When you think about risky cosmetic procedures, you probably don’t put chemical peels on the list. And that would make sense, given they’re often performed by aestheticians and downtime is generally said to be just a few days of redness and peeling. But that’s not the case for all chemical peels. Their potency, efficacy, and risk level varies greatly, and there are none that are more intense—or potentially problematic—than phenol peels. Take a quick scroll through TikTok, and you’ll see what we mean; videos of the phenol peel aftermath are the stuff of horror movies. But what, in particular, makes these peels so risky, and are there any alternatives that aren’t quite so scary? Here’s what you need to know.
What is a phenol peel?
First of all, it’s nothing new, despite how popular it’s become on social media. “Phenol peels have been used since the 1800s but really came into fashion 50 years ago, before we had the armamentarium of lasers that’s available now,” explains Dr. Cameron Chesnut, a board-certified dermatologist in Spokane, Washington. In a phenol peel, phenol, also known as carbolic acid, is often combined with croton oil, resulting in a peel that penetrates deeper into the skin than any of its counterparts. Chemical peels are graded according to depth, on a scale ranging from superficial to deep, notes Dr. Monica Kiripolsky, a board-certified dermatologist in Beverly Hills, California. For context, the majority of peels performed by aestheticians are superficial, whereas those performed in a doctor’s office are medium. A phenol peel is deep—the deepest there is, as mentioned—penetrating all the way to the reticular dermis, the bottom layer of the dermis, she explains. It’s this depth of penetration that makes phenol peels so effective—and dangerous.
What do phenol peels do?
“Because they penetrate so deeply into the dermis, they’re especially effective for treating any kind of scarring—acne scarring, in particular,” Dr. Chesnut says. Dr. Kiripolsky adds that they also tighten the skin nicely and are often used around the eyes to treat dark circles. This is because of the skin-lightening effect of the peel, but more on that in a moment.
@doctoryoun #duet with @João Castro Phenol peel to treat pitted acne scarring! #acnetreatment #acnescars #acnescartreatment #acnescar #phenolpeel #phenol ♬ som original – Adriana senra
What are the risks of phenol peels?
There are quite a few. For starters, the downtime is lengthy and intense. According to Dr. Kiripolsky, you’re looking at anywhere from 9 to 12 days of serious redness, swelling, and open sores that require diligent care. Phenol peels also lighten the skin; they cause such major damage that they destroy the pigment-producing cells. (To that point, full-face phenol peels are typically not recommended for skin types darker than a Fitzpatrick III.) But before that happens, there’s a more immediate and acute onset of postinflammatory hyperpigmentation, during which the skin looks darker for potentially up to six months, says Dr. Kiripolsky.
Skin appearance aside, phenol peels are also notorious for their systemic side effects, particularly on the heart. Again, credit the depth of penetration. The phenol penetrates all the way into the vascular system, where it can damage the myocardium, Dr. Chesnut notes. This can result in cardiac arrhythmias; in one study, 39% of phenol peel patients developed some form of cardiac arrhythmia. Anytime phenol is being used on a large surface area, cardiac monitoring is required, he explains. And the systemic damage isn’t specific to the heart; there’s also the potential that it could damage other vital organs, such as the kidneys, Dr. Chesnut adds. Not to mention that a full-face phenol peel is so painful that it has to be performed under IV sedation or even general anesthesia.
@dermguru #duet with @João Castro #peelingdefenolprofundo #scarringacne #phenolpeel #chemicalpeel #dermguru #dermreacts ♬ som original – Adriana senra
What are the best alternatives to a phenol peel?
It is worth noting that, despite how it may appear on TikTok, full-face phenol peels are not particularly popular. “It’s rare that anyone in the field of facial aesthetics is using phenol to treat an entire face, although there is a group of ‘unicorns’ who still love and use them all the time,” says Dr. Chesnut. “But based on the risk and safety profile, those types of doctors really are few and far between.”
What’s much more common is using phenol in a notably more targeted way. For example, Dr. Chesnut says he uses it as a very specific spot treatment for certain acne scars, using a microdroplet of phenol that’s inserted only into the particular scar in question with the tip of a 32-gauge needle. Dr. Kiripolsky adds that phenol peels are typically used only around the eyes—the skin-lightening effects make it a good option for treating dark circles—and around the mouth for skin tightening. Using the ingredient in this type of very limited application mitigates the risks of cardiac implications as well as the need for cardiac monitoring and sedation, she says.
For those who want to steer clear of phenol entirely, both derms we spoke with sing the praises of ablative CO2 lasers. The boon here (aside from the fact that they won’t affect your heart) is how customizable they are. “Phenol peels can’t be adjusted in strength, whereas lasers can be customized and controlled, to treat the skin at different depths in different areas. They’re more programmable and predictable and have a better safety profile,” Dr. Chestnut says. As far as peels go, TCA peels tend to offer more medium-depth penetration, though they can also be very effective, says Dr. Kiripolsky. She also notes that for those who want an even deeper treatment, a TCA peel can be performed immediately following a resurfacing laser. (However, this comes with its own set of risks for scarring and hyperpigmentation and should absolutely be performed only by those who are well trained in that technique.) Still, both doctors are quick to note that while opting for these alternatives alleviates the health and safety risks associated with phenol peels, you shouldn’t expect the downtime to be significantly less. You may not be channeling the Freddy Krueger vibes of the phenol peel aficionados on TikTok, but there is a direct correlation between the efficacy of the treatment and the results, Dr. Chestnut notes. In other words, you’re still looking at up to two weeks of redness, swelling and the like as your skin heals and before you see any significant improvement.
