The origins of the chemical peel date into Roman times at the least, with Cleopatra and other women of the elite class of the era utilizing mild acids, derived from wine or milk, to revitalize their skin. A variety of various peels of different depths and strengths has led to a resurgence in this age-old technique.
As the name implies chemical peels are simply chemicals, usually acids, or combinations of acids that are applied in a controlled manner to remove outer layers of skin. How deep the damage extends depends upon the agent itself, the strength of the agent, the application time, pretreatment regimens, and other factors. A variety of safe alternatives are available to treat many different problems, making them a solid and cost effective choice for patients with diseases as dissimilar as acne, photodamage, and dyspigmentation.
Peels themselves are categorized as either superficial, medium depth, or deep peels. Superficial peels confine their action to the outermost layers of the skin, the stratum corneum and the epidermis.
One of the more common agents for superficial peels, glycolic acid, is an alpha hydroxyl acid. The acid’s effects are neutralized after a specific amount of time, and post-treatment instructions are given, with very mild redness expected to last a few days, and dry flaking skin for a bit longer. The after effects of this type of peel are easily concealed with moisturizers and makeup.
Other peel options include Jessner’s solution and salicylic acid. Salicylic acid peels are very lipophilic, so they are particularly useful for active acne vulgaris.
As a general class, superficial peels are ideal for troublesome acne, mild dyspigmentation, and superficial scarring and wrinkles. These peels affect the outermost layers of skin, are safe, and usually are applied sequentially, over a period of a few months, increasing the concentration of the agent with each subsequent visit. Because of the superficial nature of these peels, a series of 6 is usually recommend, and performed at two to three week intervals. Medium depth peels can reach the next layer of the skin, the dermis, and therefore can have more profound effects. Trichloroacetic acid (TCA) is a utilized for medium depth to deep peels, based upon concentration of the acid. Unlike glycolic acid, TCA does not require neutralization, but its effects are seen by ‘frosting’ the skin, turning it slightly white as the keratin in the skin is coagulated. A combination of various
superficial peels, such as Jessner’s solution and TCA, layered together is another manner of achieving a medium depth peel. In general, medium depth peels result in a bit more downtime, and redness can be expected for a week to ten days, with mild discomfort for a day or two. Because of the more vigorous action of this subset of peels, they offer more dramatic results than the superficial peels in terms of smoothing the texture of the skin, eliminating wrinkles, and evening out skin tones.
Deep peels have fallen out of favor due to the risk-benefit profile, concerns about scarring, and also due in large part to the evolution of other more predictable ablative techniques, such as laser treatments.
Target areas for peels are varied, and include the entire face, the neck, and chest; all areas prone to solar damage. Combination therapy is very effective and oftentimes at Suncoast Skin Solutions we combine one of the above peels with laser or light-based techniques, such as intense pulsed light, to stimulate collagen remodeling and remove pigmented lesions, or we utilize topical prescription medications like Retin A™ or Tazorac™ to combat wrinkles, or inject soft tissue fillers and Botox® to eliminate deeper more inset wrinkles. Peels, along with a quality skin care regimen can achieve noticeable results without significant downtime.
At SunCoast Skin Solutions, we understand the nuances of chemical peels, and their use is an important part of the skilled dermatologist’s armamentarium. The process starts with correctly diagnosing the problem, moves then to selection of the right pre-treatment regimen, and then culminates with the application of the right peel for the patient for the right amount of time. A solid post-procedure skin care regimen can aid the process, and ensure lasting results.
Our technique is meticulous, and extreme care is used during the application of the peel, and patient comfort and safety is paramount. Post-care instructions and care of your new layer of skin is an equally critical part of achieving the desired results. Contact our office if you wish to schedule a consultation.