Bellevue, Seattle Chemical Peels
Chemical peels with glycolic acid (“fruity acid”), salacylic acid and mild TCA (trichloroacetic acid ) are very useful in reversal of mild skin changes induced by sun damage and weathering (solar brown spots, brown pigmentary changes, weathered, thickened, cornified, dry skin). The skin is a living organ made up of millions of cells organized in several layers.
Everyday thousands of cells are sloughed off, and new cells from deeper layers of the skin replace them. As part of aging, this process becomes slower and more disorderly, causing the skin to appear more dull, blotchy and “sun damaged”. The function of a skin peel is to create a controlled shedding of several outer layers of damaged cells. This exposes a new fresh layer of skin with a more even color and a smoother texture. It can also be used to even out brown pigmentary changes (liver spots, sun spots) or to remove precancerous skin lesions such as actinic keratoses.
Application of a light, superficial peel solution causes only minimal discomfort easily tolerated especially if cooling is applied. A series of chemical peels can further magnify the result. Various acidic solutions of varying concentrations such as glycolic acid and trichloroacetic acid (TCA) are painted onto the face producing exfoliation of the superficial layers of skin. Healing time varies with the depth of the peel. Most commonly, Dr.Zemplenyi uses 70% glycolic acid or mild TCA peel and such procedures cause redress of the skin to persist one to two days. Cover-up make-up may be applied immediately to camouflage this redness so that there is no need to loose time from work or social activities.
On the other hand, higher percentage TCA peels (35%) achieve penetration of skin to deeper levels and result in medium depth peeling. This tends to improve fine wrinkles to a greater degree, but a recovery is needed for these medium depth peels (Please see Cosmetic Plastic Procedures). Peels are often performed on neck, chest and hands as many people have age and sun-damage changes of these areas in addition to the face. Fortunately, these peels can be safely performed on these body locations as well. Use of sunscreens to protect the fresh, new skin is mandatory for at least three months following chemical peeling.
- What Is A Chemical Peel?
- A chemical peel is a chemical solution applied to the skin formulated to penetrate to various depth to remove outer layers of skin. Damaged skin is thus sloughed, allowing new skin of improved texture to replace the blemished layer. Peels come in varied strengths for different intensities of treatment. The type of chemical, the time it is left on the skin and the number of application coats, all determine the depth of the treatment. The deeper the peel’s penetration, the more conspicuous the effect, but the longer the recovery and greater the discomfort.
- Where can peels be used?
- Although peels are mainly used on the face, they can be applied to the neck, hands or chest or other areas that may benefit from exfoliation and improved texture.
- Who can benefit from a peel?
- Individuals with many conditions benefit from peel treatment:
- Sun damaged skin
- Acne scars
- Superficial scars
- Skin discoloration
- Age spots
- Fine lines and wrinkles
- Rough, scaly skin patches
- Who should avoid chemical peels?
- Individuals with darkly pigmented skin, Afro-Caribbean or Asian skin, are at risk of uneven pigmentation or loss of pigmentation after chemical peel. Persons with a history of abnormal skin scarring should be cautious. Peels should not be done in an area of an active herpes simplex infection or if acne treatment with isotretinoin has recently been used. Radiation therapy or recent surgery to the area of treatment are additional contraindications to chemical peel since these can inhibit skin regeneration.
- What are the different types of chemical peels?
- Chemical peels can be divided into light, medium and deep peels. Light chemical peels affect only the most superficial layer of skin and can be used on all skin types. A mild acid such as glycolic acid is most often used. Combinations of alpha hydroxy acids and beta hydroxy acids such as lactic acid, salicylic and maleic acid can also be used. These peels can brighten complexions and help those with dryness, acne, fine wrinkling or uneven pigmentation. Repeat treatment will continue the refreshing effect of these peels. Medium chemical peels penetrate the superficial epidermis layer through to the upper part of the deeper layer underneath, the dermis. Since they reache deeper into the skin, medium peels can treat deeper wrinkles as well as acne scars and even pigmentation. Trichloroacetic acid is a commonly used agent for this depth peel, sometimes used in combination with a lighter peel such as glycolic acid. Deep chemical peels penetrate from the epidermis through the dermis, causing a second-degree burn of the skin. These may be used to improve deeper wrinkles, treat pre-cancerous growths and blotchy skin color. Phenol is the chemical used for these treatments. The deeper penetration of these peels carries the risk of hypopigmentation where the skin pigment does not regenerate leaving lighter colored areas. For this reason, deep peels should not be used in dark colored individuals and even lighter-skinned people can experience skin bleaching. Phenol peels should not be repeated.
