Chemical peeling is a process whereby a chemical solution is applied to the surface of the skin to peel away the top cell layers which will be replaced during the healing process with a fresh, new skin surface.

The following description will give you a basic idea of chemical peeling including peel types, who are the best candidates, what to expect, what each type of peel entails and what results you can expect. Chemical peels are not a substitute for facelifts, but can improve the texture of the skin. Dr. Wright will discuss your individual circumstances and review the procedure and the peel he plans to use with you. It is important that you understand the procedure, so be sure to ask Dr. Wright any questions you may still have.

ARE YOU A GOOD CANDIDATE?

Chemical peels can enhance the appearance of facial and other skin on men and women of all ages. While chemical peeling is available to almost everyone, skin type and coloring are important considerations. The best candidates are usually those with fair, thin skin that has a tendency toward fine wrinkling or scarring on the face. Deeper chemical peels are usually not recommended for highly pigmented skin, such as Asian, Black and Mediterranean, or oily complexions.

This procedure will not prevent aging, however, chemical peels can erase, fade or reduce fine facial wrinkles and remove other surface imperfections. Before your surgery, think carefully about your expectations and discuss them with your cosmetic surgeon. Remember, improvement, not perfection, is the goal.

IF YOU’RE CONSIDERING A CHEMICAL PEEL…

Chemical peels use a chemical solution to improve and smooth the texture of the facial skin by removing its damaged outer layers. It is helpful for those individuals with facial blemishes, wrinkles and uneven skin pigmentation. Phenol, trichloroacetic acid (TCA) and alphahydroxy acids (AHAs) are used for this purpose. The precise formula used may be adjusted to meet each patient’s needs. Although chemical peels may be performed in conjunction with a facelift, it is not a substitute for such surgery, nor will it prevent or slow the aging process. A chemical peel is most commonly performed for cosmetic reasons — to enhance your appearance and your self confidence. Chemical peels may also remove pre-cancerous skin growths, soften acne facial scars and even control acne.


TYPES OF PEELS

ALPHAHYDROXY ACIDS

Alphahydroxy Acids (AHAs) , such as glycolic, lactic, or fruit acids are the mildest of the peel formulas and produce light peels. These types of peels can provide smoother, brighter-looking skin for people who can’t spare the time to recover from a phenol or TCA peel. AHA peels may be used to treat fine wrinkling, areas of dryness, uneven pigmentation and acne. Various concentrations of an AHA may be applied weekly or at longer intervals to obtain the best result. An alphahydroxy acid, such as glycolic acid, can also be mixed with a facial wash or cream in lesser concentrations as part of a daily skin care regimen to improve the skin’s texture. AHA peels may cause stinging, redness, irritation and crusting. However, as the skin adjusts to the treatment regimen, these problems will subside.

Uses:
Smoothes rough, dry skin
Improves texture of sun-damaged skin; aids in control of acne
Can be mixed with bleaching agent to correct pigment problems
Can be used as TCA pre-treatment

Considerations:
A series of peels may be needed
As with most peel treatments, sun block use is recommended

TRICHLOROACETIC ACID

Trichloroacetic Acid (TCA) can be used in many concentrations, but it is most commonly used for medium-depth peeling. Fine surface wrinkles, superficial blemishes and pigment problems are commonly treated with TCA. The results of TCA peels are usually less dramatic than and not as long-lasting as those of a phenol peel. In fact, more than one TCA peel may be needed to achieve the desired result. The recovery from a TCA peel is usually shorter than with a phenol peel.

With a TCA peel, your healed skin will be able to produce pigment as always; the peel will not bleach the skin. However, TCA-peel patients are advised to avoid sun exposure for several months after treatment to protect the newly formed layers of skin. Even though TCA is milder than phenol, it may also produce some unintended color changes in the skin.

Uses:
Smoothes out fine surface wrinkles
Removes superficial blemishes
Corrects pigment problems

Considerations:
Can be used on neck or other body areas
May require pre-treatment with Retin-A or AHA creams
Treatment takes only 10 to 15 minutes
Preferred for darker-skinned patients
Peel depth can be adjusted
Repeat treatment may be needed to maintain results
Sun block must be used for several months
Healing is usually quick, much quicker than with a phenol peel

PHENOL

Phenol is the strongest of the chemical solutions and produces a deep peel. It is used mainly to treat patients with coarse facial wrinkles, areas of blotchy or damaged skin caused by sun exposure, or pre-cancerous growths. Since phenol sometimes lightens the treated areas, your skin pigmentation may be a determining factor as to whether or not this is an appropriate treatment for you. Phenol is primarily used on the face; scarring may result if it’s applied to the neck or other body areas.

With a phenol peel, the new skin frequently loses its ability to make pigment (that is, tan). This means that not only will the skin be lighter in color, but you’ll always have to protect it from the sun. Phenol may pose a special risk for patients with a history of heart disease. It’s important that you make Dr. Wright aware of any heart problems when your medical history is taken. It is also possible that phenol will cause some undesired cosmetic results, such as uneven pigment changes. Certain modified phenol peels are gentler and may be preferred in some circumstances.

Uses:
Corrects blotches caused by sun exposure, birth-control pills, aging
Smoothes out coarse wrinkles
Removes pre-cancerous growths

Considerations:
Used on the face only
Not recommended for dark-skinned individuals
Procedure may pose risk for patients with heart problems
Full-face treatment may take one hour or more
Recovery may be slow – Complete healing may take several months
May permanently remove facial freckles
Sun protection, including sun block, must always be used
Results are dramatic and long-lasting
Permanent skin lightening and lines of demarcation may occur

YOUR CONSULTATION

During your initial consultation, it is important that you discuss your expectations with Dr. Wright. Don’t hesitate to ask any questions or express any concerns that you may have. The procedure will be explained in detail, including its risks and benefits, the recovery period and the costs. If you have a history of herpes, you should inform your physician prior to the procedure.

