Chemical Resurfacing (Peel)

A chemical peel is a medical procedure that involves applying one or more chemicals to the skin, targeting damaged cells, and facilitating the resurfacing process of the skin. It is important to distinguish chemical peels performed in spas from those performed in dermatology offices, as these are two entirely different procedures. Those performed in spas are considered closer to home treatments: less effective chemicals are used, different post-procedure effects are observed, and more sessions are required for results to become visible.

In dermatology, three different types of chemical peels are used: alpha-hydroxy peels, trichloroacetic acid peels, and phenol-croton oil peels.

A peel works by removing multiple layers of sun-damaged skin cells, leaving only fresh skin with a more even colour and surface. It helps to stimulate collagen production to improve the overall texture of the skin.

Chemical peels are often used to treat skin damage caused by sun exposure (photoaging), including actinic keratoses. They are also used to remove pigmentation in patients who have melasma and freckles, as well as to improve acne. They can also reduce facial fine lines and wrinkles.

Peels are repeated as needed. The procedure is typically repeated every 3 to 6 weeks, if required.

Chemical peels are distinguished based on their strength and are divided into three categories: superficial peel, medium-depth peel, and deep peel.

Superficial Peels

In superficial peels, glycolic acid, Jessner solution, and salicylic acid are used. They are sometimes referred to as "lunchtime peels" due to their lighter effects and are most often performed by aestheticians in spa settings. They remove lesions on the skin surface, which helps to reduce surface dryness and overall pigmentation. Multiple sessions are needed for results to become evident. Superficial peels are generally performed in salons rather than clinical settings.

Clinical Graded Resurfacing

Clinical graded resurfacing is considered a surgical procedure and should be performed only by a board-certified dermatologist or a plastic surgeon.

Medium-Depth Peels

In the medium-depth peel, trichloroacetic acid (TCA) is used. The concentration of the chemical is carefully calculated by a physician and may vary between 15% and 35%. The treated areas tend to be swollen, red, and crusted in the days following the procedure. Significant improvements in skin texture can be achieved: blotchy pigmentation, freckles, and actinic keratoses will be reduced. Fine lines, wrinkles, and acne scars will also become less noticeable. However, there may be little to no effect on areas with deep furrows.

Deep Peels

The deep peel uses phenol, which causes significant skin injury. It is rarely used today due to scarring side effects and its level of toxicity. However, it is considered effective in improving deep furrows and surface wrinkles.

The Peeling Procedure

The peeling procedure begins with thorough cleansing of the face to remove surface oils, followed by application of the peeling agent for several minutes. A stinging sensation is expected; its duration depends on the chemical used, its concentration, and individual factors. A fan may be used to help manage the stinging. After the peel is neutralized, the burning sensation should lessen.

Recovery and Aftercare

Superficial peels cause mild facial redness and swelling that typically resolves within 48 hours. The peeling is similar to a mild sunburn. Most patients are able to continue normal activities after the procedure, and makeup can be applied a few hours afterward.

Medium-depth peels result in more intense inflammation and swelling that may take approximately one week to resolve. Mild redness can persist for several weeks. Most patients take approximately one week off from work to recover.

Following any peel, sun protection is strongly advised. The skin should be kept moisturized, and picking at the skin should be avoided, as it slows the healing process and can result in unwanted scarring.

Complications

Complications following a chemical peel are uncommon when the procedure is performed by a properly trained and experienced health professional. The physician's instructions should be carefully followed. In the event of any complications, the treating physician should be notified promptly.