I know glycolic acid peels are superficial, but a variety of doctors have advised that after ~6 you can see a reasonable decrease in acne scarring. I am curious what the consensus is with respect to healing/peel duration. I have heard everything from "wait 1-3 months between peels" all the way to "a low % peel done once a week for 6 weeks gives the best results." I've even seen peer reviewed publications saying daily use of low % glycolic acid improved stretch marks after 6 weeks. Advise?
What is Optimal Time Between Chemical Peels for Acne Scarring?
Doctor Answers 6
Glycolic acid peels are superficial, can be done often, but do little for acne scarring
Because glycolic acid peels only work on the outer layer of skin, they are more effective at exfoliation, reducing pigmentation & temporarily improving appearance of pores than at actually making a difference with acne scarring. They can be done as often as every one to two weeks, if low enough concentration, but glycolic acid peels don't stimulate collagen remodeling because they don't reach the dermis where the scar tissue is. We use either stronger peels or fractionated lasers to more effectively treat acne scarring, keeping in mind the patient's skin type. Consultation with an experienced cosmetic dermatologist is logical.
Glycolic acid peels generally not strong enough for acne scarring
A series of weekly, bi weekly, or even monthly glycolic acid peel can help treat acne, hyperpigmenation from acne or fine lines but these peels do little for atrophic (depressed) acne scars. Consider modified Jessner's peels, TCA peels or laser treatment for true acne scarring. These generally require a 2-4 week interval or longer if the peel is deeper.
Chemical peels treat superficial skin discoloration and fine lines but cannot treat deep acne scars
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The Punctuated Phenol Peel Is An Effective Approach For Acne Scars
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 for many decades before lasers came on the scene. Since acne scars tend to be deeper within the dermis, superficial chemical peels, even when performed in a series, tend to produce little benefit in my experience. Deeper peels, on the other hand, such as those employing TCA in concentrations of 50% or higher or the Baker's Phenol Peel, while offering more dramatic results, entail a risk of scarring, irreversible loss of pigmentation or permanent hyperpigmenation. For this reason, despite its efficacy, deep peeling fell in considerable disfavor in the last twenty years.
If a deeper peel is needed, such as for acne scars, I prefer to perform the "Punctuated Phenol Peel"--a very recent advance in chemical peeling technique, 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, the scars 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, 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 for the use of fractional lasers.
The "Punctuated Phenol Peel" technique is a novel approach to rejuvenation that limits the overall potential for toxicity and downtime of traditional deep peels while constituting focal spots of more intense peeling. Treatment sessions can be repeated at monthly intervals if necessary until the desired result is obtained.
(As a sidebar, I have found the CROSS technique, which utilizes 100% TCA, to be an effective approach for improving pit scars. In this technique, the highly concentrated acid is placed deeply within the pit with a fine needle or very sharp end of a toothpick. The irritation that results ultimately leads to permanent sealing of the pit and improves its appearance. One treatment is often enough.)
Consultation with and treatment by an aesthetic physician experienced in chemical peeling is an absolute must for determining the appropriateness of these approaches for any particular situation.
Chemical peels acne scars dermabrasion
I prefer dermabrasion under sedation as the best and most effective treatment for acne scar. No laser nor chemical peel could match its results for the scarring. I have been performing this procedures for years. The right chemical peel is excellent for controlling acne and hyperpigmentation under the hands of an experienced dermatologist familiar and experienced with the wide variety of chemicals available for peeling and their indications.
Superficial chemical peels for acne scarring
Glycolic acid peels are intraepidermal peels and are therefore superficial. Most acne scarring is dermal in nature and I would not expect even a series of chemical peels to give you much of a result if you are dealing with deep dermal acne scarring.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.