Question 1

What is a phenol peel?

Accepted Answer

A phenol acid peel is the most aggressive, deep chemical peel available, penetrating down to the dermis. Also known as a Baker-Gordon peel, this skin resurfacing procedure can be extremely effective at treating signs of severe sun damage, including deep wrinkles, fine lines, uneven skin tone, and discoloration (hyperpigmentation), as well as acne scars, precancerous growths, and other blemishes.

Because the exfoliation is so strong and deep, a phenol peel should be administered only by an experienced, board-certified plastic surgeon or dermatologist. It should be applied to the face alone; the skin on the neck is too delicate.

This type of peel also requires an oral sedative and/or IV anesthesia during the procedure, as well as an anesthetic cream to numb your face.

Related: Which Type of Chemical Peel Is Right for You?

This cosmetic procedure has a lengthy and uncomfortable recovery, but the results can be dramatic and long-lasting.

RealSelf Tip: A more modern take on this treatment is the Hetter peel (or modified phenol peel), which tweaks the classic formula by reducing the concentrations of phenol and croton oil (an exfoliant which increases the depth of the peel). In a 2017 study involving 896 patients who were treated for freckles with a modified phenol peel, over 99% of patients exhibited 51% or greater improvement. The researchers reported no scarring or systemic complications.

Question 2

What are the pros and cons of a phenol peel?

Accepted Answer

Pros

A phenol chemical peel can improve the quality of facial skin in just a single treatment, yielding dramatic results, including a smoothing of deep facial wrinkles and acne scars.
By fully removing the epidermis and upper dermal layers, a phenol peel can prevent your risk of developing skin cancer.
Results can last as long as 10 years.

Cons

Phenol is absorbed through the skin during the treatment and can put stress on your heart, kidneys, and liver. If you have heart problems or other serious medical issues, you’re not a good candidate.
This peel can have a significant bleaching effect in the treated area, so it’s only suitable for people with a Fitzpatrick skin type of I-III—not those with olive, brown, or deep skin tones.
By lightening the face but leaving the neck untouched, the phenol peel can create an obvious line of demarcation between the two areas. The same problem can happen when spot-treating select regions, like around the mouth or eyes.
The recovery period after this deep chemical peel is painful, difficult, and long. You’ll need to take strong pain medication and won’t want to go out in public for at least the first two weeks of the healing process.
Side effects include peeling, flaking, crusting, and discomfort for up to six weeks, and redness for up to three months.
While you may have seen this treatment marketed as a “facelift in a bottle,” a deep phenol chemical peel cannot eliminate jowls or sagging skin.
Sun exposure after the peel can cause extreme burning and skin discoloration, especially within the first year following treatment, so you’ll have to be diligent about sun protection afterwards. You'll also lose the ability to tan on your face.

There’s a risk of scarring and hypo- or hyper-pigmentation from the procedure itself, if your provider is inexperienced or you don’t heal properly.
Infection can occur during the healing process if wound care isn’t meticulous.
Phenol can damage the heart, liver, and kidneys. It can also cause an irregular heartbeat.
Due to the risks, most doctors don’t offer phenol peels, so it may be difficult to find an experienced provider to perform the procedure.
Unlike other resurfacing procedures, a phenol peel cannot be combined with a facelift, due to the risk of compromised healing and skin loss.

Related: Why Phenol Peels Are So Risky—and Which Treatments to Consider Instead

Question 3

How much does a phenol peel cost?

Accepted Answer

Your phenol peel cost will depend on:

your provider’s credentials and level of experience
their practice location
the type of sedation, anesthesia, and numbing you have
the specifics of your procedure

During your initial consultation, request a personalized and detailed cost quote that lists all anticipated fees. It may be worth your time to get price estimates from more than one provider, so you can compare them. Just make sure you’re choosing the most qualified provider, not just the one offering the lowest price.

Question 4

Phenol peel before and after pictures

Accepted Answer

The phenol peel photos in our gallery have been shared by the provider who performed the procedure, with the patient's consent.

Question 5

Who’s a good candidate for a phenol peel?

Accepted Answer

Good candidates for this procedure have:

severe sun damage or scarring
a fair skin tone, with a low risk of hyperpigmentation
no underlying heart problems or other medical issues
the time and tolerance for a lengthy recovery period
the willingness to commit to extensive aftercare instructions
realistic expectations (even this deep peel is no substitute for a facelift)

Phenol peels are not safe for women who are pregnant or nursing, those on Accutane, or anyone with a history of keloids or irregular scarring.

