Chemical peels reduce brown spots, improve skin tone and texture, reduce pore size, treat acne and acne scars, add a youthful glow to the skin, and reduce fine lines and scars.
How chemical peels work
Types of Chemical Peels
Peeling solutions are graded from superficial to deep. Superficial peels lift away the top layers of skin, and the stronger solutions go deeper. Glycolic acid, salicylic acid, and Jessner’s solution are superficial peels. Glycolic and salicylic acid peels come in various strengths with more concentrated solutions being more aggressive.
TCA (trichloroacetic acid) peels are more aggressive, and their concentration can be adjusted too. A peel combining both Jessner’s and TCA is more aggressive and is considered a medium depth peel. Phenol provides deeper peeling.
In addition to these chemicals, brand name peels, such as the ViPeel or Perfect Peel, offer different degrees of peeling.
In addition to the concentration and type of solution used, how the skin is prepared also affects the depth of the peel.
What to expect
Prior to getting a chemical peel, you may be prescribed creams such as tretinoin and hydroquinone to make your skin more receptive to peeling and to reduce the chance of discoloration afterwards. For deeper peels, you may also be prescribed an antibiotic and antiviral medication.
On the day of peeling, your skin will be thoroughly scrubbed and the chemical peel solution applied. Peels typically sting for a few minutes during application but do not hurt afterward.
For superficial peels, peeling usually starts 1 – 2 days after the peel is applied and lasts for 2 – 3 days. Sometimes, obvious peeling does not occur after a superficial peel. This is especially true after the first peel. Subsequent peels tend to produce more peeling.
Superficial peels are often performed in a series consisting of 3 to 6 peels performed every 2 to 4 weeks depending on the condition being treated, the type of peel, and the skin type.
Salicylic acid and Jessner’s solution are particularly good superficial peels for treating acne because these chemicals hone in on the oil glands and break apart plugged pores.
Combining two superficial peels together, Jessner’s solution and TCA, results in a deeper peel. Results from this combination are more dramatic, and there is accordingly more downtime. Before this peel, oral medications are prescribed to protect against organisms that may infect the exposed, peeling skin. Stinging occurs during the procedure that lasts 3 – 5 minutes, but there is no pain afterward. Peeling afterward is significant and lasts 5 – 7 days.
Chemical Peel Side Effects
As with any procedure, a chemical peel carries certain risks. The main ones are scarring, infection, and discoloration.
Scarring is directly correlated with the strength of the peel. The deeper the peel, the higher the risk.
Peeling skin is more susceptible to infection by bacteria and cold sore viruses. Additionally, the irritation of a chemical peel can trigger a cold sore breakout. For these reasons, antibiotic and antiviral medications are often started prior to more aggressive peels.
After healing from a chemical peel, skin may appear darker temporarily. This is called hyperpigmentation. Although it is temporary, it is distressing. To minimize the risk, we recommend pre-treating skin with hydroquinone, which is a bleaching cream, to turn down the pigment producing capacity of skin.
Additional measures to avoid discoloration include strict sun protection after a chemical peel.
The length of time peeling depends on the strength of the peel. Skin may only flake for 1-2 days after weaker peels using salicylic or glycolic acids. Peeling typically starts on the third day after the chemical peel.
Peeling may last about a week after a more aggressive TCA peel.
Chemical Peel for Rejuvenation
Chemical peels for rejuvenation treat fine lines, mild discoloration, and provide a youthful glow. For those with minimal damage, light peels repeated every month or two produce great results.
Patients with more damaged skin, require a series of more assertive peels to reduce the damage and then may switch to lighter peels for maintenance.
Chemical Peel for Acne Scars
Acne scars come in a variety of types including rolling, box car, and ice pick. Ice pick scars are the deep, narrow scars.
CROSS (chemical restructuring of superficial scars) is a specific type of peeling technique using very high concentrations of TCA dropped directly into ice pick scars. Although the solution is very concentrated, the amount used is so small that there is usually not much downtime. Treatment often results in only small scabs lasting a few days. Several treatments may be necessary to achieve best results.
A series of traditional chemical peels may also help reduce shallow acne scars. Chemical peels are a helpful technique used in combination with other procedures to treat acne scars.
Chemical Peel for Hyperpigmentation
Although chemical peels carry a risk of triggering hyperpigmentation, they are excellent at treating it too.
Irregular skin tone caused by hyperpigmentation is distressing whether the increased pigment is from sun damage, acne, or melasma.
A variety of peels help reduce hyperpigmentation, and the choice of peel depends on the cause of increased pigment, the amount of downtime one can accept, and the natural tone of the underlying skin.
More moderate peels such as a Jessner’s peel or ViPeel often require a series of treatments for best results; whereas, a more aggressive TCA peel may provide excellent results after one treatment.
Repeating Chemical Peel to Maintain Results
How often you need to repeat a peel depends largely on the condition being treated. For mild sun damage or to add a youthful glow, repeating peels monthly gives great results. Similarly, peels used to treat acne are often repeated monthly.
A deeper peel used to treat fine lines and more severe sun damage may be repeated every 1-2 years.
The CROSS technique for deep acne scars doesn’t need to be repeated once results are achieved. However, multiple treatments repeated every 2-3 months are often needed to achieve optimal results in the first place.
Another very important factor that determines when a peel needs to be repeated is how well the skin is maintained after the peel. For example, it is critical to follow a rejuvenating skincare program which includes the daily use of a broad spectrum sunscreen. I prefer ones that contain zinc.
Similarly, if you got chemical peels to reduce acne scars, you must control your acne to prevent new scars from developing.