Chemical Peel (Chemexfoliation or Derma-Peeling)

Chemical Peel Systems

  • Alpha Hydroxy Acid (AHA) peel
    • glycolic acid
    • lactic acid
  • Beta hydroxy Acid (BHA) peel
    • sylicylic acid
  • TCA peel
  • phenol peel
  • Retin-A peel
  • liquid nitrogen

A chemical peel is an excellent way to refresh and rejuvenate the appearance of wrinkled, spotted, or otherwise aged skin. A special solution, containing glycolic acid, trichloroacetic acid (TCA), Retin-A or liquid nitrogen, is applied to the skin to remove damaged outer layers and expose underlying fresh, smooth, unblemished skin. Glycolic peels are great for superficial treatment, and they can be a good option for patients with acne as the solution lifts layers of skin that block pores. With TCA peels the concentration can be varied, giving them more flexibility to treat a variety of facial conditions. The Retin-A® Peel promotes dramatic improvements in skin tone and texture. The deep exfoliation it causes helps to do away with dark sun sports, sun damage, and even fine lines. The Retin-A® Peel is an ideal treatment for patients who are not good candidates for laser skin treatments and for patients of all skin colors. Patients of African, Asian, European, and Hispanic descent can all enjoy the benefits of a Retin-A® Peel treatment. Chemical peel has been used in conjunction with facial massage and relaxation to maximize the treatment efficacy through stimulation of skin circulation to reinvigorate cell renewal, detoxify the skin, balance energy, and ultimately provide complete relaxation.

Despite the proliferation of alternatives, such as laser resurfacing or dermabrasion, chemical peel — a traditional rejuvenating methods in use– remain widely used because they are relatively inexpensive and their short and long-terms effects are well understood. Also, many practitioners have much more experience with peels than with the newer procedures. Chemical peels are based on a very simple idea. A solution of a chemical agent is applied to the skin and the agent’s reaction with the skin causes superficial damage and peeling. Mild peeling solutions only loosen and remove stratum corneum (the upper part of the epidermis consisting of dead cells), while the stronger ones can affect the entire epidermis and even the upper dermis. Hence, chemical peels are classified as light (superficial), medium and deep. The deeper the peel, the greater is the potential for both cosmetic improvement and side effects.

There are 4 major categories of chemical peels. Increasing in strength and epidermis penetration, they are alpha-hydroxy acids (AHAs), beta-hydroxy acids, trichloroacetic acid (TCA), and carbolic acid (phenol). Some chemical peels are actually combo which means they are the mixture of AHA, BHA, or TCA(e.g. Jessner peel). Liquid Nitrogen, strictly speaking, is not a chemical peel, but a cryo (cold)  peel.

Superficial peels -AHA and BHA

Superficial peels are the mildest of the chemical peels and are mainly used to improve skin texture and reduce roughness. They mainly remove stratum coneum (dead skin surface cells) and sometimes the upper epidermis. They might improve discolorations, especially if the peeling solution includes a bleaching agent. Some types of superficial peels (such as salicylic acid peel) may help improve acne but that is not well researched. Superficial peels are generally repeated at regular intervals to maintain results. Improvements with superficial peels are usually short-lived – hence superficial peels are often used repeatedly. Some people get cumulative improvement with repeated superficial peels; others simply maintain initial improvement; yet others see little or no improvement. Superficial peels require no downtime but it is common to have a brief period of redness, flaking and/or skin sensitivity after a peel. However, peels should not be repeated so often as to create a state of chronic skin irritation and hypersensitivity. Otherwise, your skin will actually end up aging faster. The most common agents used for superficial peels are alpha hydroxy acids (e.g. glycolic acid, lactic acid) and beta hydroxy acids (salicylic acid). Sometimes additional bleeching agents (e.g. hydroquinone, kojic acid) or other modifiers are added to customize the effects. Superficial peels, such as 30% alpha or beta hydroxy acid peels, are not considered medical procedures by the FDA and are often performed by estheticians rather than doctors.

AHA peels

* Citric Acid peels: 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 Peels: formulated from sugar cane, this peel 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 Peel: An in-office 70% or less alphahydroxy facial peel to remove dead skin cells, and promote healthier, softer and more radiant skin. Lactic acid helps encourage cell turnover and stimulates collagen formation while helping to smooth and soften skin. This peel is derived from either sour milk or bilberries. 50% strength is a little stronger than the Glycolic Acid Peels but less irritating to the skin than Glycolic Acid.

* Malic Acid Peel: 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 Peels: This peel is derived from grape extract and is capable of delivering the same benefits as the above peels. Have your skin technician determine which is best for your individual needs.

