Chemical Peels PDF Print E-mail

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Purpose: To improve the appearance of the skin, correct the appearance of facial blemishes, and to reduce the effects of smoking and sun exposure.  Peels can also be used for reducing uneven pigmentation, acne and acne scarring.

 

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Procedure: A chemical peel is designed to accelerate the removal of old, dead skin cells at the surface of the skin to promote new cell growth, and can be used to treat a particular area (such as lines around the eyes or mouth), or all over the face, arms, hands and neck.

Chemical peels can take anything from just a few minutes to over thirty minutes, depending on the type of peel that you are having. There are three types of peel: superficial, medium, or deep. With all types of peel you may need to use specified homecare products before your peel. These products will help to prepare your skin and ensure that it is in optimum condition prior to the peel. You may also need to use specified homecare products after your peel.


Superficial Peels: Remove skin cells from the epidermis (the top layer of the skin). These peels usually use combinations of alphahydroxy acids (AHAs) and betahydroxy acids (BHAs) e.g. glycolic acid, lactic acid, salycilic acid and maleic acid. Treatment takes only a few minutes, and your skin may feel pink and feel tight for a couple of hours after the treatment.

These types of peels can provide smoother, brighter-looking skin for people who can't spare the time to recover from a medium or deep peel. AHA peels may be used to treat fine wrinkling, areas of dryness, uneven pigmentation and acne. Various concentrations of an AHA may be applied weekly or at longer intervals to obtain the best result. Your doctor will make this decision during your consultation and as the treatment proceeds. An alphahydroxy acid, such as glycolic acid, can also be mixed with a facial wash or cream in lesser concentrations as part of a daily skin-care regimen to improve the skin's texture. As superficial peels only affect the top layers of the skin you may need to have regular treatments to maintain the effect.

  

Medium Peels: Can remove skin cells from both the epidermis and upper part of the dermis (the middle layer of the skin). These peels usually contain trichloroacetic acid (TCA) and this is sometimes used in combination with glycolic acid. The peel remains on your face for a few minutes before being neutralized. A burning or stinging sensation may be felt during the application of the peel and the skin may go brown or red in the days after the peel. It can take up to six weeks for the skin to return to normal. The results of TCA peel are usually less dramatic than and not as long-lasting as those of a phenol peel. Medium peels may need to be repeated every 6 - 12 months to maintain the effect. The recovery from a TCA peel is usually shorter than with a phenol peel.

  

Deep Peels: Go deeper into the lower part of the dermis. They are performed using phenol (a strong form of TCA) and may require a local anesthetic and sedative. The peel is applied to the face, and the treatment feels as if the face is 'freezing'. The peel may be left on the face for up to 30 minutes or more, depending in the desired affect. Post-peel pain is treated with painkillers. There will be some peeling, redness and discomfort for a few days depending on the type of peel used. You should use the recommended cleanser and cream, wear no make up for the first 24 hours and use sunscreen. Most of the swelling should disappear within 14 days, although there may be some redness of the skin for some time after that - up to three months in some people. It is used mainly to treat patients with coarse facial wrinkles, areas of blotchy or damaged skin caused by sun exposure, or pre-cancerous growths. Since phenol sometimes lightens the treated areas, your skin pigmentation may be a determining factor as to whether or not this is an appropriate treatment for you. Phenol is primarily used on the face; scarring may result if it's applied to the neck or other body areas. A deep peel is a 'one-off' treatment with lasting effects, unlike superficial and medium peels.

  

Results: As described above, the result will depend on what chemicals are used, how deep the peel is and any special requirements you may have.

 

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The Risks of Chemical Peels: There are some risks associated with chemical peels, including infection, skin colour changes and scarring. The treated skin may appear darker or be tight or swollen for a time. You will need to avoid exposure to the sun for some time after your peel, but your surgeon will give you full information on this and other aftercare, depending on the strength of your peel. Phenol may pose a special risk for patients with a history of heart disease. It's important that you make your surgeon aware of any heart problems when your medical history is taken.


Before you start: Make sure you know what to expect from a chemical peel. Chemical peels cannot change pore size, tighten loose skin or remove deep scars. 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. Some doctors prescribe a pre-treatment skin regime (for four to eight weeks).


Peel Formulas at a Glance


Alphahydroxy acids (AHAs) - Uses:

  

* Smooths rough, dry skin


* Improves texture of sun-damaged skin


* Aids in control of acne


* Can be mixed with bleaching agent to correct pigment problems


* Can be used as TCA pre-treatment


Considerations:


* A series of peels may be needed


* As with most peel treatments, sun block use is recommended
  

Trichloroacetic acid (TCA) - Uses:


* Smoothes out fine surface wrinkles

   
* Removes superficial blemishes


* Corrects pigment problems

  

Considerations:


* Can be used on neck or other body areas


* May require pre-treatment with Retin-A or AHA creams


* Treatment takes only 10-15 minutes


* Preferred for darker-skinned patients


* Peel depth can be adjusted


* Repeat treatment may be needed to maintain results 

  
* Sun block must be used for several months


* Healing is usually quick, much quicker than with a phenol peel


Phenol - Uses:


* Corrects blotches caused by: sun exposure, birth-control pills, aging


* Smoothes out coarse wrinkles


* Removes pre-cancerous growths


Considerations:


* Used on the face only


* Not recommended for dark-skinned individuals


* Procedure may pose risk for patients with heart problems


* Full-face treatment may take one hour or more


* Recovery may be slow - Complete healing may take several months


* May permanently remove facial freckles


* Sun protection, including sun block, must always be used


* Results are dramatic and long-lasting


* Permanent skin lightening and lines of demarcation may occur


Planning for a Chemical Peel: During your initial consultation, it is important that you discuss your expectations with your plastic surgeon. Don't hesitate to ask any questions or express any concerns that you may have. Your plastic surgeon will explain the planned procedure in detail, including its risks and benefits, and the recovery period. If you have a history of herpes, you should inform your physician prior to the procedure.

