The chemical peel has been performed since the times of ancient Egypt, Greece, and Rome to help people achieve smoother, more youthful skin. Today, chemical facial peels are popular because they offer nearly immediate non-surgical results and can be performed as an outpatient procedure, with little downtime. If you would like to reduce or eliminate the appearance of fine lines, wrinkles, acne scarring, sun damage and uneven pigmentation, or if you simply want to rejuvenate your skin, Dr. Armstrong can work with you to decide which kind of peel is best for your skin.
Skin resurfacing historically was performed with a wire brush or sanding wheel (dermabrasion). Modern alternatives include laser treatment and chemical peeling. There are advantages and disadvantages to each type of treatment but they can also be broadly categorized by the depth of changes to be expected.
Superficial Exfoliation is routinely performed by licensed estheticians using microdermabrasion, abrasive scrubs or with exfoliating lotions. These treatments are very safe and can provide a relaxing and refreshing improvement in skin quality by removing the superficial horny layer of skin and uncovering the newer skin cells that lie beneath. There is virtually no risk of scarring with these treatments and you may apply makeup and resume normal activity immediately.
“Lunch time peels” include light glycolic acid peels and physician-supervised microdermabrasion, which are designed to lift off the superficial epidermis. These treatments are more effective at bringing out a pink healthy glow but are slightly uncomfortable and have a small risk of leaving some crusting or flaking after the procedure. You might look like you have spent a little too much time in the sun after one of these treatments. Intense pulse light (IPL) “Fotofacials” can also be included among lunch time treatments. While glycolic acid and microdermabrasion are more effective at exfoliating, Fotofacials are more effective for removing pigmented freckles and spider veins. All of these will minimally tighten the very finest wrinkles.
Medium depth treatments involve some visible recovery. The most commonly performed treatment in our office is a Jesner’s/35% trichloroacetic acid peel. These treatments are a little bit more painful and resemble a moderate sunburn. The skin will darken and then flake off over a course of a week such that the entire epidermis is replaced with fresh new skin. This will give a dramatic improvement in the homogeneity of color and texture, although it will not remove deep wrinkles. There is a small risk of scarring and of changes in skin color, especially with darker skin types. This type of treatment can also be performed by traditional dermabrasion or with Erbium laser or newer fractionated lasers. Results of medium peels, light dermabrasion and medium depth lasers are comparable.
The most aggressive treatments available are deep dermal ablations. These are chemical peels performed with phenol or Baker’s solution or they may be performed with traditional carbon dioxide laser or with deep dermabrasion. In skilled hands, these procedures can dramatically reduce the presence of acne marks, smoker’s lines and even moderate wrinkles and produce a significant tightening in the skin. These procedures do come with a risk of scarring and they create an open wound that requires significant wound care for 2-3 weeks after surgery. These procedures require constant application of moisturizing masks and possibly even taping or bandaging the face for the first week. These procedures also leave significant redness that can last for up to six months and which ordinarily requires camouflage makeup.
Postoperative skin care is important to maintain healthy skin. Our esthetician can make recommendations based on your skin type and can custom-blend maintenance products prescribed for your skin. The face should be washed twice daily with a mild cleanser — avoid harsh drying soaps. A toner will then restore the normal pH following the use of alkaline cleansers. Moisturizers should be applied twice daily. Acne prone or oily skin is best treated with foaming cleansers followed by a water-based moisturizer. Dry skin types may do better with creamy cleansers followed by an oil-based moisturizer. Avoid the sun for 30 days after a medium or deep treatment. After full healing, choose a moisturizer with a sun protection factor (SPF) of at least 15 for indirect daily sun exposure. Apply SPF 30 or greater if you plan to be in the sun for more than one hour. Additional maintenance treatments may including hydroquinones, alpha-hydroxy acids and Vitamin A derivatives should also be avoided for the first month.
- Milia and acne outbreaks. Acne outbreaks often occur immediately after a peel and should resolve within a few days. After the first week, milia may develop. These are tiny cysts that occur from resurfacing and they may need to be lanced with a needle. If they persist more than a month then retinoic acid may be helpful. Herpes simplex outbreaks are more worrisome and are characterized by clustered lesions with more of a yellow vesicle that burns painfully. This needs to be treated immediately with antiviral medication as it can cause scarring.
- Hyperpigmentation can develop 3-5 weeks after a chemical peel. Patients with dark skin should start on hydroquinone 4% three weeks after the procedure every other day and then begin nightly application after five weeks. This product is too irritating to use immediately. Hypopigmentation can also occur several weeks after resurfacing and is most and is generally limited to deep chemical peels such as phenol or C02 laser resurfacing. There is a very small risk of hypopigmentation with 35% TCA. Symptoms may be more noticeable along the jaw line. The risk is less noticeable on the lower lids, glabella and around the mouth.
- Redness is expected for 1-2 weeks after medium depth treatments but may last for several months after deep treatments. Redness that persists beyond the expected time or which is becoming worse should be quickly evaluated for potential dermatitis. Early recognition and treatment is important to prevent scarring. Treatments may include tropical or even systemic steroids.
- Scarring is a very rare complication of cutaneous resurfacing. The risk of scarring is greatest with deeper treatments but I have even seen one scar occur with a superficial glycolic acid treatment. Any problems with healing should be immediately brought to Dr. Armstrong’s attention.