A thorough evaluation is essential for a good result from a chemcial peel for photodamage. Visual examination of the skin followed by an UV light examination can determine the nature and depth of your photodamage. We also use the Fitzpatrick scale to determine your existing skin tone. In my practice we also perform an ultrasound examination of the skin. This gives us an indepth view of the exact level and degree of photodamage.
(http://www.primacenter.com/SpaSkinCare/BeautiquePacifique.aspx)
From this exam we then discuss the different forms of chemcial peel that would be appropriate.
1. Retin-A or Renova, glycolic acid and spa type peels are essentially interepidermal peels, they will only treat the problem if it is superficial
2. Alpha Hydroxy peels and Beta hydroxy peels can be effective and penetrate slighly deeper
3. TCA or tricholoracetic acid peels go into the more superficial layers of the dermis and typically we use between 20 and 35% TCA. A TCA peel can be done in layers with each layer penetrating slighty deeper.
4. Phenol based peels penetrate the deepest and are appropriate for certain conditions however this type of peel can remove all you the pigmentation in the skin.
For your condition you would need to be pretreated with a skin lightening agent that contains Hydroquinone and Kojic acid, for 4 - 6 weeks prior to a peel. Next you would select the peel that is most appropriate to the level of your pigmenation. Most likely a level 2 20% TCA peel may be the correct choice for you.
