Chemical peel

A chemical peel is a body treatment technique used to improve and smooth the texture of the facial skin using a chemical solution that causes the dead skin to slough off and eventually peel off. The regenerated skin is usually smoother and less wrinkled than the old skin. Thus the term chemical peel is derived. Some types of chemical peels can be purchased and administered without a medical license, however people are advised to seek professional help from a dermatologist, plastic surgeon, maxillofacial surgeon, or otolaryngologist on a specific type of chemical peel before a procedure is performed.

Types

There are several types of chemical peels.

Alpha hydroxy acid peels

Alpha hydroxy acids (AHAs) are naturally occurring organic carboxylic acids such as glycolic acid, a natural constituent of sugar cane juice and lactic acid, found in sour milk and tomato juice. This is the mildest of the peel formulas and produces light peels for treatment of fine wrinkles, areas of dryness, uneven pigmentation and acne. Alpha hydroxy acids 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.

There are five main fruit acids: citric acids (citrus-derived), glycolic (derived from sugar cane), lactic acid (although derived from milk, this is still considered a "fruit acid"), malic (derived from apples) and tartaric (derived from grapes).

Citric Acid: Usually derived from lemons, oranges, limes and pineapples. These peels are simple and effective, although not incredibly invasive or capable of significant improvement with one treatment.

Glycolic Acid: Formulated from sugar cane, this acid creates a mild exfoliating action. Glycolic acid peels work by loosening up the horny layer and exfoliating the superficial top layer. This peel also stimulates collagen growth.

Lactic Acid: This acid is derived from either sour milk or bilberries. This peel will remove dead skin cells, and promote healthier, softer and more radiant skin.

Malic Acid: This peel is the same type of mildly invasive peel derived from the extracts of apples. It can open up the pores, allow the pores to expel their sebum and reduce acne.

Tartaric Acid: This is derived from grape extract and is capable of delivering the same benefits as the above peels.

AHA peels are used to:

• reduce fine wrinkling
• treat areas of dryness
• reduce uneven pigmentation
• aid in the control of acne
• smooth rough dry skin
• improve the texture of sun-damaged skin

AHA peels may:

• cause stinging
• cause skin redness
• cause mild skin irritation
• cause dryness
• take multiple treatments for desired results

Beta hydroxy acid peels

It is becoming common for beta hydroxy acid (BHA) peels to be used instead of the stronger alpha hydroxy acid (AHA) peels due to BHA's ability to get deeper into the pore than AHA. Studies show that BHA peels control oil, acne as well as remove dead skin cells to a certain extent better than AHAs due to AHAs only working on the surface of the skin.

Salicylic acid (from the Latin Salix meaning: willow tree) is a biosynthesized, organic, beta hydroxy acid that is often used. Sodium salicylate is converted by treating sodium phenolate (the sodium salt of phenol) with carbon dioxide at high pressure and temperature. Acidification of the product with sulfuric acid gives salicylic acid. Alternatively, it can be prepared by the hydrolysis of Aspirin (acetylsalicylic acid) or Oil of Wintergreen (methyl salicylate) with a strong acid or base.

Jessner's peel

Jessner's peel solution, formerly known as the Coombe's formula,was pioneered by Dr Max Jessner, a German-American dermatologist. Dr Jessner combined 14% salicylic acid, lactic acid, and resorcinol in an ethanol base. It is thought to break intracellular bridges between keratinocytes. It is very difficult to "overpeel" the skin due to the mild percentages associated with the acid combination.

Retinoic acid peel

Retinoic acid is derived from retinoids; which is denatured vitamin A. It is chemically similar to Retin-A. This type of facial peel is also performed in the office of a plastic surgeon or a dermatologist or Med Spa setting. This is a deeper peel than the Beta Acid peel and is used to remove scars as well as wrinkles and pigmentation problems. It is usually performed in conjunction with a Jessner; which is performed right before, in order to open up the skin, so the retinoic can penetrate on a deeper level.

The client leaves with the chemical peel solution on their face. The peeling process takes place on the third day. More dramatic changes to the skin require multiple peels over time.

Trichloroacetic acid peels

Trichloroacetic acid (TCA) is used as an intermediate to deep peeling agent in concentrations ranging from 20-50%. Depth of penetration is increased as concentration increases, with 50% TCA penetrating into the reticular dermis. Concentrations higher than 35% are not recommended because of the high risk of scarring.

Trichloroacetic acid peels:

• are preferred for darker-skinned patients over Phenol
• smooth out fine surface wrinkles
• remove superficial blemishes
• correct skin pigment problems

Trichloroacetic acid peels may:

• require pre-treatment with Retin-A or AHA creams
• require repeat treatment to maintain results
• require the use of sunblock for several months (this is a must)
• take several days to heal depending on the peel depth

Phenol peels

Phenol is the strongest of the chemical solutions and produces a deep skin peel. Recent studies suggest that phenol is most likely only the carrier for another active component in the solution, namely croton oil. In fact, phenol alone produces only a light peel which is ineffective for restructuring the deeper dermal structures (such as wrinkles). The term Phenol/Croton oil peel has been proposed as a more accurate descriptor, but the established terminology phenol peel continues to be of dominant usage, as the role of croton oil in the mix is not as widely understood.

Effects of a phenol chemical peel are long lasting, and in some cases are still readily apparent up to 20 years following the procedure. Improvements in the patient’s skin can be quite dramatic. A single treatment usually achieves the desired result.

Phenol peels are used to:

• correct blotches caused by sun exposure or aging
• smooth out coarse deep wrinkles
• remove precancerous growths

Phenol peels may:

• pose a risk for patients with heart problems
• permanently remove facial freckles
• cause permanent skin lightening by reducing the ability to produce pigment
• take several months to heal
• require increased protection from the sun for life

Anesthesia

Light chemical peels like AHA and glycolic acid peels are usually done in dermatologists’or plastic surgeons' offices. There is minimal discomfort so usually no anesthetic is given because the patient feels only a slight stinging when the solution is applied. If a patient were to request something for pain, an oral pain pill like Tylenol with codeine would be appropriate.

Medium peels like TCA are also performed in the doctor’s office or in an ambulatory surgery center as an outpatient procedure and are a bit more painful. Frequently, the combination of a tranquilizer like Valium and a pain pill usually suffice. TCA peels often do not require anesthesia because the solution itself has a numbing effect on the skin. The patient usually feels a warm or burning sensation.

Phenol is the classic deep chemical peel. The application is very painful and most practitioners will perform it under either general anesthesia, administered by an MD-anesthesiologist or nurse anesthetist. Less often, the procedure is done using very heavy sedation, usually intravenous or intramuscular. But that approach is less desirable for several reasons including possible adverse influences of the phenol upon the heart.

See also

• List of cutaneous conditions