Other associated terms: Skin Peel, Acid Peel, Face Peel, AHA peel, TCA peel, phenol peel, advanced peel, deep peel.
Chemical peel is a technique used to improve and smooth the texture of the facial skin. The procedure utilizes a chemical solution that causes the dead skin to eventually peel off. The regenerated skin tissue is usually s
moother and less wrinkled than the old skin. Some types of chemical peels can be purchased and administered without a medical license, however people
are advised to seek professional help from a dermatologist, cosmetic surgeon, plastic surgeon or maxillofacial surgeon regarding a
specific type of chemical peel before any procedure is performed.
New skin regenerates without lines, wrinkles or other imperfections are the major benefits of a chemical peel. For some, a deep chemical peel is an effective treatment for the extreme wrinkling caused by sun exposure or for the treatment of pre-cancerous growths.
If you are getting a light peel (AHA), no anesthesia or sedation is needed and sometimes, a single treatment can produce very noticeable and desirable results. There is also the added benefit of not having to take time off from your job or refrain from most of your regular activities when you undergo an AHA peel.
Types of Chemical Peels:
There are 3 general types of chemical peels that fall into the categories of “light”, “medium” and “deep”. These are:
AHA Chemical Peel (alpha hydroxyl acid):
Light chemical peels are usually are performed with a solution that contains lactic acid, fruit acid, salicylic acid or glycolic acid. This procedure works by removing the outer layers of the skin to smooth fine wrinkles and rough skin.
TCA Chemical Peel (trichloroacetic acid):
Medium chemical peels are performed with trichloroacetic acid to smooth out fine wrinkles, to remove surface blemishes, and to correct uneven skin tone. This treatment can be used on the neck and body as well as the face, and is recommended for darker-skinned patients.
Phenol Chemical Peel (carbolic acid):
Unlike a light or medium chemical peel, a deep chemical peel, also known as a phenol peel, is performed only once. A deep peel can give more dramatic, longer-lasting results than the lighter peels by smoothing coarse wrinkles and even removing pre-cancerous growths.
Chemical peels are helpful for individuals with facial blemishes, wrinkles and uneven skin tone. Patients with advanced or severe skin damage are also good candidates for chemical peels. Those individuals with fine and deep wrinkles, uncontrollable acne, acne scars, freckles, liver spots, or rosacea are also suitable for treatment with chemical peels. Chemical peels will also remove certain pre-cancerous skin growths and can be a good preventative regimen for cancer skin care and as an element of skin cancer treatment.
For deep chemical peels, only women with a fair complexion were originally considered ideal candidates. But lately, phenol-based peel techniques have been developed that can now be safely performed on patients with olive and dark skin (check with your doctor). Thick male skin is usually less responsive to a deep peel so this skin resurfacing procedure is not normally suitable for that skin type.
AHA chemical peels:
A detailed consultation with your doctor is essential and should include viewing of numerous before and after patient photos (this is true with all chemical peels). You should take this opportunity to ask any questions that you have regarding the procedure to include realistic expectations, the procedure, itself, and what to expect after surgery.
An AHA peel can be used on the entire surface of the skin or in specific locations with the exception of around the eyes and lips. The procedure is simple and quick and can be performed in the surgeon’s office or an outpatient surgical center. The skin is first prepared and cleansed from any skin oil or debris. Then the surgeon will apply the AHA peel solution and it will be left on for 10-15 minutes before removing. The procedure will be finished by rinsing the face with cold water. No “after-peel” ointment or covering is required. Although it may require more sessions to see the full, expected results, this chemical peel treatment is perfect for patients who expect a quick recovery.
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 their desired goal. The cosmetic surgeon may add Retin-A (vitamin A) or a bleaching agent to your at-home treatment regimen. After several weeks of at-home treatment, the doctor will examine patient’s skin to determine if the regimen needs adjustment.
TCA chemical peels:
As with all cosmetic procedures, an initial consultation will be made with your doctor in order to discuss the procedure, in detail.
A TCA peel often requires pre-treatment with AHA or Retin-A creams. It takes about 15 mins. to apply the TCA peel. A mild stinging sensation will be felt, at first, but this should disappear as the treatment progresses.
Depending on circumstances, your doctor may decide to adjust the depth of surface peeling - this may require more than one session. Mild swelling and discomfort are just some of the initial side-effects and it will take about a week before you may already be able to continue your day-to-day activities.
Although this treatment is more effective than an AHA peel, the effects are not as dramatic or permanent as those from a phenol peel. Two or more TCA peels may be needed to obtain the desired result. These may be spaced out over several months but mild TCA peels may be repeated more often (every month).
