Chemical peels for skin resurfacing
Chemical peels, also known as chemexfoliation or derma-peeling, are a technique used to improve the appearance of the skin. In this treatment, a chemical solution is applied to the skin, which causes it to "blister" and eventually peel off. The new, regenerated skin is usually smoother and less wrinkled than the old skin. The new skin also is temporarily more sensitive to the sun.
Chemical peeling (chemexfoliation) for the treatment of certain cutaneous diseases or conditions or for aesthetic improvement consists of the application of one or more chemical exfoliating agents to the skin, resulting in destruction of portions of the epidermis and/or dermis and the regeneration of new epidermal and dermal tissues. See Table I for definitions of some terminology used in this document.
Chemical peel uses a chemical solution to improve and smooth the texture of the facial skin by removing its damaged outer layers. It is helpful for those individuals with facial blemishes, wrinkles and uneven skin pigmentation. Phenol, trichloroacetic acid (TCA) and alphahydroxy acids (AHAs) are used for this purpose. The precise formula used may be adjusted to meet each patient's needs. Although chemical peel may be performed in conjunction with a facelift, it is not a substitute for such surgery, nor will it prevent or slow the aging process. This brochure provides basic information about certain types of chemical peel treatments and the results you might expect. It won't answer all your questions, since a lot depends on your individual circumstances. Once you and your plastic surgeon have decided on a specific peel program, be sure to ask about any details that you do not understand.
Glycolic acid and Jessner's peels result in superficial skin injury and are well tolerated - the 'lunchtime' peel. They remove thin lesions on the skin surface, reducing pigment and surface dryness. The result of the first peel may be disappointing, but after repeated peels, significant improvement is usually evident.
Trichloracetic acid (TCA) is the most common chemical used for a medium depth peel. The results depend on its concentration, usually 20 to 35%. The treatment is painful and treated areas are swollen, red and crusted for the next week or so. It can lead to an impressive improvement in skin texture with a reduction in blotchy pigmentation, freckling and solar keratoses (dry sunspots). Although fine wrinkles and some acne scars are less obvious, the TCA peel has no effect on deep furrows.
Phenol results in deep skin injury. It is rarely used for facial peels nowadays because of the risk of scarring and because of its toxicity. Absorption of phenol through the skin results in potentially fatal heart rhythm disturbances and nerve damage. However, it is very effective at improving both surface wrinkles and deep furrows. After a phenol peel, the treated skin is pale and smooth but it may be waxy and "mask-like".
All chemical peels carry some uncertainty and risk Chemical peel is normally a safe procedure when it is performed by a qualified, experienced plastic surgeon. However, some unpredictability and risks such as infection and scarring, while infrequent, are possible.
Fine wrinkling can be reduced, though deeper lines will remain, (some of which can be improved by other methods) with chemical peeling. Most brown marks, freckles and pigmentation can be removed or lessened, especially age and liver spots (lentigines). However, pigment changes can be caused by a peel in people prone to this complication due to their skin type. Those known to develop brown discolouration after injury such as a mild burn should have a test area peeled first before undergoing a full face chemical peel. Scaly patches and rough skin (keratoses) can be removed. Very thick keratoses may needadditional treatment for complete removal.
Skin that is thin and fragile eg sun-damaged skin, bald scalpskin, can be significantly rejuvenated.
Chemical peeling is not a substitute for a facelift. It does not tighten sagging skin, stimulate collagen production or remove broken capillaries. Chemical peeling is not appropriate for people who will continue to have excessive sun exposure.Superficial chemical peels are a minor procedure and no special arrangements are needed. But you may need painkillers, sedation, local anaesthetic or even a general anaesthetic for deeper peels.
First the face is thoroughly washed to remove surface oil. The peeling agent is then applied for several minutes. It stings - how badly and for how long depends on the chemical, its concentration, whether you've had pre-treatment with aspirin, and individual factors. A fan can help. The peel is then neutralised, and the burning sensation lessens. Individual treatments may include peels with several agents on the same occasion, with the aim of improving results and reducing risks.
Antibiotics and oral antiviral agents may be recommended after deeper peels. Superficial peels result in mild facial redness and occasional swelling which usually resolve within 48 hours. The peeling is similar to sunburn. Most people can continue their normal activities. Make-up can be applied a few hours after the procedure. Moderate depth peels result in intense inflammation and swelling, which resolve within a week. The peeling is more marked. Mild redness can persist for several weeks. Most people take a week off from work after a moderate depth peel.