Chemical Peel Recommendation for Fair Skin with Severe Sun Damage and Wrinkles?

What type of chemical peel would you recommend for someone with very fair skin, severe sun damage, wrinkles on top of lips and crow's feet? What concentration would you recommend and are there any risks? Does chemical peel thin the skin? I am 40 years old and I notice on each side of my cheekbone that I have light purple veins running vertical down my face. I have been using renova A. Thank you.

Doctor Answers 7

Consider Fraxel for wrinkles and sun damage

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Chemical peels normally don’t improve wrinkles and a deep chemical peel would be out of the question at your age. It is rarely done these days. Chemical peels certainly don’t help the lines that are produced by muscle movement such as the upper lip lines and crow’s feet. Fraxel Re:store might be a more effective treatment for you. Chemical peels might lighten some sunspots (brown flat areas) but it won’t help the texture unless you have a medium-depth chemical peel, which induces a one week period of down-time with significant post operative care. Fraxel can improve texture, fine lines and brown spots with minimal down time.

Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

You might do better with a Fractional CO2 Laser treatment

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It depends on the doctor's office that you go to, what technology they have available to them, and what procedures they are comfortable with. Sounds like you are a perfect candidate for a combined Active/ Deep FX treatment. It is not a peel, but a fractional CO2 laser resurfacing treatment. It will probably give you less downtime and better results than an average chemical peel, but it will likely be more expensive. Some offices don't have this laser, and they might want to do a chemical peel, usually a medium depth TCA peel, or perhaps use a similar laser.

The veins might not improve with either of these treatment as well, but sun damage, eye and lip wrinkles will likely get much better. Any procedure comes with risks. In general, the more damage you have, the more intensive of a procedure you will need, with perhaps higher risks.

The risks are minimal in the hands of an experienced provider. Your doctor should discuss your options at the consultation, and go through risks and benefits of each procedure.

Stella Desyatnikova, MD
Seattle Facial Plastic Surgeon

You have several peel options

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The two main types of chemical peels are TCA or phenol/croton oil. Each can very in concentration depending on which area of the face is being treated. I prefer phenol/croton oil peels for treatment of lines/wrinkles/hyperpigmentation of the face, as this peel treats the isues beautifully and definitively. TCA may improve the situation somewhat, but likely will need to be repeated at some point.

Regardless of method, you will absolutely need to receive a full skin evaluation prior to undergoing resurfacing, and in my practice we require that you are using Retin-A as well as a hydroquinone 4% for at least 6 weeks prior to peeling to insure a good result. I have skin care specialists who evaluate your skin and map out a plan with you for pre and post peel skin care.

The resurfacing peel may or may not take care of the spider veinds. these may require the use of a special laser or sclerotherapy.

Good luck!

Brian S. Glatt, MD, FACS
Morristown Plastic Surgeon
5.0 out of 5 stars 59 reviews

A mild Glycolic Peel may be what you need

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A mild Glycolic Peel (70%) may be what you need. The Glycolic peels are much more gentle on your skin than TCA or Phenol. You may need several treatments, but it will have a nice effect. For the crow's feet, I would suggest a touch of Botox as well as the peel for the maximum effect. The Botox will help relieve the stress on the skin from constant movement and will allow the underlying dermis to heal. Also, keep using the Renova A.

Good Luck.

There is no way to answer this question without a personal consultation

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Chemical peels are fantastic in the right hands.

I have a CO2 and an erbium laser in my office but I love the results I can obtain with an appropriate chemical peel. It is important to recognize that doing a chemical peel is a flat out art form that is very difficult to teach to another doctor. No one learns how to do a chemical peel in their plastic surgery residency. It literally requires performing hundreds of chemical peels and this experience is best acquired in a cosmetic surgery fellowship.

There are many different choices in peeling agents. However several lighter peels do not equal the effects of one deeper peel. There is no free lunch in chemical peeling or laser resurfacing. The deeper the peel that is needed, the more downtime, recover, and increased risk of complications if healing is not closely monitored.

Regarding specific agents, 35% trichloroacetic acid is good for firming the face and improving sun damage without affecting natural pigmentation. Stronger agents like phenol and Baker's phenol are needed on deeper lines. However, these stronger agents are more often associated with loss of pigmentation. The key is to only use these agents when absolutely necessary and do proper blending to avoid demarcation lines. A peel should be like painting an oil painting. The agents need to be applied considering all of these factors including skin thickness, degree of damage, how much hypopigmentation is acceptable, etc.

What you need can only be determined by a personal consultation with a master chemical peeler. Look for someone who is conservative. If the doctors boasts that he or she only does a taped Baker Phenol peel, do yourself a favor and go elsewhere. Very few people need such an intense result. Less is more.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Chemical peels for sun damage and wrinkles

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A medium-depth peel, for example 20-30% TCA would give you the best results as far as peels are concerned. Alternatively, fractionated CO2 lasers such as Active FX or Fraxel re:pair are good as well. As far as the purple veins on the face, you would need to find an office with a vascular laser such as the Pulsed-dye or Nd:Yag laser. I would seek an experienced physician - dermatologist or plastic surgeon who can walk you through all phases of procedure, recovery and potential complications.

Good luck.

Bryan K. Chen, MD
San Diego Dermatologist

I would consider a laser option

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Hi there- I prefer the precision of lasers over chemical peels for anything as deep as what you will need to achieve meaningful improvement. Consider any one of the excellent fractionated CO2 laser available, such as the Mixto, the DOT, or the Active FX. In my opinion, the risk to benefit ratio is much more favorable, and you are more likely to get what you wanted after a single treatment.

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.