- What kind of anesthesia is used during a chemical peel?
- Light chemicalpeels generally do not require anesthetic. Cool air decreases any stinging sensation felt during application and penetration of the chemical. Patients are comfortable after the treatment and do not require analgesia post-procedure. Medium peelswith their greater penetration to tackle deeper wrinkles, generally require more pain relief. Oral medication before treatment along with cooling during the procedure keep the patient comfortable. Deep peels are the most painful because they reach deep into the dermal layer to attack lines and wrinkles. Oral pain medication and sedatives to control pain and anxiety are given. IV sedation or a shot can also be part of the pain-control regimen. Oral pain medication may also be needed after the procedure.
- How do you prepare for a chemical peel?
- First you and the doctor will decide on the type of chemical people you want depending on the desired effects, your skin type and length of recovery. There may be a small “test spot” of chemical peel placed to see how you respond to the chemical. In some cases, pre-treatment with tretinoin (Retin A) is suggested. This is an acne treatment medication which will allow the chemical peel to penetrate faster and may speed healing. All patients should use sunscreen before and after chemical peel treatment. Additionally, patients with a history of cold sores, herpes simplex infection, may be started on an anti-viral medication such as acyclovir to prevent viral infection.
- What can I expect during the chemical peel procedure?
- Light chemical peel: The skin is first thoroughly cleaned, the chemical is then carefully applied across the treatment area with a small brush or gauze. After application, the peeling agent is left on the skin for several minutes, then neutralized and washed off. The sting which can be felt during the procedure is relieved by cooling the area with cool blown air. Medium chemical peel: A medium chemical peel is performed in much the same manner as a light peel, but the chemical agent may be left on for a longer time. The procedure may last 40 minutes. Because of deeper skin penetration, medium peels are more painful than the more superficial light peels. Cooling relieves the discomfort but oral medication may be needed for pain control during the procedure. Deep chemical peel: Because of the depth of skin penetration, as stated above, deep peels require sedation. Following proper anesthesia administration, the skin is meticulously cleaned, the chemical is applied and allowed to penetrate. After the appropriate amount of time, the chemical is neutralized and a thick coat of ointment is smoothed over the treated area with a gauze cover to keep the area moist and to minimize pain. The ointment and dressing are removed after two days and the process is repeated as needed while healing occurs. A deep peel may take 60 to 90 minutes to perform.
- What can I expect after a chemical peel? What is the recovery time for a chemical peel?
- The experience and recovery after a chemical peel depends on the type of peel. Light chemical peels usually leave the person with pink skin which may sting and with temporary peeling. Regular social and work activities may be resumed immediately with cover-up make up applied to camouflage any redness. The skin should be cleaned daily with either water or a wash as instructed by your doctor and moisturizer should be used daily. It is important to avoid sun exposure until skin peeling stops and then use sunscreen whenever exposed to the sun since the new skin is more susceptible to sun damage. Medium chemical peels as opposed to light peels, leave the skin redder for a longer period of time, sometime requiring a few days off of work. The peel causes a second degree sun burn which may take a week to heal. The skin first turns reddish brown for a couple of days, then crusty and then peels. An ointment or a dressing, as instructed by your doctor, should be placed on the healing skin to keep it moist as it regenerates. After the skin has healed, makeup can be applied to hide the redness. Although discomfort is minimal, there may be some swelling, especially in the thin skin under the eyes. As with the lighter peel, washing, moisturizing and sun screen are important after the skin has healed. It may take six weeks for the skin to return to normal. Deep chemical peels result in a deeper second degree sunburn which may require up to two weeks for the skin to grow back. The skin will be red and crusty and then peel during which time it is important to keep the wound moist with ointment and wash to keep the crusts from accumulating. Acyclovir, an anti-viral, may be given to prevent infection during healing. There may be swelling as the skin heals which can be decreased by keeping the head elevated and may even need corticosteroids administration. Patients generally stay off from work until the skin has healed enough for makeup to hide the redness. The redness gradually resolves over as long as three months. Moisturizers and sunscreen are essential over the sensitive regenerated skin. There can be pain the first few days after the peel which oral medications can control.
- What are the risks associated with chemical peels?
- All peels involve certain risks which are more severe and longer lasting the deeper the peel:
- Peeling, crusting
- Color change, either hyper or hypopigmentation
- Infection (especially for people with history of herpes simplex infection)
- Failure to achieve desired result
- Allergic reaction to the chemical
- What is the cost of a chemical peel?
- The cost of a peel depends on the type of peel and the number of treatments involved.