
- Your skin may still be pink.
- Your skin tones will begin to blend naturally.
- Your surgeon will advise if camouflage makeup can be used.
How long will my results from a chemical peel last?
Because of the persistence of skin pinkness following deeper chemical peel procedures, it may take months before you can fully appreciate your new look. Most patients feel that the results are definitely worth waiting for and, in the case of deeper treatments, the benefits are relatively long-lasting. Superficial resurfacing procedures may need to be repeated periodically in order to maintain their benefits.
Your skin will continue to age, and wrinkles caused by movement of your facial muscles will eventually reappear. Some wrinkles may recur sooner than others, depending on their location as well as the type and extent of your chemical peel treatment. Despite this, you can expect that improvements in skin quality and texture achieved by a chemical peel will make your complexion appear younger and fresher for many years to come.
Maintain a relationship with your aesthetic plastic surgeon
For safety, as well as the most beautiful and healthy outcome, it's important to return to your plastic surgeon's office for follow-up evaluation at prescribed times and whenever you notice any changes in your skin that has been treated. Do not hesitate to contact your surgeon when you have any questions or concerns.
The cost of chemical peels varies from the type of peel, from doctor to doctor, and from one geographic area to another.
Because chemical peels are elective procedures, insurance usually does not cover these costs. Occasionally, however, if the peel is being performed to treat precancerous skin conditions or improves certain types of scars, insurance coverage may be available. Your plastic surgeon's office will explain how you can find out from your insurance company if a particular procedure will be covered. Many surgeons offer patient financing plans to make the procedure more affordable.
Choose your surgeon based on quality, training and experience—not cost.
Fortunately, significant complications from chemical peels are infrequent. Your specific risks for chemical peels will be discussed during your consultation.
All surgical procedures have some degree of risk. Some of the potential complications of all surgeries are:
- Adverse reaction to anesthesia
- Hematoma or seroma (an accumulation of blood or fluid under the skin that may require removal)
- Infection and bleeding
- Changes in sensation
- Allergic reactions
- Damage to underlying structures
- Unsatisfactory results that may necessitate additional procedures
Other risks specific to chemical peels are outlined below:
- Abnormal healing
- Unanticipated color changes or skin blotchiness
- Eruption of cold sore (herpes virus)
- Tiny whiteheads
You can help minimize certain risks by following the advice and instructions of your board-certified plastic surgeon, both before and after your chemical peel treatment.This article was originally published for Smart Beauty Guide and was legally licensed