Chemical peels have been used for centuries to help beautify the skin. Ancient Egyptians used various herbs and chemical extracts to purify and smooth the skin. The modern age of chemical peels began in the late 1800s while treating burns and military injuries. Multiple agents have been described and studied since then including phenol, trichloroacetic acid (TCA), resorcinol, and alpha and beta hydroxy acids. Multiple methods of application and concentration of agents have been used with the end result of improving the appearance of the skin.
- Lighter chemical peels can help to exfoliate the skin by removing just the outer layer of skin. Some agents help to remove oily build up as well as exfoliate the skin.
- Medium depth peels can help to strengthen the underlying collagen which improves the tone and texture of the skin.
- Deeper peels can effect skin tone, texture, and pigment changes.
Chemical peels can be individualized for the skin type and goals of the procedure. Dr. Trussler has significant experience with multiple chemical peeling agents and can help to design a chemical peel regimen that is right for your skin.
What Are My Options?
There are four main types of chemical peels that may be performed to improve the appearance of the skin, including:
Alpha Hydroxy Acids (AHAs)
Alpha Hydroxy Acids (AHAs) are the gentlest of the types of chemical peel. They consist of a group of glycolic, lactic and fruit acids that smooth and brighten skin by chemical exfoliation of the epidermis or top layer of skin. AHA peels are gentle and can be varied with concentration and technique. They are ideal to help freshen the skin, and can be performed repetitively to help prevent build up on the skin. There is very little downtime with AHA peels because they do do penetrate into the skin.
Jessner’s Peel
Jessner’s peel utilizes Jessner’s solution< which was described over 70 years ago and contains a combination of Alpha and Beta Hydroxy Acids, as well as Resorcinol and Ethanol. Lactic Acid (AHA) in Jessners which helps to exfoliate, while the Salicylic Acid (BHA) helps to dissolve oils and decongest the skin. Resorcinol helps with exfoliation. This is a mild chemical peel that can be used to freshen acne prone skin, oily skin, and in preparation for a deeper chemical peel.
Trichloroacetic Acid (TCA)
Trichloroacetic acid (TCA) is a very versatile chemical peeling agent which can be used for light to moderate depth peels. It can be used to rejuvenate the face through smoothing fine lines, improving skin tone, erasing superficial blemishes, and refining skin texture. TCA can be used for facial scarring and pre-malignant skin lesions. The depth of the TCA peel can be controlled with the concentration, number of applications and the technique of application. Lighter peels can utilize a 10 to 20% TCA concentration and medium depth peels can be achieved with 35% TCA. Jessner’s solution can be added as an effective pre-treatment for the skin immediately before TCA application.
Considerations
Chemical peels can be used to improve the health of the skin. They can be altered to fit most skin types.
When approaching the method of chemical peeling the goals of the peel should be discussed, as well as acceptance of down-time (recovery) and season (sun-exposure).
Skin pigment: pre-existing pigment abnormalities can be faded by moderate to deep chemical peels. Chemical peels which enter into the dermis (moderate) depth can effect the pigment cells of the skin called the melanocytes. These should not be activated in darker skinned patients and can be controlled in patient skin pre-treatment with skin lighteners.
Skin Tone: moderate to deep chemical peels and repetitive lighter peels can help to stimulate collagen and thicken and tighten the skin.
Skin Texture: fine lines can be smoothed with light to medium depth peels. Scarred skin can be evened with medium to deep chemical peels.
Skin Wrinkle Pattern: facial rejuvenation can be achieved with an active skin care regimen combined with a medium to deep chemical peel. Localized treatment of deeper wrinkles in the forehead and around the lips can be selectively treated with a deeper peel and then blended with a full face medium depth peel. This highlights the versatility in chemical peeling.
Non-facial peels can be thoughtfully performed on the neck, chest and hands for patients seeking a nonsurgical approach to skin rejuvenation, though lighter peels are selected because of the inherent skin differences in these areas.
- Salicylic Acid peels can be applied to the upper extremities and hands for effective treatment of premalignant lesion and pigment changes.
Expectations
- A chemical peel can help restore, rejuvenate and repair the skin through controlled application of variable chemical peeling agents.
Fine lines, skin tone, texture and pigment can all be improved with a chemical peel. Each chemical peel procedure performed by Dr. Trussler can achieve a natural rejuvenated look without the need to undergo an invasive procedure.
- Chemical peels can be commonly combined with surgical procedures, such as neck lifts, brow-lifts and mid-face lifts. Segmental chemical peels are offered to full facial rejuvenation patients, which would include a High SMAS facelift, browlift and blepharoplasty.
It is important for patients to realize that a chemical peel does have risks which do vary directly with the peel depth. Common risks of chemical peels include: infection, scarring, pigmentation changes, and un-eveness. Peel planning, including depth selection, skin pretreatment and viral prophylaxis can all help decrease the risks involved with chemical peels. Dr. Trussler will discuss any risks with you prior to treatment in order to ensure the most successful results for your procedure.
