Do Chemical Peels Risk Causing Premature Skin Aging Like Lasers?

 

Chemical peels have been a reliable mainstays of the cosmetic physician's toolbox for well over a century. Trichloroacetic acid (TCA), Jessner's solution, salicyclic acid, glycolic acid and phenol have all been used in varying concentrations and protocols for treating acne scarring, pigmentary problems, wrinkles and other unwanted manifestations of photoaging for many decades before lasers came on the scene. Rather than causing premature aging of the skin, they have long been important treatment options for skin aging.

Although quite a number lasers and light treatments have come and gone in the past fifteen years, chemical peels have not only remained an important treatment tool, but have actually been experiencing a kind of renaissance. In experienced hands, they offer reliable and reproducible results. (As an aside, microdermabrasion, which has also been heavily advertised and hyped in recent years,  amounts to little more than just another method to buff and exfoliate the surface of the skin and is of little value in my opinion, particularly in treating acne scarring whose roots lie more deeply in the skin).

Chemical peels are typically divided into three categories: light, medium and deep peels. Light peeling agents include low concentrations (10-25%) TCA, glycolic acid, salicylic acid and Jessner's solution. Light peels are good for skin maintenance, and for fading mild hyperpigmentation and softening very fine wrinkles. Light peels are accompanied by little downtime and make great lunchtime beauty fixes.

Medium peeling agents include TCA 50%, and Jessner's solution or  glycolic acid 70% followed by 35% TCA. Medium peels can help with more stubborn pigmentation and more pronounced photoaging.  They typically are associated with more prolonged healing times and downtimes of seven or more days.

Deep peeling often meant the use of a combination product known as Baker's Phenol. Deep peels were quite useful for more severe wrinkling and skin laxity, but entailed, much like surgery, nearly two weeks of downtime, required strong sedation to perform and possessed signicant risks for the developing permanent loss of skin pigmentation and even scarring.For this reason, despite its efficacy, deep peeling fell in considerable disfavor in the last twenty years.

The "Punctuated Phenol Peel" is the most recent advance in chemical peeling techniques, and one that is sure to put chemical peeling squarely back on the map and in competition with the more expensive, more heavily hyped laser and light-based therapies currently intensively marketed to consumers.

The procedure is simple, requires no sedation, and has little or no downtime. Using 88% plain phenol, fine lines and crinkles are treated in punctuated (i.e. fractionated or pixelated)  fashion. Using a very finely pointed applicator, the chemical is applied in a serial spot fashion with each spot separated from surrounding treatment spots by approximately one-quarter inch. The use of serial spot coverage (i.e. a "fractional" application, rather than coverage of whole areas), allows for rapid recovery as healing takes place from the intervening non-treated areas. It is precisely the same rational as for the use of fractional lasers.

Consultation with and treatment by an esthetic physician experienced with all forms of chemical peels and in the various methods for treating acne scars and skin disolorations  is an absolute must for determining which techniques are best and most cost-effective for your particular needs.

All skin treatments have risks.  Depending on the severity of your acne scars, you may benefit from either a deep chemical peel or ablative laser.  Both have enormous benefits if performed safely and effectively.

Chemical peels and lasers do not cause premature skin aging. On the contrary, they reduce or improve premature aging and sun damage, wrinkles, age spots and discolorations. They remove the damaged skin on the surface and allow the new healthy skin to show through. Usually the more peels you do, the better your skin looks, but you need other prescription creams with the peels to maximize the benefits and minimize the side effects. Sincerely,

David Hansen,MD