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Chemical Peels
Glycolic- a good all round anti aging peel,
Salycic- great for acne and rosacea and blocked pores,
Kojic- excellent to remove pigmentation
Lactic-a milder alternative to glycolic
Mandelic- good for pigmentation and anti aging, less irritant than glycolic
The use of chemical peels to soften and improve the appearance of the
skin, dates back to the ancient Egyptians. Little did they know that they
were benefiting from the superficial skin peeling effects of hydroxy acids;
lactic acid in the milk they were bathing in and tartaric acid in the grape
skins they rubbed on their skin. Today, scientists have identified
numerous forms of acid which can be used to induce beneficial changes
for our skin, including salicylic acid, trichloroacetic acid (TCA) and
phenol.
Chemical peeling (chemo exfoliation) involves the application of a
chemical solution to the surface of the skin to produce the careful
removal of its outer layers. The amount of skin removed will depend on
the type of chemical used, the strength of the product (superficial,
medium depth and deep) and how long it is left on the skin. They can be
used on most areas of the body, but are commonly used on the face or
the backs of the hands to improve rough skin texture, fine lines and
wrinkles, age spots, sun damage, blemishes, scars or acne and actinic
keratosis (precancerous skin growth). Private costs for chemical peels
depend upon the type of peel and problem being treated.
Chemical Peels background information
The use of chemical peels to soften and improve the appearance of the
skin dates back over 3,500 years to the ancient Egyptians. Historians
describe the use of several different techniques, including the use of
animal oils, salt, and alabaster to smooth the skin. Egyptian women
bathed in sour milk, or rubbed fermented grape skins from the bottom of
wine barrels over their skin to enhance beauty. Little did they know that
they were benefiting from the superficial skin peeling effects of a family
of chemicals called hydroxy acids which remove the outer layers of the
skin. These acids have now been identified as lactic acid in milk and
tartaric acid in grape skins and can be found in a huge number of
modern beauty products.
Later in history, poultices (something like our modern face packs)
containing mustard, sulphur, and limestone were used for similar
purposes. Indian women mixed urine with pumice and Turkish women
singed their skin with fire to create an early form of exfoliation or removal
of the outer, rough surface of the skin.
Today, scientists have identified numerous forms of acid which can be
used to induce beneficial changes for our skin, including salicylic acid,
trichloroacetic acid (or T.C.A.) and phenol peels. Facial peels have
grown enormously in popularity over the past twenty-five years and now
it can be a very effective treatment when performed by an experienced
practitioner.
Such is their success rate that chemical peels are now the 5th
commonest cosmetic procedure in the U.S.A.. Official statistics from the
American Society for Aesthetic Plastic Surgery (ASAPS) reveal that
just under 444,000 procedures were performed in 2012, an increase of
15.5% on 2011 figures.
As yet, no similar reliable figures are available for the U.K., but there is
evidence that treatments are growing very rapidly. More practitioners
than ever before are seeking training in a constantly growing market of
different kinds of chemical peels.
If you are considering a chemical peel procedure, the following
information will give you a basic understanding of the process. It can't
answer all your questions, since a lot depends on the individual patient
and the practitioner. Please ask your practitioner about anything you
don't understand.
What are chemical peels and how do they work?
The procedure known as chemical peeling (or chemoexfoliation to give it
its proper name) involves the application of a chemical solution to the
surface of the skin to produce the careful removal of its outer layers. The
amount of skin removed will depend on the type of chemical used, the
strength of this product and how long it is left on the skin.
Chemical peels are usually described according to how deep they work
on the skin. Below are some examples of the type of peels and the kind
of language you can expect to hear used when discussing chemical
peels.
Look at the diagram below to see where the different layers are and
where different types of peels act on the skin.
SUPERFICIAL PEELS
Remove the outer layer of the skin or the “epidermal layers”.
MEDIUM DEPTH PEELS
Remove both the epidermal layers and upper dermal layers. These are
the next layers down as you can see on the diagram.
DEEP PEELS
Peeling extends deeper into the lower dermal layer of the skin.
No matter how deep the peel, your skin will re-grow and should heal
fully.
If you choose to have a deeper peel – maybe to get rid of wrinkles or
acne scars – when the skin re-grows, it will not “remember” the
blemishes that were there before. As the new skin develops, a new band
of collagen in the dermis will grow along with a thicker epidermis. Hence,
your skin will appear smoother and more perfect than before the
treatment.
The deeper the peel, the greater potential for improvement to the skin.
However, a minority of people can experience some side effects with
deeper peels.
What skin problems can chemical peels treat?
Chemical peels can be used on most areas of the body, but the
commonest use is to improve the appearance of sun damaged skin on
the face, or the backs of the hands.
They can also be used to improve certain skin spots, blemishes or
lesions such as acne and actinic keratosis. If you are considering having
a chemical peel, you must go to an experienced practitioner as the
success of the treatment depends on a variety of factors. Your skin type
and the problem which requires attention both need to be investigated
fully by you and your practitioner.
Below is a list of the treatments and the type of skin problems which they
can reduce.
