Chemical Peel Overview
A chemical peel involves the application of a solution to the entire face or specific areas to remove the skin's top, most damaged layers, allowing newer, healthier skin to emerge. Chemical peels come in a range of strengths, from a deeper phenol peel to more superficial peels like a glycolic acid peel. Several light to medium-depth peels can often achieve similar results to one deeper peel treatment, with less risk and shorter recovery time.
Peel solutions may contain alpha hydroxy acids, tricholoracetic acid (TCA), or phenol. Peel "depth," or the number of skin layers removed, is determined by both solution ingredients and concentration.
Here are several types of chemical peels:
- TCA skin peels use trichloroacetic acid and can be applied to the face, neck, hands, and other exposed body areas. It has less bleaching effect than phenol peels, and is good for "spot" peeling of specific areas. It can be used for deep, medium, or light peeling, depending on the concentration and method of application.
- A phenol peel is a deep chemical peel. Phenol is a full-face treatment used when sun damage or wrinkling is severe. It can also be used to treat limited areas of the face, such as deep wrinkles around the mouth, but it may permanently bleach the skin, leaving a line of demarcation between the treated and untreated areas that must be covered with makeup.
- Lactic acid lotions like Lac-Hydrin can help treat keratosis pilaris, caused by a buildup of keratin, and lighten brown spots at the same time.
- At-home chemical peels are less concentrated than those offered by a medical provider. If you use an at-home peel, there is a risk of applying too strong an acid for your skin type. Some reports on RealSelf of at-home treatments for acne scars, acne, and other facial skin concerns reveal that people can get severely burned and scarred from products.
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Light-to-medium strength peels
Alpha-Hydroxy Acid (AHA) peels: Generally, the most superficial peels are those using AHAs, including glycolic acid. Sometimes, a single treatment with an AHA peel will give your skin a fresher, healthier appearance and a radiant glow. Repeated treatments can help improve your skin's texture, reduce the effects of aging and sun damage. Your treatment provider can also recommend a maintenance program with AHA products that you can regularly apply at home.
An in-office AHA peel requires no anesthesia or sedation. You will only feel a tingling or mild stinging sensation when the AHA peel is applied to your face. Immediately after the treatment, you should be able to wear makeup, and go back to your daily routine.
TCA peel: A TCA peel is often used for the treatment of wrinkles, pigmentary changes, and skin blemishes. Many patients benefit from having TCA applied on the face, neck, and other areas that have been exposed to the sun. For spot peeling of limited areas, including around the mouth or eyes, TCA peels are often preferred because they have less bleaching effect than solutions containing phenol, another popular peeling agent. For that reason, some medical providers have found TCA to be effective in treating darker-skinned patients.
Milder TCA peels can be frequently repeated to achieve cumulative effects, or TCA can be used to achieve a medium or even a deep peel, depending on the acid concentration and manner of application.
Deep (phenol) peel
A phenol, also known as carbolic acid, peel is sometimes recommended for treating particularly rough and/or sun-damaged facial skin. Phenol is effective in reducing the appearance of wrinkles ranging from fine lines to deeper creases. It can correct pigmentary problems, including blotchiness or age-related brown spots, and may be used to treat precancerous skin conditions.
Phenol is particularly helpful in minimizing the vertical lines that form around the mouth due to aging. The disadvantage of phenol for spot peeling of limited areas is that it often has a bleaching effect. After being treated with phenol, you may need to wear makeup to help the treated area blend into the surrounding skin. Unlike TCA peels, phenol cannot be used on your neck or areas. Variations in a phenol peel formula, creating a "buffered" or milder solution, may allow for greater flexibility in its use.
"Buffered phenol" offers yet another option for severely sun-damaged skin. One such formula uses olive oil, among other ingredients, to diminish the strength of the phenol solution. Another slightly milder formula uses glycerin. Buffered phenol peels may be more comfortable for patients, and the skin heals faster than with a standard phenol peel.
For light-to-medium skin peels (TCA and AHAs), your medical provider will select the best chemical or chemical mix for your skin. The solution is then applied with a sponge, cotton pad, cotton swab, or brush, avoiding the eyes, brows and lips. Various concentrations of an AHA may be applied weekly or at longer intervals to obtain the best result. A TCA peel is stronger and has a greater depth compared to AHAs.
A full-face deep chemical peel takes one to two hours, with more limited procedures, like treating the wrinkles above the lip, will generally take less than a half-hour. A solution is applied to the area being treated, avoiding the eyes, brows, and lips. There is a slight burning sensation, but it should be minimal since the solution also acts as an anesthetic.
After the peel solution has worked on the skin, it is neutralized with water. Approximately an hour later, a thick coating of petroleum jelly is layered over the patient's face, covering the protective crust which rapidly develops over the area. This stays in place for one to two days. In an alternative technique, the patient's face is covered by a "mask," or strips of adhesive tape, with openings for the eyes and mouth, which is particularly effective in cases of severe wrinkling.
Chemical peels can treat the following skin conditions:
- Wrinkled or sun-damaged facial skin
- Vertical wrinkles around the mouth, including those that cause lipstick "bleed"
- Crow's feet lines around your eyes, and perhaps some skin laxity in your lower eyelid area
- Fine wrinkling of your upper eyelids
- Brown spots or blotchy skin coloring
- Some precancerous skin growths
- Acne or chicken pox scars
- Superficial facial scars from a past injury
Certain other characteristics of your skin, such as its thickness and texture, may influence whether you are a good candidate for chemical peel. Always consult with a reputable medical provider to determine which peel is best for you.
