Chemical Peels

What is a chemical peel?

A chemical peel, also known as chemexfoliation or dermapeeling, uses a chemical solution to improve the appearance of your skin. In this treatment, a chemical solution is applied to your skin, which causes trauma or injury to your skin’s layers. The skin layers eventually peel off revealing more youthful skin. The new skin is usually smoother with fewer lines and wrinkles, has a more even color and is brighter in complexion.

What conditions does a chemical peel treat?

Chemical peels are used to treat certain skin conditions or to improve your appearance by improving the tone and texture of your skin.

Chemical peels are most commonly performed on your face, neck or hands. They can help reduce or improve:

• Fine lines under your eyes or around your mouth and wrinkling caused by sun damage, aging and hereditary factors.
• Certain types of acne.
• Mild scarring.
• Sun spots, age spots, liver spots, freckles, uneven skin coloring.
• Precancerous scaly spots called actinic keratosis.
• Rough skin, scaly patches, dull complexion.
• Dark patches (melasma) due to pregnancy or taking birth control pills.

You will work with your dermatologist to determine the depth of your peel. This joint decision can vary depending upon the condition of your skin and the objectives of treatment.

Sags, bulges, deep scars, deep facial lines and more severe wrinkles don’t respond well to chemical peels. If these are your concerns, other cosmetic surgical procedures, such as carbon dioxide laser resurfacing, a face lift, brow lift, eye lift or soft tissue filler will be better options. A dermatologic surgeon can help determine the best treatment for your concerns.

Is a chemical peel good for all skin types?

Generally, superficial peels can be used on all skin types. However, if you have a darker skin tone, you have a greater risk of experiencing a darkening of your skin after treatment. This condition is called post-inflammatory hyperpigmentation. If you have a naturally darker skin tone, you may want to get the advice of your dermatologist about other less aggressive treatments to reduce the risk of hyperpigmentation.

Chemical peeling may also not be recommended if you:

• Have a history of abnormal skin scarring.
• Have extra coloring in your scars.
• Have skin conditions or take medications that make your skin more sensitive.
• Can't stay out of the sun for the healing period.

How are chemical peels performed?

A chemical peel can be performed in a doctor’s office or in a surgery center as an outpatient procedure. Your skin will be thoroughly cleansed with an agent that removes excess oils, while your eyes and hair are protected. A chemical solution is then applied to your skin. Chemical solutions typically used include glycolic acid, trichloroacetic acid, salicylic acid, lactic acid or carbolic acid (phenol). The different types of chemicals cause a controlled injury, each penetrating through to a different skin depth, then peeling away to reveal a new layer of skin.

The different chemical solutions provide different results. The choice of chemical depends on your goal. You will work with your dermatologist to determine the depth of your peel.

• A light (“lunchtime”) chemical peel provides subtle improvement over time and is often done in a series. The outermost layer of skin is removed. This choice may be best if you have fine wrinkling, acne, uneven skin coloring or dry, rough sun-damaged skin to help promote a healthy glow. Recovery from this type of peel may be within hours to a few days but with little to no down time.
• A medium chemical peel gives your skin a smooth, fresh look. The outermost layer and the upper part of your middle skin layer are removed. This choice may be best if you have uneven or moderate skin discoloring, age spots, acne scarring or fine-to-moderate wrinkles. Recovery from this type of peel may take a week or more and require some down time.
• A deep chemical peel produces the most dramatic results. This chemical penetrates down to the lower middle layer of your skin. Recovery time is longer with a deep peel. This choice may be best if you have moderate lines and wrinkles, extensive sun-damaged skin, deep acne scars, blotchy skin, and/or precancerous growths called actinic keratosis. A deep chemical peel requires pretreatment for up to eight weeks. Your doctor will provide specific instructions. A deep chemical peel is a one-time only treatment if applied to your face and does have significant down time.