Treatment
The majority of chemical peels may be performed as an in-office procedure. Deep chemical peels and chemical peels combined with facial surgery are performed in the operating room under anesthesia. Full face Phenol and Croton oil peels are performed in the operating room to monitor vital signs and for comfort, though segmental peels can be performed in the office. Ice, cooling fan, topical numbing cream, and/or local anesthesia is all that is needed for the majority of chemical peels.
- All chemical peel patients should be evaluated for risk of viral infection and sun exposure.
- No make-up or moisturizer should be applied to the skin the day of the peel procedure.
AHA Peel, commonly a Glycolic Acid peel which is 70% is performed in the office with minimal discomfort or downtime. It is important to be compliant with a skin care regimen before and after the procedure, including a retinol and skin lightener. The skin is cleaned and degreased prior to the peel. The glycolic acid gel applied over the entire face. After the 10 minute procedure the peel is neutralized with Sodium Bicarbonate and water to control the depth of the peel. After the peel procedure, skin is cleansed and moisturized. There may be mild redness and sensitivity, but downtime is minimal. It is ideal to repaeet this peel every 4 to 6 weeks to help freshen and smooth the skin.
Jessner’s Peel is a similar procedure to an AHA peel, though can be applied to oily and acne prone skin. Patients undergoing a Jessner’s peel should be on a skin care regimen specific for their skin type, including a salicylic acid based cleanser and lightening agent. The skin should be primed for at least 3 weeks prior to treatment. The skin is cleansed and degreased and the Jessner’s solution is applied and left in place for 5 to 10 minutes. There can be mild irritation and stinging, which is limited by cool air. Frosting and redness are temporary. Moisture care is recommended after the peel.
TCA Chemical Peel can be varied with concentration to help control the depth of the peel.
- Superficial TCA peels can be performed in the office with 10 to 20% TCA with minimal discomfort and downtime. Mild frosting followed by redness can be expected with a superficial skin peel over the next 3 days.
- Moderate depth TCA peels can be safely performed in the office with topical and local anesthetic. The skin is degreased and commonly pre-treated with Jessner’s solution to help the TCA penetrate into the skin. One to two gentle applications of TCA will create an initial frost followed by a pink color to the skin. There is no post-peel neutralization. The face is covered with a post-peel moisturizer or anti-biotic ointment. The skin gradually darkens and tightens over the next 3 days and begins to peel during the first week. Redness can be expected. Moisture care and gentle cleansing is advised after the peel with resumption of skin care after 3 weeks.
Phenol and Croton Oil Peels can be varied with the concentration of the two agents to provide an even peeling on different anatomic areas of the face. Segmental facial peels can be safely performed in the office with topical and local anesthetic. Full face Phenol and Croton Oil peels are performed in the procedure room under sedation with monitoring secondary to the potential systemic effects of Phenol.
- The skin is degreased and commonly pre-treated with for at least 3 weeks with an aggressive skin care regimen which includes a Retinol product and lightening agent. One to two gentle applications of the Phenol peel solution will create an initial frost followed by a pink color to the skin. There is no post-peel neutralization. The face is covered with a post-peel moisturizer or anti-biotic ointment. The skin gradually darkens and tightens over the next 3 days and begins to peel during the first week. Redness can be expected. Moisture care and gentle cleansing is advised after the peel with resumption of skin care after 3 weeks.
After Care & Recovery
The majority of chemical peels are performed as in-office procedures with little recovery needed. All chemical peel patients should have a stable skin care regimen which has been utilized for at least 3 weeks ahead of time. This will be resumed after the skin has healed after the initial peeling period.
- A gentle moisturizer and lotion based cleanser should be used twice daily after the procedure and through the healing phase.
- It is important not to pick or rub the skin during the peeling phase of the recovery so that a deeper wound is not created.
- Sunscreen must be used to protect the skin from the harmful UV rays after the peel procedure
AHA and Jessner’s peels can cause temporary stinging, redness, irritation and flaking or crusting. This is secondary tot he exfoliating effects of the treatment. Persistent areas of crusting and redness can be treated with hydrocortisone cream, but healing time is less than a week.
TCA peels can result in tingling, flushing, and stinging of the skin. The skin then tightens and bronzes over a 3 day period and ultimately peels. Redness, swelling and crusting can persist for over one week. Pre-treated skin will recover faster after a TCA peel.
Recovery after a phenol peel is similar to an aggressive TCA peel, though swelling and crusting may be more pronounced, and recovery may be well over one week.
All chemical peel treatments carry potential risks including: premature peeling, infection, allergic reactions, persistent redness, scarring, acne eruptions, and pigment changes. Proper skin preparation, infection prophylaxis, and adherence to the post-peel instructions (given to patient) will decrease the risk of a chemical peel complication, and improve the ultimate result of the procedure.
Publication
- Herbig K, Trussler AP, Khosla R, Rohrich RJ. Combination Jessner’s Solution and TCA Chemical Peel for Facial Rhytides: Technique and Outcomes. Plast Reconstr Surg. 2009 Sep;124 (3):955-64.
Whether you have a question or would like to setup a chemical peel consultation, Dr. Trussler and his staff are here to help. Please fill out our contact form, or call our Austin office at 512-450-1077 to schedule an appointment. Start your skin resurfacing journey to not only looking, but feeling better today!