Phenol chemical peels:
Phenol peels represents the most aggressive of chemical peels, since the skin will produce less pigment as a primary after-affect. The procedure normally takes at least an hour (sometimes two hours) and the recovery period usually lasts for more than a month. The original phenol chemical peel solution was not advised for darker-toned patients (but newer techniques have been developed) as is still not advised for people with heart ailments.
The doctor will apply the phenol solution to the appropriate areas (avoiding the areas around the eyes, brows and lips). The phenol peel acts as its’ own anesthesia which is why a separate anesthetic is not needed. At the end of the procedure, the skin will be washed with cold water.
One hour, afterwards, your skin will be covered with a thick layer of petroleum jelly in order to form a protective crust. You may feel a throbbing sensation during the treatment, but pain medication is usually prescribed by your doctor.
AHA chemical peels: Recovery is relatively quick for an AHA peel, however, expect temporary inconvenience from dryness, redness, and skin flaking following this chemical treatment. It is important to note that you should avoid the sun during the heeling process after a chemical peel. An aggressive use of sun block will be indicated since overexposure to the sun hastens the aging process and can even reverse the effects of the peel.
TCA chemical peels: The first week, following the peel, your skin will be red and most likely swollen. The most common side effect is skin discoloration. You will need to diligently use a sun block, of SPF 25 or greater, whenever you venture out into the sun and you will need to limit sun exposure. During the initial 3-4 days, after the peel, the dead layers of your skin will shed until the skin is completely healed. Skin moisturizers with antibacterial ointment will also be indicated for use, by your doctor. Completed results can be expected in approximately two weeks. If, in any case, skin redness lasts more than two weeks you should inform your doctor since, left untreated, discoloration and scarring can occur.
Phenol chemical peels: After a phenol chemical peel, your face will be swollen, red, and uncomfortable. A crust will form on the treated skin several days after treatment. Within 7-10 days, this crust will flake off and a new layer of bright pink skin will be revealed. After 2-3 months, this bright pink color will fade to a paler, smoother complexion.
As with any type of chemical peel, deep chemical peels are not without risks and side effects. But many side effects can be minimized or avoided by following your doctor’s recovery/aftercare instructions. Sun exposure should be avoided for up to several months after the peel. You should also be careful to refrain from picking at the skin as it crusts and flakes. Normal activities, such as work, can be resumed after about 2 weeks with the use of concealing make-up.
Risks Associated With Chemical Peels:
If you have oral herpes, you should gain the approval of your primary physician and you may be given a prescription for oral acyclovir (e.g. - Zovirax®) which would decrease the chance of a herpes breakout. If you have a break out during your recovery period, there is the possibility that it can spread to your entire face - resulting in severe and permanent scarring.
Be aware of crusting or excessive moisture formation.
In AHA peels you may think this is normal but there is a limit that you must watch out for. Ask your doctor for details regarding what to look for. If for a typical AHA peel, you should feel and look normal within 3 - 4 days. For TCA and phenol peels your downtime will take longer for a complete recovery. If you experience significant pain, in excess of what is expected, contact your surgeon or the on-call medical team immediately (especially if you are susceptible to cold sore development). Any blistering will need to be treated as soon as possible!
Hyper-pigmentations (excessive coloration) and hypo-pigmentation (lack of pigmentation) can occur with misdiagnosed skin types, failure to reveal any skin issues, or improper post-peel care. Infection is uncommon but possible – so, watch out for redness and pain and monitor your body temperature frequently during the first few days of recovery. Follow your doctor’s recovery instructions carefully to avoid scarring or any permanent signs of skin damage.
Chemical peel prices vary by type, region and the experience of the doctor. In general:
For light chemical peels (AHA chemical peels) patients can expect to pay between $150- $300. Although, the price of this chemical peel is the lowest of the three types, the procedure usually must be repeated multiple times for optimal results.
Medium chemical peels (TCA chemical peels) typically cost from $1000 to $2000. However, please note that these procedures may need to be repeated every 2-3 months.
Patients should consider that a deep chemical peel (phenol chemical peels) requires a longer recovery period that will prevent them from returning to work for at least two weeks. Deep chemical peels cost between $2500 to $5000, which may or may not include anesthesia, facility costs and follow-up care.
10 Things to Discuss With Your Doctor Regarding Chemical Peels:
1. What are the realistic expectations for this procedure?
2. Are numerous before and after photos available for viewing?
3. What is the doctor’s level of experience with this procedure (how many procedures, of this type, have been performed)?
4. What percentage of the patients experience complications as a result of this procedure (what are the most common complications)?
5. Where is the peel performed and how long will it take? Is the facility accredited?
6. What is the total cost of the procedure? (including facility costs, anesthesia and follow-up care)
7. What are my anesthesia options?
8. What is the doctor’s policy regarding correction of procedures that are below agreed upon standards?
9. What should I expect, regarding discomfort during recovery? What about scarring?
10. What financing options are available?