Skin Peels: A Solution for Every Age and Skin Type
Article by Daniel Levy, MD
Bellevue Dermatologic Surgeon
Skin peeling, also known as exfoliation, is an essential component of rejuvenation. Removing damaged outer layers allows a fresh, new layer of skin cells to emerge. A new layer of skin cells not only results in a refreshed appearance, but is also therapeutic as the peeling process improves acne and sheds precancerous cells. If we could stimulate such a renewal process for every organ in our body, we certainly would. Skin peels are beneficial for all skin types, skin colors, and ages. They’re often used in combination with other procedures, such as dermal fillers or Botox. Skin peeling can be accomplished in three ways: pharmacologically, chemically, or with a laser.
Pharmacological peeling is achieved with retinoids, a class of compounds derived from vitamin A. The retinoid compound attaches to specific skin receptors, activating a cycle of skin renewal. The result is a dose-dependent, time-released skin peel. While many people who use retinoids consider the shedding skin a side effect, I consider it to be a reassuring sign of skin renewal.
Topical retinoids (in cream or gel form) are applied nightly as a thin, mask-like layer over the skin. Examples include Retin-A, Differin, Renova, and Tretin-X. Oral retinoids, such as Accutane, are typically used to treat resistant cases of acne associated with scarring and accelerate the renewal of all three layers of the skin from the inside. Most people who complete a course of an oral retinoid find that the renewed skin is smoother with less scarring, less oil, and an even color.
Chemical peeling is generally achieved with acids, resulting in new skin that is smoother, less wrinkled, and more even in color. Alpha hydroxy acids (AHAs), such as glycolic, lactic, or fruit acids are the mildest of this category and produce light peels. Alpha hydroxy acids can also be mixed with a facial wash or cream in a lower concentration as part of a daily skincare regimen to improve the skin's texture. Deeper peels may be achieved with trichloroacetic acid (TCA) and carbolic acid (phenol). Some chemical peels also incorporate a retinoid to stimulate peeling in a dual fashion. The type or mixture of peeling agents are selected according to skin type and desired depth of penetration. Greater depth typically yields greater results.
In general, chemical peels:
» Reduce fine lines, especially under the eyes and around the mouth
» Treat mild scarring and certain types of acne
» Diminish skin discoloration, such as sun spots, age spots, liver spots, freckles, or blotching
» Refresh skin texture and color
Laser peeling is best done with the erbium or Fractionated CO2 laser (FX). In the Medical Spa, I use the most advanced version of a Fractionated C02 laser known as Active, Deep, or Total FX, depending on the depth of penetration.
While CO2 has historically been the gold standard of laser-guided skin peeling or skin resurfacing, older technologies required weeks of healing. In contrast, the new “Fractionated” technology preserves micro-islands of skin intact, thereby accelerating healing. The results are medium to deep even plane of peeling which lasts 3-5 days, new collagen formation, and skin that continues to look better over time.
Here is a complete plan for skin renewal which incorporates pharmacological, chemical and laser modalities:
1. Nightly: pharmacological - retinoid Tretin-x, retin-A
2. Every morning: chemical - glycolic acid VIVITÉ® exfoliating cleanser
3. Daily: mechanical exfoliation with Clarisonic; add daily SPF 50 Environmental Defense Skinmedica sunscreen
4. Quarterly: chemical and retinoid Skinmedica Vitalize Peel
5. Annually: chemical and retinoid Skinmedica Rejuvenize peel
every 1-3 years: laser Active FX
every 5-10 years: laser Total FX