Most Aggressive of All Peels?

Phenol peels are the most aggressive and problematic. Very few docs use them any more. A few 35% TCA chemical peels will give great results without the side effects of the phenol peel. The phenol peel depigmented the skin in many patients so they had a sharp demarcation where the peel ended and they also scarred the skin in some patients more so than any other chemical peel does. Without knowing what your severe condition is then it is hard to advise what the best treatment or combination treatments would be.
Good Luck,
David Hansen,MD

The deepest peel in our arsenal is the TCA Peel. It can only be performed by physicians as it contains powerful but effective trichloroacetic acid to deliver intense treatment and results.• Frequency: Once every 5+ years• Downtime: Up to 2 weeks

The most aggressive of all peels is the phenol peel. The old Baker-Gordon formulation of phenol, however, is no longer used because of some major, unacceptable risks including cardiac arrhythmias and death. Modifications of the Baker-Gordon formulation are available that have dramatically improved the safety of phenol peels.
A 35% TCA peel would be somewhat comparable to a deeper phenol peel, but that is about the highest strength of TCA I would use on anyone. Higher concentrations of TCA carry an unacceptably high risk of side effects including scarring.
Alternatively, CO2 laser is an aggressive skin resurfacing procedure that carries similar risks to the aggressive chemical peels.
I would speak to your dermatologist extensively regarding the indications, risks, potential side effects, down-time, after-care and other aspects of such aggressive cosmetic procedures. Perhaps your severe condition can be addressed by a less aggressive procedure.
Good luck.

Phenol peels are the most aggressive but cause permanent skin lightening, and so they can only be used on very light complexions.
Next is TCA (trichloroacetic acid) at 35-50%. Layering less aggressive peeling agents like Jessner or Glycolic 70% with 25 % TCA is another option.
15-30% Glycolic, 10-15% TCA, 5-10% LHA and 20-30% Salicylic acid are the typical "lunchtime peel" agents.

Phenol peels and aggressive deep CO2 laser resurfacing cause the deepest injury of any peels.
Aggressive peels lead to deep skin injury.
Deep injury causes prolonged healing, hypopigmentation and often scarring.
They are not used by most doctors today because of the risks.
In fact, new fractional non-ablative 1540 Erbium laser resurfacing goes very deep with little risk and is more effective for deep acne scars.
Combined non-ablative 1540 Erbium and ablative 2940 Erbium are excellent for tretament of deep wrinkles with virtually no risk of hypopigmentation and require only a week of recovery.