- People have been using chemical peels since the ancient Egyptians, Greeks, and Romans.
- Both at-home and clinical chemical peels can help to treat a number of skin concerns.
- Without proper protection and an appropriate post-care regimen, the likelihood of complications rises significantly
How do chemical peels work?
Chemical peels stimulate exfoliation of the epidermis — the top most layer of skin. Among other common skin concerns, chemical peel may benefit those with pigmentary, issues, acne, or fine wrinkles.
The body’s ability to repair the skin via various pathways is still not well understood. What we do know is that the better quality skin below becomes brighter, tighter, and more even-toned through the repair mechanism triggered by chemical peels.
Most clinical providers getting patients prepared for chemical peels will recommend a topical retinoid or alpha-hydroxy acid (AHA) based treatments — such as glycolic acid — to prime the skin for more even results.
For patients who suffer from cold sores caused by herpes infection, providers will typically give patients oral anti-viral medication the day before the chemical peel and have them continue taking it every day for up to seven days.
Using a test called the Fitzpatrick scale, dermatologists may also decide that your skin tone is not suitable for deeper peels. This is often true for patients with darker skin tones (IV-VI on the Fitzpatrick scale) as peels are more likely to lead to skin discoloration.
Types of chemical peels
Chemical peels are classified by their depth: superficial, medium, or deep.
While superficial peels exfoliate the epidermis, medium-depth peels can penetrate deeper into the epidermis and upper layers of dermis, and deep peels can penetrate all the way down into the lower layers of the dermis (anatomically defined as the reticular dermis).
Peel “depth” and indications of use vary depending on the ingredients, their concentration, pH, time of application, and how they are applied.
|Substances typically used||Alpha-hydroxy acid:|
|Trichloroacetic acid (TCA) +/- components of superficial peels||TCA + phenol|
|Frequency||Every 2-4 weeks||Every 1-2 months||Possibly once*|
|Pain level||Heat or tingling sensation||More intense heat or tingling||Very intense pain usually requiring general anesthesia|
|Number of treatments||4-6 applications||1-6 applications depending on goal||1 application|
|Downtime (redness, peeling)||1-7 days||1-2 weeks||2-4 weeks|
* Skin changes caused by deep phenol peels have been observed for as long as 20 years after the procedure was performed.
Superficial peels use alpha-hydroxy acid or beta-hydroxy acid. When applied, these acids may cause a mild tingling or warm sensation.
Superficial peels are most often used for photoaging changes, pigmentary disorders, and acne. Photoaging causes fine lines, tactile roughness, and liver spots. Pigmentary disorders include melasma (typically a hormone-related pigmentation disorder), and post-inflammatory hyperpigmentation.
Jessner’s solutions – a widely known combination of salicylic acid, lactic acid, resorcinol, and ethanol – belong in the category of superficial peels. These peels have been proven in many clinical dermatologic journals to not only improve skin quality and clarity, but also to help treat female hormone-related acne.
These treatments should be applied four to six times at intervals of two to four weeks for optimal results. Each application is followed by one to seven days of redness and peeling.
Trichloroacetic acid (TCA) is used for more advanced chemical peels. While available for at-home use, these peels should generally be performed by an experienced practitioner.
Medium peels are applicable to all conditions associated with superficial peels, as well as acne scars, pockmarks, and other types of superficial scarring. These peels will cause a more intense heat or tingling sensation than superficial options, but should not be particularly painful.
Depending on the issue that you are attempting to correct, you may require between one and six treatments at one to two month intervals. Each treatment will lead to one or two weeks of redness and peeling.
TCA and phenol peels are used for deep peels. This option is only recommended for use by qualified professionals as it often requires general anesthesia due to the significant discomfort caused by the procedure.
Deep peels are used for severe photoaging, pigmentary disorders, and scarring. Other less studied uses for these peels include flat warts, rhinophyma (a severe type of rosacea on the nose), and pseudofolliculitis barbae (hair bumps of the beard or back of the neck at the hairline).
Only one treatment may be required, but redness and peeling may last for as long as a month.
Professional chemical peels
Some of the best peels on the market — brands like SkinMedica, Skinceuticals, VI Aesthetics, and Obagi — are exclusively used in aesthetic medical offices.
Vitalize and Illuminize peels by SkinMedica are both designed to minimize downtime.
Illuminize can only be used on those with lighter skin tones (I-IV on the Fitzpatrick scale), while Vitalize can be used on all skin tones. Vitalize is widely considered to be the more popular of the two options.
Advanced Corrective Peel by Skinceuticals is another common in-office peel that uses clinical-grade acids to correct discoloration and minimize enlarged pores. This peel can be used on skin tones that fall between I-V on the Fitzpatrick scale, meaning that it is suitable for all but the darkest skin tones.
VI Peel comes in five variations — including VI Peel with Precision Plus, VI Peel PURIFY — to specifically target a patient’s needs. These peels target signs of aging, skin damage, discoloration, or a combination of these issues. VI Peels may be used on all skin tones, with extra caution needed when applied to darker skin tones.
Each brand has its merits and without trying all varieties of peels at various levels, it can be difficult to identify one peel as being truly superior to another for your specific skin issue. Talk with your provider about which peel best meets your concerns, budget, and available recovery time.
At-home chemical peels
When performing any type of chemical peel at home, it is important to take safety into account. Attempting to use chemicals intended for clinical use can be dangerous, not to mention damaging to the skin, if not performed properly. As a result, at-home peels should be limited to superficial peels.
Before committing to any peel treatment, spot tests should be performed in order to minimize any potential damage.
There are also a number of mild homemade chemical peels to treat a variety of skin issues. These peels typically use the natural qualities of everyday products — such as lemon juice and baking soda — to improve the skin’s tone and texture.
Warnings and side effects
Every procedure comes with some level of risk. Superficial peels are the least likely to cause side effects, whereas deep level peels carry a greater risk. Superficial peels can cause redness, temporary skin darkening (hyperpigmentation), and acne. Medium depth peels share the same risks as superficial peels, and may also lead to sun spots or lentigines (small brown patches).
In addition to all of the previously mentioned side effect, deep level peels are associated with hypopigmentation (light spots) that may be temporary or permanent. In rare cases, phenol may also induce arrhythmia.
Patients with active herpes infection should stay away from peels, as should those who are pregnant or nursing. Peels that contain phenol are not recommended for patients with kidney disease.
Those with darker skin tones have a higher risk of experiencing skin discoloration if a chemical peel is improperly performed or if the wrong type of peel is applied. If you have a darker skin tone (IV-VI on the Fitzpatrick scale), you should exercise a level of caution when seeking chemical peels.
Chemical peel before and after
Peels can make freckles vanish, sunspots disappear, and fine lines to fade away.
Below are some images provided by companies that document their own studies on peels, as well as a few images of deeper peel transformations.
Keep in mind that not every patient will see the same results as the next. In other words, as the old adage goes, “your results may vary”.
In general, superficial peels range from $100-300, whereas a deep peel may cost as much as $6,000. Bare in mind, however, that the deep-level peels are done no more than once a year and sometimes never require a second session, whereas the superficial peels usually require at least four to six sessions.
No patient or provider should underestimate the importance of post-procedure skin care. Without proper protection and an appropriate post-care regimen, the likelihood of complications rises significantly.
Daily sunscreen use, herpes flare up prevention, and hydroquinone (bleaching cream) treatments may be part of your post-care regimen. Paying attention to your provider’s instructions once you leave the office will ensure the best results possible.