A chemical peel is a skin treatment intended to visibly improve the structure of treated tissue by the external application of a caustic solution
Chemical peels are the 3rd most common aesthetic procedure carried out worldwide in the Dermatology clinic. They are predominantly used for their exfoliating properties and influence on collagen matrix turnover, which improves lines and wrinkles, decreases discoloration, and improves skin tone and smoothes texture. They are also used to help with a wide variety of common Dermatology skin conditions including photo-damage/solar elastosis, acne vulgaris, acne rosacea, melasma or hyper-pigmentation.
There are a wide range of chemical peels on the market. Although many patients present with similar skin problems, it is not possible to treat everyone with the same solution. Patients should attend first for a Dermatology consultation. The choice of peel for the patient depends on many different factors. These include: skin concern/condition, patient expectations, budget, time off work/downtime, Fitzpatrick skin type, Glogau scale of photo-ageing, pain threshold, past medical history, history of scarring/hyper-pigmentation.
Chemical peels are acid solutions that have a significantly lower pH level than your skin’s natural pH. When used on your skin, a chemical peel has the ability to dissolve the “desmosome connections” (adhesive substance) that hold the layers of dead-skin build up on your face. This process allows new skin to regenerate and helps your skin appear smoother, more hydrated and with less wrinkles and more even skin tone. Newly developed carrier solutions take the acids and associated treatment ingredients across the stratum corneum and deep into the skin before being released to target specific skin concerns.
Superficial skin peels are generally very well tolerated. Most peels will sting, but there is minimal downtime with most superficial peels. Make-up can be applied over a sunscreen straight after the peel and the patient can return to work immediately etc. The slightly deeper peels (TCA or Jessner’s peel) will peel after day 3 and the patient looks like they have eczema for a day or two but that settles fairly quickly. The medium depth peels like a TCA 35% will require at least one week off work and the skin will peel aggressively after 48 hours for 7-10 days and redness can persist for a while after the peel. Most patients find this chemical peel quite painful. A phenol peel is a deep chemical peel and is only for severe photo-ageing or very severe acne scarring. The results can be excellent but there is a lot of downtime and usually 2 weeks off work. Most peels (except phenol and TCA 35% peel) are done as a course of 5- 6 peels over a few weeks. Patients results will differ and sometimes further courses of peels will be needed. The initial consultation will discuss patient’s expectations, time off work expected, pain, budget and what can be realistically achieved from the peels. Peels should be used in combination with proper skin care. This will be recommended by your Doctor and it is important you follow it for safety reasons but also to maintain and enhance the result of your peel.
The Chemical Peels available at The Adare Clinics are as follows:
Glycolic acid peels: Glycolic acid is an alpha hydroxy-acid. It is a small molecule which penetrates the epidermis easily. It is considered a very superficial to superficial peel depending on the strength of the peel applied. Usually 6-8 treatments will be done in total; one peel weekly, increasing the strength of the peel every time, depending on the patient. It improves texture, open pores and mild sun damage and improves the overall health and look of your skin. It is good for very mild acne. There may be no visible peeling with lower percentages although microscopic exfoliation is taking place. These peels are suitable for the patient who wants no downtime and wants a mild improvement in skin.
Salicylic acid peels: This is a Beta-hydroxy acid and is beneficial for patients with acne vulgaris. Usually 6 peels are done(weekly) and it must be used in conjunction with a proper anti-acne skin care regime for prolonged effects.
Lactic acid peels: This is an alpha-hydroxy acid with moisturising and anti-ageing activities. Lactic acid inhibits the tyrosinase enzyme activity directly, so it is a good peel to use when targeting issues with pigmentation. It also helps hydrate and smoothen chronically dry skin and improves the delicate under-eye skin. There is minimal downtime with this peel. Peels are done weekly and a course of 6-8 peels will be needed.
Pyruvic acid peels: This is an alpha-keto acid which has several properties including oil and sebum skin reduction. It breaks the links between the corneocytes, renewing the appearance of the stratum corneum. It interacts with the fibroblast receptors, stimulating the production of proteoglycans and collagen in the dermis. It increases dermal hydration and is good for the mature, oily sun-damaged skin. 4 peels are usually recommended every 2 weeks.
Mandelic acid peels: This is also an alpha-hydroxy acid. Mandelic acid is a larger molecule that penetrates the epidermis very slowly and evenly and so is much safer for patient with darker Fitzpatrick skin types. It is a safe peel that can be used in all skin types. It is used for melasma or hyper-pigmentation, acne, and mild erythema associated with early acne rosacea.
Jessner’s peels: Jessner’s peels contain a mixture of salicylic acid, resorcinol, and lactic acid. It is used in mature, oily, sun damaged skin. Salicylic acid will improve the appearance of small scars and post acne marks. Lactic acid will give skin a smoother texture. Resorcinol has a keratolytic action which helps to reduce fine lines and acne leaving the skin smooth and regenerated. There will be visible peeling after Jessner’s peels and sometimes pigment darkening in the first few days. These peels are done every 2 weeks. An SPF 30+ must be worn after this peel.
TCA peels: Trichloracetic acid 12-15% peels are usually done as a course of 6 every week or 2 weeks. There will be visible peeling and redness that can persist for a while depending on the strength of the peel. Patients complain of an uncomfortable stinging sensation and as the percentage increases for example a medium depth peel TCA 35% can be quite uncomfortable and a week off work would be required. TCA 35% peels are done as a once off procedure every few years. These peels give very good results and are for the patient who will accept visible peeling but want a superior result. Theses peels will greatly improve the texture of the skin, improves fine lines and wrinkles and acne scarring. Analgesia (pain-killers), antibiotics, anti-histamines and anti-viral therapy will be required after this peel. SPF 30+ is essential after this procedure. Other skin products will also usually be recommended to maintain the results of your peel.
Phenol peels: This is a deep chemical peel. It requires about 2 weeks off work. It gives excellent results but can cause cardio toxicity so it can be done in two stages. It gives excellent results for upper lip wrinkles, upper and lower eyelid wrinkles where surgery is not wanted/required and elsewhere. It is sometimes performed on the eyes only or upper lip only but then it needs to be combined with a TCA 35% peel or CO2 laser as the texture of the treated skin will be completely different. There is considerable downtime with this peel. The redness can persist for up to 6 months. It is not risk free; there is a risk of scarring, dyspigmentation, although this would be very rare. Antibiotics, anti-virals, anti-histamines and painkillers will be required after this procedure