Chemical peeling is a well-established method of improving skin health and appearance. Because of the enormous success of the technique, however, some misconceptions have arisen surrounding chemical peel best practices.
In this blog, the skincare professionals at Faces PLLC help peel back the curtain on any misunderstandings associated with chemical peeling in this comprehensive guide to the procedure.
From choosing the correct peel for you, right through to healing, and then to prolong the results, this article has you covered.
What is a Chemical Peel?
Also referred to as chemoexfoliation, chemical peeling is a cosmetic procedure that removes targeted layers of the skin – in other words, it removes skin to the desired depth.
The process works to enhance skin texture by revealing new, undamaged skin cells underneath the lower surface layer. This older skin layer may have become damaged due to sun exposure, physical trauma, such as acne, or scarring caused by accidents.
Using special natural chemicals, peels are a form of controlled damage to the skin that causes the ablation of outer skin layers and stimulates the production of new skin cells. Generally used on the surface of the face, chemical peels can also be used to treat damaged skin of the hands and neck.
Chemical peels vary in intensity and treat different levels of skin damage. The more intense the peel, or the stronger the chemical solution, the deeper into the skin the peel goes.
When Was the Chemical Peel Invented?
The earliest mention of chemical peeling – although she may not have known what she was doing – came from Egyptian Empress Cleopatra’s discussion of her milk baths. Stories of antiquities’ most beautiful and captivating queen often include her lying in baths full of milk, which gave her skin her royal shine and splendor. Interestingly, Cleopatra had begun the first form of chemical peeling.
We now know that milk contains lactic acid, and sits on the pH scale at around 6.5, making it slightly acidic. When Cleopatra bathed in milk, it is likely that the lactic acid would gently remove the outermost layers of her skin, thus eliminating the oldest and most damaged cells.
However, the first purposeful mention of chemical peels to resurface and restore skin seems to be in the late nineteenth century by an Austrian dermatologist Ferdinand Ritter von Hebra, who founded the Vienna School of Dermatology. Von Hebra made cautious combinations of nitric acid, croton oil and phenol to treat freckles and skin irregularities.
Since this time, dermatologists have significantly advanced the procedure to reliably treat varying depths of the skin and different skin problems.
What do Chemical Peels Help?
The overall goal of chemical peeling is to improve the aesthetic appearance of the skin, by improving wrinkles and acne scars, reducing acne lesions, clarifying discolored skin from sun damage, and restoring a more youthful appearance.
The extent of damage inflicted on the skin determines the strength of the peel required. Deep acne scars, for example, may require a deep chemical peel. Whereas, mildly sun-damaged skin may only require a superficial peel done using a low to medium concentration chemical solution.
Do Different Skin Colors React Differently to Chemical Peels?
Contrary to popular belief, clinicians are now able to carefully choose chemical peeling agents with appropriate strengths to treat all skin types.
While there have been some reports of hyperpigmentation as a result of chemical peels in darker skin types, this has been due to inexperienced clinicians performing the procedure, or patients receiving inappropriate over-the-counter peels to use at home.
With the correct assessment of skin phototype, patient ethnicity, and skin response, experienced and qualified clinicians are able to accurately help people from all backgrounds restore youthful, smooth skin using chemical peeling.
What Happens During a Chemical Peel?
Chemical peel formulas are composed of various caustic agents – caustic agents are “chemicals that damage organic tissue by chemical action.” When any caustic agent is applied to the skin, skin proteins such as keratin and collagen are destroyed. This results in a “white frost” forming on the skin surface, similar to water being added to baking soda.
This reaction is an important indicator showing how deep the peel is working. The stronger the caustic agents in the peel formula, the deeper the peel will work, and the thicker the “white frost” will be as the formula reacts with the skin cells. As such, during your chemical peel, your clinician will first wash the treated area. Depending on the depth of the peel, you may also require some form of topical anesthetic for comfort.
Once you are properly prepared, your clinician will expertly apply the chemical peel solution with an applicator brush. This step ensures uniform application of the formula and a predictable result from the procedure.
The formula will then be left on your skin for a predetermined amount of time, after which your clinician may apply a neutralizing agent to the treatment area to stop the caustic reaction of the chemical peel.
Depending on the peel you received, you will then be given specific instructions to follow during your recovery from the skin peel, to ensure your skin stays safe during recovery.
What are the Different Types of Chemical Peels?
Chemical peels, depending on their function, are composed of varying concentrations of substances.
There are three main categories of chemical peels, according to the amount of skin removed by the peel. These are:
– Superficial Peels
– Medium-depth Peels
– Deep Peels
Each category of peel has a different application and treats different skin problems. This also means the different peels have different application durations, healing times, and recovery treatments.
It is important to discuss your skin’s condition and your desired results in-depth with an experienced and qualified skin care specialist to ensure an optimal outcome in your treatment.
Superficial peels, also referred to as mild peels, remove the outermost layers of the skin – the skin layer known as the epidermis.
The objective of a mild peel is to treat the damage done to the epidermis, while minimizing recovery time from the procedure and any side effects.