To prepare for your chemical peel, some general instructions include:

• Avoid tanning and direct sun exposure for two weeks before each treatment.
• Apply topical products (such as hydroquinone) as instructed before treatment to prepare your skin.
• Don’t use any products containing retinoids (such as tretinoin) one to two weeks before treatment, unless your physician tells you differently.
• If you have been prescribed oral antibiotics or an oral antiviral medicine, start taking it at least 24 hours before your chemical peel.
• Peel areas must be free of any open sores, lesions or skin infections.

Your doctor will give you specific instructions for your peel type and your unique skin condition.

Day of peel: Your skin will be thoroughly cleaned. If you are having a deep chemical peel, you will receive general anesthesia (you will be asleep).

The procedure: During a chemical peel, solution is applied to your skin. You may feel a warm to somewhat hot sensation that will last a few minutes. This is followed by a stinging sensation. To relieve the sting, a cool compress may be applied your skin. The chemical is then washed off and/or neutralized.

What are the possible complications of chemical peels?

In certain skin types, there’s a risk of a temporary or permanent change in the color of your skin. Taking birth control pills, pregnancy or a family history of brownish discoloration on your face may increase your risk of developing abnormal pigmentation.

There’s also a low risk of scarring in certain areas of your face and certain individuals may be more prone to scarring. If scarring does occur, it can usually be treated with good results.

If you’ve had a history of herpes outbreaks, there’s a small chance of reactivating the cold sore. Your dermatologist can prescribe medication to reduce the chance of a flare up. Follow the instructions of your doctor.

Before your chemical peel, be sure to tell your dermatologist if you have a history of keloids (scar tissue overgrowth created at the site of a skin injury), any unusual scarring tendencies, any X-rays of your face or history of cold sores.

Infections are rare but still a risk.

What should I expect after the chemical peel?

What to expect varies depending on the depth of your chemical peel.

If you’ve had a light chemical peel:

• Expect a sunburn-like reaction to occur after your peel, meaning you’ll see redness followed by scaling that lasts between three and seven days.
• Apply lotion or cream as directed until your skin heals. After your skin heals, apply daily sunscreen.
• You can wear makeup immediately after treatment or the next day.
• Additional peels may be repeated every two to five weeks until you achieve your desired results. Typically three to five peels are needed to achieve your goal.

If you’ve had a medium chemical peel:

• Expect some redness, swelling, stinging and flaking of your skin. Swelling may last and/or worsen for 48 hours. Blisters can develop and will break open. Skin will crust and peel off over seven to 14 days.
• Perform daily soaks as directed by your doctor. Apply ointment after each soak. Apply lotion or cream daily. Don’t expose your skin to sunlight until completely healed.
• Antiviral medication will need to be taken for 10 to 14 days.
• You can wear makeup after five to seven days.
• Additional medium-depth peels may be repeated at six to 12 months intervals, if needed, to maintain results.

If you’ve had a deep chemical peel:

• The treatment area will be bandaged. Your bandages will be removed in a few days. Expect a healing time of 14 to 21 days.
• Perform daily soaks as directed by your doctor. Apply ointment after each soak. After 14 days, apply moisturizer as directed. Don’t expose your skin to sun for three to six months.
• Antiviral medication will need to be taken for 10 to 14 days.
• Wait at least 14 days before using any makeup.
• You can only have one deep peel performed on your face.

To get the best results, regardless of the depth of your peel, follow these tips:

• Don’t use a tanning bed or other type of indoor or even outdoor tanning while your skin is healing.
• After your skin heals, always apply a daily sunscreen.
• Apply a daily moisturizer, as directed, to keep your skin moist to prevent scarring.

Your new skin is fragile and more susceptible to complications. Your doctor will provide you with post-treatment instructions to reduce the chance of developing abnormal skin color after your peel and other complications.

If your skin itches, swells or burns, call your doctor. Scratching your skin could lead to an infection.

Is a chemical peel covered under insurance?

No, usually not. Chemical peels are considered a cosmetic treatment and therefore not covered by insurance.