Question 6

How to prepare for a phenol peel

Accepted Answer

It's important to follow your doctor’s pretreatment instructions to the letter, to avoid complications. In addition to avoiding certain active ingredients or medications immediately prior to your treatment, your doctor may prescribe a pretreatment protocol to help manage potential post-inflammatory hyperpigmentation during healing.

This may involve taking oral tranexamic acid (TXA) or using a retinoid or hydroquinone-containing cream in the weeks leading up to your procedure, before eventually discontinuing these products the week before your peel.

You’ll also be advised to avoid the sun and practice vigilant sun protection for several weeks in advance.

Question 7

How does a phenol peel work?

Accepted Answer

Phenol, also known as carbolic acid, removes the outer layers of skin. This skin resurfacing procedure eliminates damaged skin cells, improves acne scarring, and promotes new collagen production.

Here’s what to expect during your appointment.

First, you'll be given a sedative or IV anesthesia as well as a topical anesthetic cream, to fully numb your face and keep you relaxed.
Your vitals will be monitored throughout the procedure.
After thoroughly cleansing your skin, your doctor will apply the phenol solution to your face in a staged fashion, section by section—not to the full face at once—to reduce your risk of systemic toxicity and cardiac injury. This process can take 90 minutes or more.
Even though your face will be numb, you may still feel tingling or burning as the peel removes the epidermis, the skin's top layer.
After the last cycle is complete, your doctor will neutralize the chemical solution with water.
They will cover your face with a petroleum-based ointment and a tape mask that will protect your skin as the new top layer develops. This mask will be removed the following day.
You will be sent home with detailed aftercare instructions.

After your procedure, you’ll be groggy from the anesthesia and/or sedation. Arrange in advance to have someone there to get you home safely.

Question 8

How long is phenol peel recovery?

Accepted Answer

Most people need at least two full weeks of downtime after a phenol peel. Here’s what to expect during the initial healing process and the weeks to come:

Immediately after your treatment, you will look swollen, inflamed, and raw, like you have a severe sunburn.
Your doctor will probably prescribe pain medication, to help mitigate the discomfort and throbbing.
Over your recovery period, your skin will ooze, scab over, and peel, eventually revealing the new skin underneath.
During the first week, you will have to keep your face moist by frequently applying wet gauze pads and an ointment like Vaseline or Aquaphor.
Your skin will be extremely sensitive, and you’ll be given strict skincare instructions—including protecting your skin from the sun every day with a high-SPF sunscreen.
Most people can return to their normal activities about two to four weeks after a phenol peel. If you’re healing well, you’ll be able to start applying mineral-based makeup after two weeks.
The sunburned look should fade after three months. At that point, you’ll start to see your final results: smoother, younger-looking new skin.

Question 9

Are phenol peels dangerous?

Accepted Answer

Phenol peel treatments can be safe when they are administered by an experienced plastic surgeon or dermatologist and for the right candidate.

That said, phenol peel risks include cardiac complications and systemic toxicity, so patients must be carefully monitored throughout the process. One study noted a 6.6% incidence of cardiac arrhythmia during the procedure.

The phenol peel has fallen out of favor in recent years, as more providers and patients opt instead for a series of light and medium-depth skin peels, such as TCA peels or glycolic acid peels. These can often achieve similar results with less risk and a shorter recovery time.

Fractional ablative laser resurfacing treatments can also be a safer alternative with similar benefits.

Question 10

Sources & studies

Accepted Answer

Wambier CG, Lee KC, Soon SL, Sterling JB, Rullan PP, Landau M, Brody HJ; International Peeling Society. Advanced chemical peels: Phenol-croton oil peel. J Am Acad Dermatol. 2019 Aug;81(2):327-336. doi: 10.1016/j.jaad.2018.11.060. Epub 2018 Dec 11. PMID: 30550827.

Sun HF, Lu HS, Sun LQ, Ping WD, Mao DS, Li D. Chemical Peeling with a Modified Phenol Formula for the Treatment of Facial Freckles on Asian Skin. Aesthetic Plast Surg. 2018 Apr;42(2):546-552. doi: 10.1007/s00266-017-1048-z. Epub 2017 Dec 26. PMID: 29279953.

Larson DL, Karmo F, Hetter GP. Phenol-croton oil peel: establishing an animal model for scientific investigation. Aesthet Surg J. 2009 Jan-Feb;29(1):47-53. doi: 10.1016/j.asj.2008.11.008. PMID: 19233006.

Landau M. Cardiac complications in deep chemical peels. Dermatol Surg. 2007 Feb;33(2):190-3; discussion 193. doi: 10.1111/j.1524-4725.2006.33037.x. PMID: 17300604.

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Modified Phenol or Croton Oil / Hetter Peel - Texas

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