BHA

Salicylic Acid is a Beta Hydroxy Acid and is the only oil soluble acid used in skin care. This makes it particularly suited to acne prone skin and oily skin types. Salicylic acid works best on acne prone and sensitive skin types. Salicylic acid helps dissolve the dirt, sebum and debris in your pores that cause blackheads, enlarged pores and acne outbreaks. Salicylic chemical peels are a perfect remedy for those who naturally have oily skin, severe acne (acne vulgaris), acne rosacea, cystic acne, body acne, clogged pores, whiteheads, and blackheads. It also helps reduce oil production and provides gentle exfoliation. Salicylic acid is an excellent deep pore cleanser with many anti-aging properties. Because of the larger size of the molecule, Salicylic Acid generates less irritation than the Alpha Hydroxy Acids (Glycolic acid), allowing the structure to cling to the surface for longer periods of time, resulting in excellent deep pore cleaning abilities. Salicylic Acid Destroys the bacteria below and unclogges the pores, allowing the skin to breathe.

Though Salicylic acid is typically prepared at lower concentrations then the alpha hydroxy acids (AHA), the acidity (2.97 pKa) is much greater then that of the AHA’s (3.83 pKa Glycolic acid). For example, a low strength Salicylic acid would be greater or equivalent to a higher strength Glycolic acid, depending on certain circumstances of course. Though salicylic acid (a BHA) is stronger then Glycolic (AHA), Salicylic acid is easier and more delicate on the skin. So, for those who cannot tolerate Trichloroacetic Acid (TCA) or Glycolic Acid, Salicylic Acid Peels may be a beneficial alternative.

Medium peels -TCA peels

Medium peels impact the epidermis and upper dermis. The damage caused by the peeling agent induces a healing response and leads to a mild-to-moderate skin remodeling. As a result, medium chemical peel usually improves not only skin texture, but also fine lines and small wrinkles. Deeper wrinkles remain mostly unaffected. Blemishes and discolorations may also improve. Medium peels may needed to be repeated two or more times to obtain the desired result. They would usually be spaced out over several months.

The most common agent for medium peels is trichloroacetic acid (TCA). It is a medium-strength acid, which produces damage by breaking up connections between cells, denaturing proteins in cells and skin matrix and so forth. After TCA treatment the skin surface becomes crusty and mild-to-moderate swelling would generally develop. You will need about 7-10 days of downtime to heal sufficiently to return to work and other normal activities. It is best to avoid sun exposure or at least use heavy UVA+UVB protection for at least a few more weeks. The improvements after medium peel are more lasting compared to superficial peel but fall short of the results delivered by deep peels.

Deep peels

Deep peels affect both epidermis and dermis and are both more effective and more risky than superficial or medium peels. It is mainly used to improve medium-to-deep wrinkles, severe skin roughness and other advanced signs of skin aging. The most common agent used in deep peels is phenol, which produces tissue necrosis by denaturing biological polymers. The degree of skin ablation, typical results, downtime and side effects of a deep peel are comparable to those of ablative laser resurfacing except deep peel is much less expensive.

“Phenol CP [chemical peel] is as effective as the laser in diminishing rhytids [wrinkles] in the thin-skinned areas of the face. The laser produces improved results in the thick, glandular areas of the face, but also produces more intense hypopigmentation, longer periods of patient discomfort, and longer periods of postoperative erythema [redness]. Both phenol CP and laser resurfacing remain useful clinical tools.”

While phenol peel produces greater and longer-lasting results, it is far less common than medium or superficial peel. One reason is that phenol peel requires 2-4 weeks of downtime during which a rather uncomfortable healing process takes place. (After all, like ablative resurfacing, phenol peel creates a large open wound.) Second, there is a substantial risk of both short- and long-term side effects. (Sort-term: infection, edema; long-term: loss of pigmentation, sun sensitivity, scarring.) In fact, pigmentation changes after a phenol peel (and, incidentally, after ablative laser too) are so common that dark skin color is considered a contraindication. Deep peels should be performed by a certified, experienced surgeon. As opposed to superficial and medium peels, which are often repeated to enhance or maintain results, deep peel is performed once.

How Are Chemical Peels Performed

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. The skin is thoroughly cleansed with an agent that removes excess oils and the eyes and hair are protected. One or more chemical solutions, such as glycolic acid, trichloroacetic acid, salicylic acid, lactic acid or carbolic acid (phenol), are applied to small areas on the skin. These applications produce a controlled wound, enabling new, regenerated skin to appear.

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