PRE-OP

Sometimes Retin A – a prescription medication derived from Vitamin A – is used to pre-treat the skin. This thins out the skin’s surface layer, allowing the TCA solution to penetrate more deeply and evenly. If your skin won’t tolerate Retin-A pre-treatment, an AHA cream may be used instead. Hydroquinone, a bleaching agent, is sometimes used in conjunction with Retin-A or AHA pre-treatment, especially if you have blotchy skin areas or pigmentation problems. You may have to spend a month or more in the pre-treatment phase before the doctor will schedule your actual peel.

You will need to arrange for someone to drive you home and help you out for a day or two if you are having a phenol or deeper TCA peel. You probably won’t need any extra assistance if you’re having an AHA peel or superficial TCA peel. Most patients are given a prescription for an antiviral and antifungal medication to help prevent herpes and fungal infections.

WHERE WILL THE PEEL BE PERFORMED?

Most chemical peels may be safely performed in our office.

WHAT TYPE OF ANESTHESIA WILL I NEED?

Anesthesia isn’t required for most peels. However, sedation may be used before and during the procedure to relax you and keep you comfortable. No anesthesia is needed for AHA peels since they cause only a slight stinging sensation during application.

THE CHEMICAL PEEL

AHA peels/treatments:
AHA solution will be applied to your cleansed facial skin, a process that usually takes no more than ten minutes. No “after-peel” ointment or covering is required. Depending on the strength of the peel, periodic treatments may be necessary until the desired effects are achieved.

For some patients, the application of an AHA-based face wash or cream once or twice a day at home will be sufficient to accomplish the desired goal. Your cosmetic surgeon may add Retin-A or a bleaching agent to your at-home treatment schedule. After several weeks of at-home use, Dr. Wright will examine your skin to determine if your regimen needs adjustment.

PHENOL AND TCA PEELS:

Typically, the skin is first thoroughly cleansed. Then, the surgeon will carefully apply the phenol or TCA solution. You may feel a stinging sensation as the peel solution is applied, but this feeling will quickly pass.

A full-face TCA peel usually takes no more than 15 minutes. Two or more TCA peels may be needed to obtain the desired result, and those may be spaced out over several months. Mild TCA peels may be repeated as often as every month. If phenol solution has been used, your plastic surgeon may coat the treated area with petroleum jelly or a waterproof adhesive tape. With lighter peels, no covering is necessary.

A full-face phenol peel generally takes one or two hours to perform, while a phenol peel to a smaller facial region (perhaps the skin above the upper lip) may take only 10 or 15 minutes. A single treatment usually suffices.

AFTER YOUR PEEL

After an AHA peel, it is common to experience some temporary flaking or scaling, redness and dryness of the skin. However, these conditions will disappear as the skin adjusts to treatment. A TCA peel may also cause significant swelling, depending on the strength of the peel used.

After a phenol or TCA peel, Dr. Wright may prescribe a mild pain medication to relieve any tingling or throbbing you may feel. If tape was used to cover your face, it will be removed after a day or two. A crust or scab will form on the treated area. To help your face heal properly, it is essential that you follow Dr. Wright’s specific post-operative instructions.

If you’ve had a phenol peel, your face may become quite swollen. Your eyes may even be swollen shut temporarily. You will need someone to help care for you for a day or two. You may also be limited to a liquid diet and advised not to talk very much during the first few days of recovery.

GETTING BACK TO NORMAL

With an AHA peel, the temporary redness, flaking and dryness that you experience will not prevent you from working or engaging in your normal activities. A fresher and improved skin texture will result with continued AHA treatments. Remember, protecting your skin from the sun is also important following these mild acid peels. Ask Dr. Wright to recommend a sun block with adequate UVA and UVB protection and use it every day.

With a TCA peel, the moderate discomfort and mild swelling you may experience will subside within the first week. In about a week to ten days, your new skin will be apparent and you should be healed sufficiently to return to your normal activities. It is best to avoid sun exposure unless you are adequately protected.

With a phenol peel, new skin will begin to form in about seven to ten days. Your face will be very red at first, gradually fading to a pinkish color over the following weeks to months. During this time, it is especially important that you use a sun block or blotchy, irregular skin coloring may result.

About two weeks after treatment, you may return to work and resume some of your normal activities. Your skin will be healed enough for you to wear makeup.

THE NEW YOU

Improvements from AHA peels may be very subtle at first. You may detect a healthier glow to your skin. With continued treatments, you will notice a general improvement in the texture of your skin. The results of a TCA peel are usually not as long-lasting as those of phenol peels, however, your skin will be noticeably smoother and fresher-looking. If you’re planning a phenol peel, you can expect dramatic improvement in the surface of your skin – fewer fine wrinkles, fewer blemishes and more even-toned skin. Your results will be long-lasting, although not immune to the effects of aging and sun exposure.

THERE ARE RISKS IN ALL SURGICAL PROCEDURES

Like all surgery, chemical peels involve some level of risk. Chemical peels are a normally safe and popular way to treat facial wrinkling and fine scarring. To help ensure a successful outcome, the patient should be a good candidate, the surgeon should be well-trained in chemical peeling techniques, the surgical facility should be properly equipped and the patient should follow the doctor’s instructions and advice.

While complications are extremely unusual, you should discuss the risks and possible side effects with Dr. Wright. Patients with liver, kidney or heart ailments need to make their cosmetic surgeon aware of this.

You should have realistic expectations and realize that the true results may not be apparent for up to a year. Chemical peels can offer softer, smoother skin to those who never thought it was possible. Discuss the benefits and risks with Dr. Wright given your particular circumstances.