Miracle path to a perfect complexion or a sure-fire way to destroy your skin? Read on!

Not unlike a snake sheds its skin, chemical peels are touted on social media as a one-stop ticket to younger, better, brighter skin. Is it the real deal or an over-hyped promise? Read on for my takes. Image by Racool_studio for Freepik.

 

I’m sure you’ve seen the online viral videos of people peeling their faces akin to snakes shedding their skin. 

 

One of the sticking factors of these videos – beyond the fact that people seem to love watching anything related to popping and peeling (Dr. Pimple Popper anyone?) – is that the skin revealed underneath does appear to be ‘nicer’. Pigmentation appears reduced, wrinkles are less noticeable, and acne scars are seemingly erased or, at the very least, blurred. 

 

The before and afters make for convincing advertising, especially if you have a skin issue that’s been difficult to treat. But do chemical peels really deliver? Or is this another example of over-promising and under delivering after your budget has been dented.

 

For the right candidates, a chemical peel is a great, inexpensive option. 

Curious about this in office treatment? The good news is that the right chemical peel can be an impactful tool in your doctor’s repertoire, but the strength (depth) that you choose matters! Image by Kroshka_Nastya for Freepik  

 

If you’re wondering whether a chemical peel is better than a laser, then you’re asking the wrong question. You’re better off asking yourself what your skin goals are and what it is you’re trying to treat. 

 

The goal of any chemical peel is to remove (or exfoliate) the outer layers of skin, namely the epidermis and dermis, to reveal a healthier, ‘glowier’, brighter complexion. Both sun damage and the natural aging process can affect skin cells turnover, a process that tends to slow down as we age leading to deep wrinkles and dull ‘grey’ or ‘sallow’ complexions. A chemical peel kicks this turnover process into high gear, forcing the body into repair mode and (hopefully!) triggering the production of more collagen. 

 

Pigmentation caused by sun damage can also see improvement from deeper exfoliation, and chemical peels can help manage redness and inflammation, making them an option for treating acne and rosacea. 

 

Which depth is right for you? Your skin, risk tolerance, and comfort will dictate what procedure is most appropriate.  Below I go over the three main depths of chemical peels, their risks, drawbacks, and best uses. 

 

Mild Peels

Milder peels comprising of alpha hydroxy acids (like those found in citrus fruits) can be a good starting point to see if chemical peels deliver the kind of results you’re seeking. Even mild peels should be performed by a professional.  Image by Freepik

 

Not to be confused with at home exfoliants, mild peels are performed in office and penetrate the upper most layer of your skin, the epidermis. Typically, they’re composed of stronger formulations of familiar ingredients: alpha hydroxy acids (glycolic, lactic, mandelic, pyruvic) and beta hydroxy acids (salicylic acid). 

 

Application: 

• A solution of the chosen acid is applied to skin by a technician who watches for reddening (erythema) and patches of ‘white frosting’ (not desired in mild peels).
• An alkaline agent is applied to stop the reaction and the skin is gently cleansed. 
• It takes 5-10 days for skin reepithelialization to complete.
• Skin is fragile for 1-2 weeks. 

What are mild peels good for? Particularly beneficial for post inflammatory acne marks and evening out mild pigmentation/sun damage/texture irregularities. Will not address deep wrinkles or acne scars.

 

Moderate Peels

Moderate chemical peels use higher concentrations of glycolic glycolic acid (> 70% plus Jessner's solution) and trichloroacetic acid (TCA) and are designed to penetrate past the epidermis and into the upper layer of the dermis (the papillary dermis). 

  

Mild chemical peels target the epidermis, moderate peels target the upper layer of the dermis (the papillary dermis), and deep peels target the lower dermis (reticular dermis). Both moderate and deep peels lead to ‘frosting’ (keratocoagulation) of the skin – caused by a separation of the dermis from the epidermis. Image by brgfx for Freepik 

 

Controlled keratocoagulation refers to the denaturing of proteins in the skin that hold the two layers (epidermis and upper dermis) together. The visible result is a white frosting, separation of the epidermis from the dermis, and deeper, regenerative changes. 

