A chemical peel is a body treatment technique used to improve and smooth the texture of the facial skin using a chemical solution that causes the dead skin to slough off and eventually peel off.[1] The regenerated skin is usually smoother and less wrinkled than the old skin. Thus the term chemical peel is derived. Some types of chemical peels can be purchased and administered without a medical license, however people are advised to seek professional help from a dermatologist, esthetician, plastic surgeon, or otolaryngologist on a specific type of chemical peel before a procedure is performed.
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There are several types of chemical peels,[1]
Alpha hydroxy acids (AHAs) are naturally occurring carboxylic acids such as glycolic acid, a natural constituent of sugar cane juice and lactic acid, found in sour milk and tomato juice. This is the mildest of the peel formulas and produces light peels for treatment of fine wrinkles, areas of dryness, uneven pigmentation and acne. Alpha hydroxy acids can also be mixed with a facial wash or cream in lesser concentrations as part of a daily skin-care regimen to improve the skin's texture.
There are five usual fruit acids: citric acids (citrus-derived), glycolic acid (derived from sugar cane), lactic acid (although derived from milk, this is still considered a "fruit acid"), malic acid (derived from apples) and tartaric acid (derived from grapes). Many other alpha hydroxy acids exist and are used.
AHA peels are not indicated for treating wrinkles.[3][4]
AHA peels may cause stinging, cause skin redness, cause mild skin irritation, cause dryness, and take multiple treatments for desired results.
It is becoming common for beta hydroxy acid (BHA) peels to be used instead of the stronger alpha hydroxy acid (AHA) peels due to BHA's ability to get deeper into the pore than AHA. Studies show that BHA peels control oil, acne as well as remove dead skin cells to a certain extent better than AHAs due to AHAs only working on the surface of the skin. Salicylic acid is a Beta Hydroxy Acid.
Jessner's peel solution, formerly known as the Coombe's formula,was pioneered by Dr Max Jessner, a German-American dermatologist. Dr Jessner combined 14% salicylic acid, lactic acid, and resorcinol in an ethanol base. It is thought to break intracellular bridges between keratinocytes. It is very difficult to "overpeel" the skin due to the mild percentages associated with the acid combination.
Retinoic acid is derived from retinoids. This type of facial peel is also performed in the office of a plastic surgeon or a dermatologist in a medical spa setting. This is a deeper peel than the beta hydroxy acid peel and is used to remove scars as well as wrinkles and pigmentation problems. It is usually performed in conjunction with a Jessner; which is performed right before, in order to open up the skin, so the retinoic acid can penetrate on a deeper level. The client leaves with the chemical peel solution on their face. The peeling process takes place on the third day. More dramatic changes to the skin require multiple peels over time.
Trichloroacetic acid (TCA) is used as an intermediate to deep peeling agent in concentrations ranging from 20-50%. Depth of penetration is increased as concentration increases, with 50% TCA penetrating into the reticular dermis. Concentrations higher than 35% are not recommended because of the high risk of scarring.
Trichloroacetic acid peels:
Trichloroacetic acid peels may:
Phenol is the strongest of the chemical solutions and produces a deep skin peel. Some publications claim that phenol peel affect could be due to the action of croton oil and that phenol would not be effective without this oil. In reality, many phenol peel solutions exist that do not contain croton oil. This last is only a penetration enhancer, acting at the epidermal very superficial layers. Croton oil is not the only penetration enhancer that can be used. Effects of a phenol chemical peel are long lasting, and in some cases are still readily apparent up to 20 years following the procedure. Improvements in the patient’s skin can be quite dramatic. A single treatment usually achieves the desired result.
Phenol peels are used to:
Phenol peels may:
The deeper the peels the more complications that can arise.[1] Chemical peels are risky and need to be administered by certified dermatologists. The possible complications include prolonged erythema, pigmentary changes, milia (white heads), skin atrophy and textural changes.[1]
Light chemical peels like AHA and glycolic acid peels are usually done in medical offices. There is minimal discomfort so usually no anesthetic is given because the patient feels only a slight stinging when the solution is applied. No pain killer is needed.
Medium peels like TCA are also performed in the doctor’s office or in an ambulatory surgery center as an outpatient procedure and are a bit more painful. Frequently, the combination of a tranquilizer like Valium and a pain pill usually suffice. TCA peels often do not require anesthesia even if the solution itself has - at the contrary of phenol - no numbing effect on the skin. The patient usually feels a warm or burning sensation.[5]
Phenol is the classic deep chemical peel. Old phenol peel solutions are very painful and most practitioners will perform it under either general anesthesia, administered by an MD-anesthesiologist or nurse anesthetist. More recent formulas easily allow a simple heavy sedation, usually intravenous. Recent phenol peel formulas can be applied locally (chemical blepharoplasty or cheiloplasty)without any kind of anaesthesia.