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Cosmetic Surgery For The Face

Chemical Peel

Last modified: 
21/03/2012 - 12:58

Contributing Author: Guy Slowik FRCS

What Is A Chemical peel?

A chemical peel is the application of an acid to the skin to achieve a controlled burn to the top layers of skin. Chemical peels are used to remove

  • fine lines, especially around the mouth
  • small scars
  • discolorations such as freckles or liver spots
  • areas of sun damaged skin and spots of precancerous keratoses

Peels can be applied to the whole face or to an isolated area, such as the upper lip. A full-face peel is usually done as a separate procedure before or after a face lift or eyelid surgery. However, if only a small area is being treated, the peel may be done at the same time as the surgical procedure. Chemical peels cannot be done around the eyes.

The type and concentration of acid controls the depth of the burn used to achieve superficial, medium, and deep peels.

  • Superficial peels are produced using alphahydroxy acids (AHA) (glycolic, lactic, and fruit acids). AHA peels are used to treat rough, dry skin and improve texture. These acids can be mixed with a bleaching agent to correct uneven pigmentation.
  • Medium peels are most often done using trichloroacetic acid (TCA). TCA peels are used to treat fine wrinkles and superficial blemishes.
  • Deep peels are produced using carbolic acid (phenol). It is used to treat coarse wrinkles, blotches caused by sun, birth-control pills, or aging, and precancerous growths. Phenol is almost always used only on the face. It may cause scarring on the neck or other areas of the body.

Nice To Know:

Regulation of chemical peels varies from state to state.

  • Some states do not require personnel applying any type of chemical peel to have a medical degree.
  • Other states regulate the types of peels that can be applied by non-physicians.

Caution is advised in choosing a practitioner to apply deep chemical peels using phenol or TCA.

The Procedure

Before the chemical is applied, the skin of the face is thoroughly cleaned with an agent to remove excess oils. The eyes and hair are protected from contact with the acid. The physician then applies the chemical to the face.

AHA peels. The process of applying an AHA solution should take no more than 10 minutes. Periodic treatments may be needed to achieve the desired result. Some people may be able to achieve the desired result by twice-daily applications of a face wash or cream containing an AHA.

TCA peels. A full-face TCA peel should take no more than 15 minutes. The solution may sting when it is first applied, but the feeling will pass quickly. Two or more TCA peels may be needed to obtain the desired result. The treatments may be spaced out over several months.

Phenol peels. After a phenol peel, the physician may coat the treated area with petroleum jelly or waterproof adhesive tape. A full-face phenol peel takes one or two hours. If the peel is concentrated to a region such as the upper lip, it may take only 10 or 15 minutes. A single treatment usually achieves the desired result.

Chemical peels are usually done as an outpatient procedure. In most cases, an anesthetic is not required because the chemical itself acts as an anesthetic. A relaxing sedative may be used. Pain medication may be needed before or during a deep peel.

After The Treatment

It is customary to return home with supervision after a chemical peel, but in some cases a day or two in an outpatient care facility may be required. The skin is not bandaged in most cases.

After a TCA or phenol peel, the doctor may prescribe a pain medication to relieve tingling and throbbing. If tape was used to cover the face, it will be removed within two days.

It is important to avoid the sun during the heeling process after a chemical peel. A commitment must be made to the continued aggressive use of sun block. Overexposure to the sun hastens the aging process and can reverse the effects of the peel.

AHA peel. An AHA peel affects the skin like sunburn. The skin will probably become red and dry, then begin to flake and peel. The flaking should end within five days. Most people can return immediately to their normal activities.

TCA peel. A crust or scab may form on the treated area and there may be significant swelling. The swelling will subside within the first week. After about 10 days, the new skin should be apparent and healing should have progressed enough to allow a return to normal activities.

Phenol peel. After a phenol peel, the face will become quite swollen. The eyes may even swell shut temporarily. Talking should be avoided if possible, and a liquid diet may be required. New skin will begin to form within ten days. The skin will be very red and several weeks may be required for the red color to subside. During this time, exposure to the sun without skin block can cause blotches and irregular pigmentation. After about two weeks, the skin should be healed sufficiently to allow a return to work and to some normal activities. Cosmetics can be worn at this time.

How Effective Are Chemical Peels?

Fine lines and wrinkles are caused by the deterioration of the connective fibers (collagen and elastin) in the skin. Chemical peels force the growth of new tissue in which fibers are more plentiful and better organized. Although it may take several months for skin to recover from a deep chemical peel, the end result is skin of better tone and more youthful appearance.

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Cosmetic Surgery For The Face

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From Andrew Maynard - Chair of the University of Michigan Department of Environmental Health Sciences, with help from David Faulkner - 2013 Master of Public Health graduate.