When the formula is applied for a superficial peel, there should be little, if any, “white frosting” that forms on the face. This is a good sign – it shows that the peel is not working deeper than necessary, as the white frosting associated with chemical peels indicates proteins being destroyed at deeper layers of the skin.
Superficial peels are most commonly composed of lower concentrations (30-50%) of glycolic acid. Derived from sugar cane, glycolic acid has demonstrated outstanding efficacy as a treatment of superficial hyperpigmentation and photoaging of the skin. Other commonly used ingredients used for superficial peels include lactic and mandelic acids and salicylic and pyruvic acids. All these products have been used in increasing popularity, due to the minimal discomfort associated with them.
Although minimal, there is some downtime associated with even a superficial chemical peel. For patients who want to further minimize downtime, a less aggressive treatment such as a HydrafacialTM, DermalinfusionTM or OxygeneoTM may be a better choice. Our Medical Aestheticians will thoroughly assess your skin’s condition and recommend the level of chemical peel required to achieve your aesthetic goals.
Medium peels are designed to treat skin at a deeper level than superficial peels. They penetrate through the epidermal layer into the upper dermal skin cell layer.
When applied correctly and with proper technique, medium peels are ideal treatments for shallow acne scars, shallow photodamage such as sunspots, and can even remove delicate rhytides, and very fine wrinkles.
Proper technique of medium peels is sequential peeling – doing different parts of the face one after the other, instead of all at once (as is the case with superficial peels). The recommended sequence is:
1) Forehead and temples
2) Cheeks and chin
3) Delicate eyelids and lips
Doing this ensures proper attention is paid to the entire field of application, which means the skin is treated equally in all areas.
In most cases, medium peel formulas are similar to superficial peels, but the caustic agents are mixed in higher concentrations. This allows the formula to reach deeper layers of skin and treat damage further away from the outer skin surface.
One of the safest, and now the most commonly prescribed medium peel agent, is a formula containing higher concentrations of glycolic acid (70% relative glycolic acid concentration).
Occasionally, multiple applications of 20-40% salicylic and pyruvic acid formulas can be used to achieve a medium-peel, as the multiple applications of the formulas remove more layers of skin. One concern of medium skin peels is ensuring the peel doesn’t penetrate too deeply into the dermal layers.
How deep any peel penetrates depends on the concentration of the formula and the type of caustic agents used, but also the length of time the formula is left on the skin to react. The longer a formula is left on the skin, the deeper it will work.
As such, to control for any variation on the depth of a medium peel, our aestheticians use pre-peel applications that can help ensure the equal distribution of the peel over the applied area. Once healed, the use of such pre-application formulas results in a skin complexion that is smooth and uniform.
Because they go deeper, medium peels hurt more than superficial peels. To ensure patients remain comfortable throughout the procedure, pre-treatment sedation can be used.
Deep peels are becoming less common because lasers are capable of treating deep skin problems with greater accuracy and predictability.
For some patients, deep peeling is necessary and, when performed by an experienced facial plastic surgeon, deep peels provide a reliable and effective treatment for those with significant sun damage and deeper wrinkles.
Nonetheless, there are significant risks and potential complications involved with deep chemical peels. These involve superinfection and extensive scarring. This makes it imperative that patients considering a deep chemical peel to ensure the experience and qualifications of their surgeon.
During deep peeling, the patient will typically have some form of sedation and pain relief either with pills, anesthetic creams, and injections, or intravenously. Vital signs are monitored throughout the treatment as well.
During the procedure, the specially mixed chemicals are applied to sequential areas similar to the medium depth peel protocol.
Healing from a deep chemical peel is a complicated and prolonged process and demands strict adherence to surgeon guidelines.
Chemical Peel Recovery?
Recovery from any of the peels can be enhanced with cold compresses for the first 24 hours, and plenty of moisturizers as instructed by your clinician. For the first twenty-four hours following treatment, patients should gently wash the treated area with a dilute acetic acid solution to ensure bacterial infections are kept at bay, followed by a liberal application of a soothing cream as recommended by our medical aestheticians. Faces carry a variety of products suitable for your follow-up care. Some brands of peels will include the products as a package.
For the following seven days, patients should continue to diligently clean their skin as instructed, followed by a soothing cream such as Aquaphor. It is imperative to keep out of the sun for a week following your peel, use sunscreen, wear broad-brimmed hats and ideally staying out of the sun until the skin has properly healed.
Healing from deep chemical peels will take weeks, and may require pain medication for the first few days. Normally, patients return to work after two weeks at home with complete downtime.
Depending on your circumstances, a superficial, medium or deep chemical peel can provide you with a new, youthful, smoother complexion. Treating skin blemishes, freckles, acne scars, sun damage or even deeper pigmentation problems, chemical peeling is a tried and tested technique that has been developed over the last hundred and fifty years.
It is essential that you consult an experienced, licensed skincare specialist regarding your peel to ensure you receive the correct type of peel and the appropriate attention during your recovery. The team at Faces PLLC pride themselves on their reputation as skincare experts.
Call 601 607 3033 or fill out our online form to arrange your consultation and get the best advice available on chemical peels.