  

Preparing For Your Chemical Peel: Your plastic surgeon will instruct you on how to prepare for your peel treatment. Sometimes Retin A - a prescription medication derived from Vitamin A is used to pre-treat the skin. This thins out the skin's surface layer, allowing the TCA solution to penetrate more deeply and evenly. If your skin won't tolerate Retin-A pre-treatment, an AHA cream may be used instead. Hydroquinone, a bleaching agent, is sometimes used in conjunction with Retin-A or AHA pre-treatment, especially if you have blotchy skin areas or pigmentation problems. You may have to spend a month or more in the pre-treatment phase before the doctor will schedule your actual peel. You will need to arrange for someone to drive you home and help you out for a day or two if you are having a phenol or deeper TCA peel. You probably won't need any extra assistance if you're having an AHA peel or superficial TCA peel.


Where Your Peel Will Be Performed
Most chemical peels may be safely performed in a plastic surgeon's office, office-based surgical facility or outpatient surgical center. Your plastic surgeon may want you to stay overnight in a facility or hospital if other cosmetic procedures are performed simultaneously.


Types of Anaesthesia: Anaesthesia isn't required for phenol or TCA peels because the chemical solution acts as an anaesthetic. However, sedation may be used before and during the procedure to relax you and keep you comfortable. No anaesthesia is needed for AHA peels since they cause only a slight stinging sensation during application.

 

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The Peel: AHA peels/treatments: Your doctor will apply the AHA solution to your cleansed facial skin, a process that usually takes no more than 10 minutes. No "after-peel" ointment or covering is required. Depending on the strength of the peel, periodic treatments may be necessary until the desired effects are achieved. For some patients, the application of an AHA-based face wash or cream once or twice a day at home will be sufficient to accomplish the desired goal. Your plastic surgeon may add Retin-A or a bleaching agent to your at-home treatment schedule. After several weeks of at-home use, your doctor will examine your skin to determine if your regimen needs adjustment. Phenol and TCA peels: Typically, the skin is first thoroughly cleansed. Then, the surgeon will carefully apply the phenol or TCA solution. You may feel a stinging sensation as the peel solution is applied, but this feeling will quickly pass. A full-face TCA peel usually takes no more than 15 minutes. Two or more TCA peels may be needed to obtain the desired result, and those may be spaced out over several months. Mild TCA peels may be repeated as often as every month. If phenol solution has been used, your plastic surgeon may coat the treated area with petroleum jelly or a waterproof adhesive tape. With lighter peels, no covering is necessary. A full-face phenol peel generally takes one or two hours to perform, while a phenol peel to a smaller facial region (perhaps the skin above the upper lip) may take only 10 or 15 minutes. A single treatment usually suffices.

    

After Your Treatment: After an AHA peel, it is common to experience some temporary flaking or scaling, redness and dryness of the skin. However, these conditions will disappear as the skin adjusts to treatment. After a phenol or TCA peel, your doctor may prescribe a mild pain medication to relieve any tingling or throbbing you may feel. If tape was used to cover your face, it will be removed after a day or two. A crust or scab will form on the treated area. To help your face heal properly, it is essential that you follow your doctor's specific post-operative instructions. A TCA peel may also cause significant swelling, depending on the strength of the peel used. If you've had a phenol peel, your face may become quite swollen. Your eyes may even be swollen shut temporarily. You will need someone to help care for you for a day or two. You may also be limited to a liquid diet and advised not to talk very much during the first few days of recovery.


Getting Back to Normal: With an AHA peel, the temporary redness, flaking and dryness that you experience will not prevent you from working or engaging in your normal activities. A fresher and improved skin texture will result with continued AHA treatments. Remember, protecting your skin from the sun is also important following these mild acid peels. Ask your doctor to recommend a sun block with adequate UVA and UVB protection and use it every day. With a TCA peel, the moderate discomfort and mild swelling you may experience will subside within the first week. In about a week to ten days, your new skin will be apparent and you should be healed sufficiently to return to your normal activities. It is best to avoid sun exposure unless you are adequately protected. With a phenol peel, new skin will begin to form in about seven to ten days. Your face will be very red at first, gradually fading to a pinkish colour over the following weeks to months. During this time, it is especially important that you use a sun block or blotchy, irregular skin colouring may result. About two weeks after treatment, you may return to work and resume some of your normal activities. Your skin will be healed enough for you to wear makeup.


Your New Look: Improvements from AHA peels may be very subtle at first. You may detect a healthier glow to your skin. With continued treatments, you will notice a general improvement in the texture of your skin. The results of a TCA peel are usually not as long-lasting as those of phenol peel. However, your skin will be noticeably smoother and fresher-looking. If you're planning a phenol peel, you can expect dramatic improvement in the surface of your skin - fewer fine wrinkles, fewer blemishes and more even-toned skin. Your results will be long-lasting, although not immune to the effects of aging and sun exposure.

 

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Last Updated ( Wednesday, 26 August 2009 )