 

Application is similar to a superficial peel with a few noted differences. 

• A pretreatment solution is often used to better control the depth and more uniformly treat the skin. Jessner’s Solution (Resorcinol, salicylic acid, lactic acid in ethanol), dry ice (CO2), or CO2 + acetone are all frequently used.  
• After pretreatment, a solution of TCA or glycolic acid is applied by a qualified technician or doctor. 
• When the achieved depth is reached, the reaction is stopped with the application of a neutralizer (sodium bicarbonate). 
• The skin is gently cleansed and ice packs and/or NSAIDs are used to control pain and swelling. 
• Redness peaks within 5 days and skin peels like a bad sunburn. 
• Mild bleach and vinegar soaks can be used as antimicrobial agents to prevent infection. Skin is protected with an appropriate ointment that’s reapplied daily.
• Skin exfoliation is complete in 10-14 days. 

 

What’s it good for? A moderate chemical peel is particularly beneficial for improving fine lines, chronic actinic photodamage, superficial hyperpigmentation, superficial acne scars, and some precancerous lesions. They can also be helpful for controlling acne and minimizing the look of blemishes. They will not address deep wrinkles or skin laxity. 

 

Drawbacks: There is a longer recovery period and these peels are painful. A sedative is often given beforehand as are non-steroidal anti-inflammatories (NSAIDs). There is a risk of scarring, unwanted pigmentation, and infection. 

 

Deep Peels (Phenol) 

Deep chemical peels are designed to penetrate to the lowest layer of the dermis – the reticular dermis – and carry added risks you need to be aware of. They must be medically supervised. 

 

They’re also expensive, ranging upwards of $4000-$6000, meaning that the cost-benefit advantage over a laser isn’t there. Considering the added risk and price, you may want to explore a laser first to see if it can achieve the same results.

 

Application of a deep peel is not something to be performed in a ‘spa’ setting. 

• Baker-Gordon Peel (50% water, phenol, a detergent, and croton oil) solution is applied in 10-20 minute intervals to protect organs from toxic exposure until desired depth is reached. 
• There are two treatment methods:

• Occluded: petrolatum is applied over the solution, sealing it in to ensure maximum depth penetration. Best for severe furrowing/photoaging. 
• Unoccluded: more cleansing in between layers and lipid removal. Not as deep. 

 

Best used for: Deep phenol peels can address deep wrinkles, sun damage, deep acne scars and precancerous growths. Results are dramatic and last up to 10 years.

Recovery time: 2-6 weeks recovery, and 2 weeks minimum before going back to work. Lots of peeling, very sensitive, red skin afterwards. It takes a while for skin to heal. 

Drawbacks: The biggest disadvantage with a deep, phenol peel is that they’re medically risky. If not used properly, they can damage the subcutaneous skin layer and cause scarring. There’s also a low risk of heart failure. Phenol can cause drastic shifts in blood pressure that lead to shock and heart arrhythmia. The potential for liver and kidney damage (though extremely rare) is nothing to gloss over either. 

Final Thoughts

If you opt to try a chemical peel, you need to have an honest conversation with yourself about whether you can realistically take the time off for recovery (especially for moderate and deep peels) and whether you will reliably commit to sun protection afterwards. If not, you might want to sit this one out. 

Looking for products safe to incorporate after a procedure? Explore Feel Confident Skincare  to discover products developed by a plastic surgeon that really can deliver on great skin…

The content of this newsletter is for entertainment and educational purposes only. This content is not meant to provide any medical advice or treat any medical conditions. Patients must be evaluated by an appropriate healthcare provider on an individual basis and treatment must be tailored to meet that patient’s needs. Results and particular outcomes are not guaranteed.