Chemical Peels

What are chemical peels and how do they work?
The procedure known as chemical peeling (or chemexfoliation 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.

What are the different types of peels used?
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.

Lower strength TCA (Trichloroacetic acid) may also be used to obtain a superficial peel.

Medium Depth Peels
Remove both the epidermal layers and upper dermal layers. This is performed by Dr Khor personally; Typically we use 20-39% TCA strength peel. These peels are designed to remove deeper pigmentation, superficial sun damage and skin blemishes; it takes seven days downtime for the skin to heal. 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 even texture than before the treatment.

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 it’s 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.

What happens during the treatment and how long will it take to recover?
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 will 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), an 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.

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.
This mild peel generally can be repeated weekly for 4-6 times

Will a peel hurt and what are the side effects?
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 out-break 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.

Who should not have a chemical peel?
Depending on the type of peel, your practitioner may not recommend treatment if you:

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.