Find medical providers near you for a chemical skin peel consultation.
Your skin care consultation with a trusted medical provider is the time to ask questions. During a consultation, your provider should evaluate the condition of your skin, discuss your treatment expectations, and review your medical history.
Your medical provider will carefully examine your skin to determine which resurfacing technique, or combination of treatments, will provide the best results. Your skin type, the severity of sun damage, uneven pigmentation, and depth of skin imperfections will be evaluated. Fine lines, coarse wrinkling, or deep acne scarring each may require a different approach to treatment.
You should also come to the consultation prepared to discuss your overall medical history. This will include information about any conditions, drug allergies, treatments you have received, previous surgeries, and medications you currently take. Be sure to share if you have ever had X-ray treatments of your facial skin, or if you have had a chemical peel before. Current or past use of prescription skin treatments, including Accutane, Retin-A or other topicals, must be reported. For your safety, it is important that you provide a complete medical history.
Your provider may place you on a pretreatment program for a few weeks or longer, which may include applying special creams, lotions, or gels. You may also be given oral medicine that you should begin taking prior to your treatment.
The chemical peel may be performed in your medical provider's office, a free-standing ambulatory facility, or a hospital. You should arrange for someone to drive you home after the procedure and probably assist you for a day or two. Arrange to take a few days off if necessary.
Medications may be administered prior to the treatment for your comfort. Frequently, local anesthesia alone or combined with intravenous sedation is used for patients undergoing skin-resurfacing procedures. Sometimes, general anesthesia may be desired.
Immediately after the chemical peel, your resurfaced skin may be covered with petroleum jelly or other protective ointment. In some cases, dressings, tape, or a bandage may be applied.
Some patients experience discomfort after a deep chemical peel, but this can be controlled with medication. A few days later, new skin with a bright pink color akin to sunburn will emerge. This pinkness will fade within a few days. Post-op puffiness will also subside in a few days, but your skin will remain sensitive. Patients should avoid exposure to sunlight and continue to use sun block.
The time it takes to recover varies greatly among individuals. For the first few days, your skin will exhibit redness and swelling to varying degrees. Depending on the post-treatment regime suggested by your medical provider, a scab may or may not form over the treated area. You will be advised about cleansing your skin, and if and when you should apply ointments. For men, shaving must be delayed for a bit. It's essential to follow your provider's recovery plan.
Within seven to 10 days, new skin will emerge. After the initial redness subsides, your skin may be pink for several weeks to months. Makeup can usually be applied within a couple of weeks.
Depending on the type and depth of your skin resurfacing, straining, bending, and lifting should be avoided shortly after your procedure. For deeper resurfacing, you should be able to return to work in a week or two.
What to expect from a chemical peel
It may take months before you can fully see the results from a chemical peel. Most patients feel that it is definitely worth waiting for, and in the case of deeper treatments, the benefits tend to last a long time. More superficial resurfacing treatments may be needed to retain your results over time.
Of course, your skin will continue to age, and the wrinkles caused by movement of your facial muscles will eventually reappear. Some wrinkles may reappear sooner than others, depending on location and the type and extent of your chemical peel. Despite this, improvements from resurfacing treatments should improve your skin's tone and texture, resulting in younger, fresher-looking skin.
Chemical peels are generally safe, however, any risks or side effects should be discussed by your medical provider prior to treatment.
Side effects may include:
- Abnormal healing
- Allergic reactions
- If prone to herpes, possible eruption
- Raised or thickened scarring
- Unanticipated skin color changes or skin blotchiness
Following all resurfacing treatments, it is important to avoid sun exposure until all skin redness or pinkness has subsided. Protect your skin with regular use of sunblock, and even a wide-brimmed hat. If the area around your eyes has been treated, wear sunglasses with full UVA/UVB protection. After some types of skin resurfacing treatments, you may need to be careful about exposing your skin to chlorinated water.
Additional notes for deeper peels:
- Possible complications can include scarring, infection, or abnormal pigmentation. These tend to bleach, and you may need to wear makeup to match treated and untreated areas.
- EKG monitoring is advised.
- Cannot be used on the neck or other parts of the body.
- Not as effective in treating individuals with dark, oily complexions.
- Some facial skin disorders do not respond to chemical peeling.
- Skin pores may appear larger, and the skin may not tan properly.
- Can activate latent cold sore infections.
- All forms of deep skin peels include the risk of delayed healing and scarring.
Minimize risks and avoid problems by following your medical provider's recovery instructions.
Chemical peel costs vary widely as reflected in our cost data. Cost can be affected by your medical provider's level of experience, type of chemical peel applied, and geographic location.
Costs may also include a facility fee, anesthesia fee, medications, surgical garments, and medical tests, among other items. Please ask your provider for a full breakdown of costs prior to your procedure.
Skin resurfacing procedures are not usually covered by insurance. Occasionally, however, if the resurfacing is being performed to treat precancerous skin conditions or improve certain types of scars, insurance coverage may apply. Your provider should explain how to check with your insurance company to see if a procedure will be covered.
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