SUPERFICIAL PEELS
Can help to lessen rough skin texture, dry or flaking skin, fine lines due
to sun damage, mild acne marks, "age spots" (brownish patches which
can be caused by sun damage) and balancing irregular skin tones (i.e.
skin which may be uneven in colour.)
MEDIUM DEPTH PEELS
Can reduce small wrinkle lines, some acne scars, and certain
pigmentation problems (again, making different coloured skin more
even.)
DEEP PEELS
Can help to reduce the appearance of deeper lines, wrinkles and scars.
PLEASE BE AWARE: chemical peels cannot change your pore size,
improve loose skin (saggy skin generally needs to be treated by
surgery), or deal with deep scarring.
What are the different types of peels used?
All the terms and descriptions below are words which your practitioner
may use when talking to you about your chemical peel, so it might be a
good idea to read up on them now. However, don’t worry, if it all seems
mind-bogglingly technical! You will be given good guidance about which
product and treatment is best for you if you go to see an experienced
practitioner in this area.
You do need to be familiar with two terms in particular:
HYPERPIGMENTATION: where the skin has too much pigment and that
can lead to brownish spots or blotches on the skin.
HYPOPIGMENTATION: the opposite of the above when the skin can
look white or bleached.
SUPERFICIAL PEELS
These are the commonest types of peel used and most often contain
some form of hydroxy acid, which is a family of chemicals known to
cause exfoliation (removing the top layer of dead skin cells in the
epidermis), when applied to the surface of the skin. A superficial peel is
like a mild “sandpapering” of the facial skin and it will give your face a
healthy glow. You might want to have a peel prior to a special occasion
when you want your face to look alive and glowing.
Different forms of hydroxy acid are available on the market. These
include alpha hydroxy acids, such as the naturally occurring lactic acid
(sour milk) and tartaric acid (from grape skins). Salicylic acid, is a beta
hydroxy acid and is unique amongst the hydroxy acids in that it can
penetrate deeper into the oil glands causing exfoliation even in the oily
areas of the face and scalp. For this reason it has been used for years
by dermatologists (skin specialists) to help treat comedonal acne in
people who have very oily skins.
Glycolic acid : This product comes in different strengths (30% - 90%)
and different pH levels (levels of acidity).
Sometimes combinations of different hydroxy acids are used, such
as Jessner's Solution which contains a combination of lactic acid and
salicylic acid.
Product brands which have Hydroxy Acid based superficial peels
include: Lower strength TCA (Trichloroacetic acid) may also be used to
obtain a superficial peel.
MEDIUM DEPTH PEELS
These involve the use of stronger peeling solutions. The commonest of
these is higher strength T.C.A., Trichloroacetic acid which can be used
on its own at up to 50% strength, but it is more commonly used in
concentrations around 25% - 35% to help reduce possible side effects.
T.C.A. can also be used in combination with glycolic acid or other
solutions to help achieve a more controlled and even peel to the correct
depth.
Product brands which have TCA based medium depth peels include:
What happens during a Chemical Peel treatment?
At your first consultation with a practitioner, you should explain what you
expect from the treatment and how you would like to look afterwards. He
or she should tell you exactly what the treatment will involve and how
long it will take for you to recover from it. A medical history should be
taken by the practitioner, to ensure that there are no reasons why you
shouldn’t have the treatment. Once this is established, you would
normally be asked to read some detailed information and sign a consent
form indicating that you have understood the potential benefits and risks
associated with the peel procedure recommended.
Photographs may also be taken by the practitioner, for use as a “before
and after” comparison at a later date.
Depending on the depth of peel and combination of peels used, different
treatment procedures are recommended.
You would normally be asked to avoid any changes in your normal
skincare routine 1 - 2 weeks prior to peel treatment. Things to avoid
include electrolysis (facial hair removal), exfoliating facial, sunbathing,
tanning beds, or the use of any new creams as these could alter your
response to the peeling agent. What happens next depends on the type
of peel used.
SUPERFICIAL PEELS
For one of the commonest peeling agents used, glycolic acid, the
procedure is generally quick and easy to perform. The face is cleansed
to strip the skin temporarily of its natural oils and allow the glycolic acid
to be absorbed into the skin. The peel is then quickly painted onto the
area to be treated and is left for between 2 - 10 minutes, depending
upon the strength and type of glycolic peel used, before it is washed off
and neutralised.
Repeat procedure
This mild peel generally needs to be repeated weekly for 4-6 weeks to
obtain a good result, which can then be maintained with monthly peels.
MEDIUM DEPTH PEELS
The skin is again thoroughly cleansed before application of the peel. An
even layer of the peeling agent is applied to the area to be treated,
which makes the skin slowly becomes whitish – grey, or “frosted”. A fan
is sometimes used to help cool the face. Once frosting has occurred,
which may take several minutes, cool saline compresses (pads soaked
in a salt water solution) may be applied to the face to neutralise the peel.
Repeat procedure
This type of peel may be repeated monthly until the desired effect is
achieved. Thereafter, maintenance peels every 6 – 12 months should
keep your skin looking good.
How long will it take to recover from a Chemical Peel?
