Best Chemical Peel for Sun Damage

Question

I'm concerned about how to get rid of sun damage and dark brown spots on my face.  I'm 37, caucasian and have medium skin pigment and tone.
Can you please advise which chemical peel (if any) would work best for these issues? What concentration is necessary for the chemical peel to be effective?

Gregory Turowski, MD, PhD, FACS · Answer

A proper skin analysis will help determine the best course of treatment. Based on your description, a TCA peel or a series of TCA peels should significantly reduce sun damage and brown spots. The Vi Peel is a TCA based medium depth peel which has proven to be very successful in sun damage reduction. You may want to consider and IPL laser treatment(s) as well.

Janet Allenby, DO · Answer

Hello,

Thank you for your question. There are several peels that may help. One that is wonderful for pigmentation problems is the newest Skinceuticals peel. It is often called a photo-facial in a bottle. This is a very strong peel, most of your brown spots will get darker and then peel or fade off. There is also the Skin Medica peels, the vitalize is right in the middle. If you are looking for something more mild, this is a good introduction into peels. Ultimately it is very important to consult with a local physician before you do anything. You want to make sure that you are achieving the right goals, and not putting yourself at unnecessary risk.

Rod J. Rohrich, MD · Answer

The optimal chemical peel depends on the
type of skin damage you have and the pigment in your skin. Generally, a
moderate strength TCA peel enhances your skin turnover and allows you then to
get on medical grade skin care including Retinol or Retin-A.

Larry S. Nichter, MD, MS, FACS · Answer

In addtion to preventative measures - sunscreen, hydroquinone and Retinoids topically, a TCA peels can be used effectively to rejuvenate the sun damage facial skin.. It is important to pre-treat with some prescription creams first. This is to prevent brown spots following a TCA or any other peel, laser or deep dermabrasion procedure. This is called post inflammatory hyperpigmentation. The inflammation part is a normal part of the healing process but unfortunately you are sensitive to the sun which is what causes it. Ideally your doctor would have pre-treated your skin some weeks before your treatment with Retin A, 4% hydroquinone, and a strong SPF sunscreen and/or other agents to prevent this from happening. As soon as you are given permission you would again start these products plus perhaps Kogic acid and use them for some time. Once they are established it is more difficult to get rid of. The same treatment can be done again but this time use products recommended by your doctor before and after. If these were not suggested you might want to seek another plastic surgeon or dermatologist to treat you. We personally like the Obagi Blue peel due to its safety and predictably great results

Raffy Karamanoukian, MD, FACS · Answer

Assessment of patients preoperatively is crucial to the success of a chemical peel. Although a clinical examination is necessary for individualized recommendations, Caucasian patients with melasma and sun damage are candidates for a medium depth TCA peel.  A good alternative is once monthly Melapeels that we perform in our office. These peels have minimal downtime and are excellent for sun damage. 
	I routinely perform chemical peels in my office and have found them to be effective with a high safety profile. Preoperatively, I instruct patients to utilize a specific and accelerated skin protocol to ensure that the risks of the chemical peels are minimiized.
	I often ask my patients to begin the Melarase program after the TCA peels to maintain results and improve the skin. Surgery90210

David Shafer, MD, FACS · Answer

Bojana,
To help improve your skin, it is best to start with prevention with SPF sun block and moisturizers for your skin.  The next step is to start with good skin hygiene and a maintenance program.  This could include Retin-A and possibly Hydroquinone.  The next step would be intervention with chemical peels or laser.  However, your plan has to be individualized to your skin, so it is hard to give specifics without examining you.
I hope this is helpful.
David Shafer, MD

David Hansen, MD · Answer

For the average 37 yr old caucasian with medium complexion and  with sun spots and sun damage, I recommend 1 or 2 chemical peels of the combination Jessner's solution plus 35% TCA given at 2-4 week intervals.   The cost is roughly $1000-1,500 each and does wonders for the skin although you do look bad for about a week or so.  Some patients prefer no down time and therefore will do 5-6 lighter Jessner's solution plus 10% TCA peels at 2 week intervals at a cost of roughly $350 each.  Good after-care is very important with use of a steroid lotion such as desowen lotion twice a day for 2 weeks and a combination bleaching cream with retin A after 1-2 weeks at night and SPF sunscreen in the morning.
Once you get your skin looking great then don't forget to do a light one every 6 months as a refresher to keep your skin looking refreshed.
Sincerely,
David Hansen,MD

Michele S. Green, MD · Answer

An in office consultation is the best way to assess which strength of chemical peel would be best for your skin.  Without a photo, from the description, it sounds like TCA peels would be best. I generally use a combination of topical bleaching agents, serums, and Retinols.  Please consult a cosmetic dermatologist with expertise with chemical peels and sun damage.

Dina D. Strachan, MD · Answer

You have many choices as how to address your sun damage especially given your lighter skin type. An evaluation would be necessary to determine which is best. You also would have to consider how much downtime you would be willing to tolerate. Having worked in both California and New York, I am aware that people tolerate more downtime on the West coast and that TCA peels are more popular. In New York, I would probably treat someone like you with a series of Jessner's peels which are great for sun damage but have less downtime per treatment. There are many choice other than chemical peels including lasers, IPL and products. Get evaluated by a dermatologist or plastic surgeon. Wear sunscreen daily and good luck!

John P. Di Saia, MD · Answer

Hello,
The pigment change you describe would probably be ideal for a TCA peel although lighter peels may also lighten it somewhat. Depending upon your skin type and preferences in length of recovery and desire for (or against) anesthesia, TCA would probably be your best bet.

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