Chemical Peels

By Steven J. Rottman, MD

Sun exposure, acne or just getting older can leave your skin tone uneven, wrinkled, spotted or scarred. If you want your skin to look smoother and younger, you may want to consider a chemical peel to deal with facial wrinkles and aging lines. Chemical peels exfoliate the superficial layers of skin damaged by exposure to the sun and from damage caused by other environmental factors.

In this blog I’ll discuss Chemical Peeling so you can begin to make an informed decision about the treatment option that is right for you. A chemical peel uses a chemical solution to smooth the texture of your skin by removing the damaged outer layers.

A chemical peel, also called chemexfoliation or derma peeling, is one of the least invasive ways to improve the appearance of your skin. Although chemical peels are used mostly on the face, they can also be used to improve the skin on your neck and hands.

A chemical peel can be beneficial for:

• Acne or acne scars
• Age and liver spots
• Fine lines and wrinkles
• Freckles
• Irregular skin pigmentation
• Rough skin and scaly patches
• Scars
• Sun-damaged skin

Sun damage is responsible for most of the fine lines of aging found around the eyes and mouth. Removing these damaged layers of skin will significantly improve the appearance of these lines. Chemical peels can also even out pigmentation changes in the skin and remove pre-cancerous lesions.

What exactly are Chemical Peels?
Chemical peels are a method of regenerating and resurfacing the skin by inducing a controlled wound to the skin. The top layers of the skin are removed to help induce collagen remodelling resulting in improvements to sun-damaged skin, skin pigmentation problems, wrinkles, skin texture, and the overall skin appearance. The strength of the chemical peel will determine its depth. Deeper peels will have a greater number of complications and a longer recovery, but also will result in a greater improvement in the skin.

Types of Peels

• Light Peels – Light peels use alpha hydroxyacids, the naturally occurring acids found in fruits and other foods. These alpha hydroxyacids are used for treating dry skin, acne, liver or sun-damage spots. A light peel can lessen the appearance of fine facial wrinkles, reduce pore size and improve the texture of older or sun-damaged skin. Light peels are generally performed in a series of six to eight treatments performed about two or three weeks apart. The effects of the peel are generally mild with redness that lasts a day or two.
• Medium Peels – These peels are generally done using trichloroacetic acid. This peel works on deeper layers of skin and is performed once every two to three years. In addition to the skin effects of light peels, a medium peel can remove deeper wrinkles and precancerous lesions. The after effects, which may last week a week or more, of a medium peel are more pronounced with redness (resembling a severe sunburn).
• Deep Peels – Deep peels are not performed as frequently as the other types of peels. The most common chemical used for deeps peels is Phenol. These peels treat much deeper layers of skin and skin damage. Besides the risk of heart problems, these peels must be used cautiously as they cause permanent whitening of the skin and have a much longer recovery time; as much as one to two months in some cases. They are not recommended for dark skinned individuals.

After a peel is performed, the treated skin will require protection from the effects of the sun. You will need to use sunscreen outside and appropriate clothing and hats to protect the skin. Drink adequate amounts of water to keep the skin well hydrated.

Which chemical peel is right for me?
Chemical peels induce a controlled wound to the skin, and can replace part or all of the top layers of skin. The major factors in determining which chemical peel is right for you include:

• The degree of the skin problem/ageing/sun-damage,
• The skin type/color,
• The amount of improvement you would like to achieve, and;
• The amount of recovery or downtime that is acceptable by you.

Typically, the deeper the peel, the more side effects, potential complications, and recovery are needed. Another rule of thumb is that the darker the skin type, the more problems that may be encountered post-peel, especially pigmentation problems such as post inflammatory hyperpigmentation where the treated skin may become darker than the untreated skin. Therefore, deeper peels in darker skin types must be considered with caution. Sometimes it may be better to perform a series of more superficial peels rather than one deep peel.
The degree of skin ageing will also determine which peel to use. For younger patients with less sun-damage, pigmentation and wrinkles, only superficial peels may be required.
Medical conditions need to be discussed with your doctor prior to having a chemical peel.

It is important to discuss medical conditions you may have before a chemical peel or, for that matter, any other type of treatment you are considering. Of particular significance is a history of or a current infection of herpes simplex virus (cold sores).If there is an active infection present, you may be asked to wait until it has passed prior to having a chemical peel. Additionally, if you have a history of keloid (thick, pigmented scars) you may also be excluded from all but the most superficial of peels.

Patients with HIV/AIDS or immunosuppression should avoid chemical peels because this may impair wound healing and increase the likelihood of infection and scarring. Also those who have recently had a course of oral isotretinoin or accutane or a recent browlift or facelift should discuss this in advance to determine the appropriate time frame for your treatment.

In conclusion, if you want your skin to look smoother and younger, consider a chemical peel. I will be happy to further discuss this treatment method with you and to answer any additional questions you may have. Please feel free to call 410-321-6868 or contact me to set up your complimentary appointment.