SUPERFICIAL PEELS
In general, most patients can return immediately back to work after this
procedure.
MEDIUM DEPTH PEELS
This can take from a few days to a week or so depending on how well
you heal, your age (older skin tends to heal less quickly) and any posttreatment complications.
What are the risks and potential complications from Chemical Peel
treatment?
As you can probably guess, the depth of peel relates directly to the pain
experienced and number of side effects.
SUPERFICIAL PEELS
During the procedure most patients experience a mild stinging sensation
whilst the glycolic acid is on the face. The face is often pink after the
solution is removed, and there may be a faintish white discoloration in
some areas, or a blotchy appearance to the skin that usually fades
within a couple of hours. Some patients do not experience any visible
peeling off of the skin after treatment, but the treatment still has a
beneficial effect, like a very good exfoliation.
Side effects or risks of superficial peels can be hyperpigmentation (too
much pigment which causes brown blotches on the skin) and a high
factor sunscreen should be applied at all times to help reduce the
potential for this problem.
In rare cases, patients may experience an infection in the skin or an outbreak of cold sores. This normally only occurs in patients who have a
history of such complaints. ( Anti- viral medication may be recommended
if such complications occur.)
MEDIUM DEPTH PEELS
The face may swell shortly after the solution has been applied and turn
pink, with some burning and stinging of the skin that can last for 30
minutes to an hour following 25% - 35% TCA peels.
Over the next few days, the face may turn a dark brown colour, with
streaks of white appearing amongst the brown. The skin will then begin
to peel, over a 5 - 6 day period, and may begin to itch during this healing
phase. After peeling, the face will be bright red – this will fade to a fresh
pink tone in most people over the following 3 - 6 weeks.
Hyperpigmentation or brown spots may occur, even if you follow your
doctor’s advice and apply sunscreen before going outdoors. Bleaching
creams may be used to help reduce the appearance of these brown
areas. Your practitioner will be able to recommend one which is suitable
for you.
Redness of the face may also last for longer than 2 - 3 months in some
patients; however, this should disappear over time. Very rarely, some
patients may develop scarring following a medium depth peel. This can
occasionally be permanent, but you should be aware that such a result
is extremely unlikely.
What should you do after a Chemical Peel treatment?
It is very important that you carefully follow the advice of your
practitioner following a peel treatment to help to improve the benefit of
the procedure and reduce the risk of complications or side effects.
SUPERFICIAL & MEDIUM PEELS
Post-treatment advice may include:
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cleansing the face gently with a soap-free cleanser, pat the skin
dry with a towel, and
moisturise twice a day;
not picking off any dead or peeling skin as this may cause bleeding
and discoloration, or even mild scarring;
not exposing yourself to the sun without a sunscreen for at least 6
weeks after treatment to reduce the risk of hyperpigmentation
(brown blotches on the face) A high factor sunblock should be
used daily to protect the skin;
Contacting your practitioner immediately if you notice any signs of
infection or pigment changes.
Who should not have a Chemical Peel treatment?
Depending on the type of peel, your practitioner may not recommend
treatment if you:
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have a history of problems with keloid or other types of scarring of
your skin;
have abnormal skin pigment/colour;
have facial warts or any current facial infection;
have used the anti-acne treatment isotretinoin within the last 12
months;
have darkly pigmented skin, or red hair with freckled skin. In such
cases, you would generally be unsuitable for the deeper peels
owing to the potential for skin bleaching. Afro-Caribbean or Asian
skin is often not suited to facial peels because of the risk of
bleaching the skin. This is particularly the case with the deeper
peels where the top layers of skin are removed. It is vital if you
have skin of a darker colour that you find a practitioner who is
experienced in using facial peels and discuss with them all these
issues before you embark on any treatment. It may be that your
skin is simply not suited to anything deeper than mild exfoliation.
Who can perform a Chemical Peel?
Superficial peels such as lactic and glycolic acid can generally be used
by all kinds of medically trained staff, including doctors and nurses, and
in some cases manufacturers train beauticians to perform very
superficial peels.
Medium peels such as TCA tend to be used by doctors of all kinds from
GPs to surgeons, but you should seek an experienced dermatologist
(skin specialist) or plastic surgeon for a deep phenol peel.
What is the average cost of Chemical Peels?
It is highly unlikely that anyone considering a chemical peel would be
able to access this free of charge on the National Health Service.
Prices for private chemical peel procedures can range from £60
per treatment session for mild glycolic peels including lactic and glycolic
acid, to around £500 upwards for a course of 4 TCA peels to over
£2,000 for the deeper phenol peels depending upon the type and extent
of the problem treated.
Summary of advice for Chemical Peels
Lactic acid, glycolic acid, TCA and phenol chemical peels have been
widely used to treat a range of different skin problems. Superficial peels
can really help to even out the colour and smoothness of your skin.
The stronger and deeper peels can have a more dramatic effect on
obvious wrinkles and skin pigment problems, but you need to find a
practitioner who understands how to use these properly. In the hands of
someone who is not experienced, such treatments will not be entirely
successful and you may find yourself with some unfortunate side effects.