Chemical Peel for Face: Tips for Choosing the Right One

Chemical peels are an extremely effective way in which to not only achieve healthy skin but also maintain it. To choose the most appropriate peeling agent, several factors should be considered, including degree of damage, allowable downtime, and budget. Taking all of these factors into consideration, we can design a program for you that will meet your goals and leave you with healthy, youthful looking skin for years to come.

For clients with minimal sun damage and/or fine lines and wrinkles, a light glycolic, mandelic, or AHA peel would be appropriate.
If a patient presents with more pronounced facial aging and wants the quickest results, we will lean more towards a TCA peel.
Although phenol peels are an excellent way in which to address facial aging, they have historically been associated with an overall lightening of the skin and so their popularity has waned in the last ten years.

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. Scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic scars and indented scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture. Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your scarring.

Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best,
Dr. Karamanoukian
Realself100 Surgeon

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, pigmentary problems, wrinkles and other unwanted manifestations of photoaging for many decades before lasers came on the scene.

Although quite a number lasers and light treatments have come and gone in the past fifteen years, chemical peels have not only remained an important treatment tool, but have actually been experiencing a kind of renaissance. In experienced hands, they offer reliable and reproducible results.

Chemical peels are typically divided into three categories: light, medium and deep peels. Light peeling agents include low concentrations (10-25%) TCA, glycolic acid, salicylic acid and Jessner's solution. Light peels are good for skin maintenance, and for fading mild hyperpigmentation and softening very fine wrinkles. Light peels are accompanied by little downtime and make great lunchtime beauty fixes.

Medium peeling agents include TCA 50%, and Jessner's solution or  glycolic acid 70% followed by 35% TCA. Medium peels can help with more stubborn pigmentation and more pronounced photoaging.  They typically are associated with more prolonged healing times and downtimes of seven or more days.

Deep peeling often meant the use of a combination product known as Baker's Phenol. Deep peels were quite useful for more severe wrinkling and skin laxity, but entailed, much like surgery, nearly two weeks of downtime, required strong sedation to perform and possessed signicant risks for the developing permanent loss of skin pigmentation and even scarring. For this reason, despite its efficacy, deep peeling fell in considerable disfavor in the last twenty years.

The most recent advance in chemical peeling technique has been called the "Punctuated Phenol Peel." This novel approach to peeling 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 actually simple, requires no sedation, and has little or no downtime. Using 88% plain phenol, fine lines and crinkles are treated in punctuated (i.e. fractionated or pixelated)  fashion. Employing a very finely pointed applicator, the chemical is applied in a serial spot fashion with each site separated from surrounding treatment areas by approximately one-quarter inch. The use of serial spot coverage, rather than coverage of whole areas, the more traditional approach to peeling, allows for rapid recovery as healing takes place from the intervening non-treated areas. It is precisely the same rational as 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. Wrinkle lines and crepeyness can be traced in this punctuated fashion, and treatment sessions can be repeated at monthly intervals if necessary until the desired result is obtained. When appropriate, hyperpigmentation and acne scarred areas may likewise be treated in a punctuated fashion.

The choice of peeling solution, depth of peel and technique of application should be made by a cosmetic physician experienced in the use of all available modalities.  Consultation is an absolute must for ensuring that the correct approach is pursued to achieve the most gratifying results.