The use of chemicals to exfoliate the skin dates back to the ancient Egyptians who used lactic acid, alabaster, and salt to smooth out the skin. Much later, in the 1800’s, trichloroacetic acid, salicylic acid, resorcinol and phenol were introduced as chemical peeling agents.

Today, with the advent of more sophisticated methods of skin resurfacing, chemical peeling still remains one of the most widely performed cosmetic dermatological procedures.

Chemical peeling, or chemexfoliation, utilizes chemical solutions to be applied to the skin, causing it to peel off gradually.

It enables damaged skin to shed off and be replaced by a healthier-looking skin cells. The efficacy and recovery time will depend on the type of chemical used, its strength, and duration on the skin.

Levels of Chemical Peeling

Superficial Peeling

It exerts its effects on the outermost layer of the skin called the epidermis. It is safe for any skin type, with minimal downtime. This is suitable for the following skin conditions:

• Fine lines due to sun damage
• Hyper pigmentation or skin discoloration
• Mild acne scars
• Dull-looking skin
• Actinic and seborrheic keratosis

Medium-Depth Peeling

It affects both the epidermis and the upper part of the dermis. This is also used as a supportive procedure to laser skin resurfacing and deeper chemical peels to blend the demarcation lines between treated and untreated skin. This is best suited for the following skin conditions:

• Mild to moderate wrinkles due to sun damage
• Hyper pigmentation
• Age spots
• Texture irregularities due to acne scars
• Actinic keratosis

Deep Peels

It extends deep into the lower layers of the dermis and yields the most dramatic effect. These are used to reduce the appearance of:

• Severe sun damage
• Deeper lines and acne scars
• Pronounced pigment changes

How Does Chemical Peeling Work?

Chemical peels induce a controlled injury to the skin using chemical solutions or wounding agents. The dealing process follows, which allows the migration of new cells to the skin surface, thereby replacing old, damaged skin cells. Collagen or dermal connective tissues will be replenished, improving skin texture.

What are the Chemicals Often Used?

The most common chemicals employed for peeling are alpha-hydroxy acids, salicylic acid, trichloroacetic acid (TCA peel), Jessner’s solution, resorcinol, and phenol. Phenol is frequently used for deeper peels. Their respective concentrations, duration of application, and interval of repeated applications will vary according to the level of depth to be penetrated.

Superficial peels may be repeated every few weeks while deeper peels will have to wait a few months before it can be re-applied. Generally, phenol deep peeling cannot be repeated.

What Are the Limitations of Chemical Peels?

Chemical peels cannot tighten loose or sagging skin. It can reduce scars only to a certain degree but it cannot remove deep scarring. The process may need to be repeated until the desired results are achieved, but deeper peeling cannot be done over and over again due to the potential toxicity to the body.

Before The Peel

A consultation with the doctor will be done to assess the appropriate treatment needed by the client. The skin type, photo aging classification, and other factors that may affect skin penetration will be determined. The expectations will be discussed and the potential risks will be explained in detail.

The patient has to be in a good medical condition. The liver and kidneys should function well to ensure adequate excretion and detoxification. There should be no heart problems because the phenol used in deeper peels can potentially cause irregular heart rhythms.

The doctor has to know the medications being maintained by the patient because certain drugs may affect the outcome of the procedure. Intake of oral contraceptives cause pigmentation, thus worsening skin discoloration that chemical peeling is intended to correct. In addition, blood-thinning agents like warfarin can possibly cause blood to pool or ooze at the peeled sites.

Smoking cessation will be advised because the substances in a smoke will trigger enzymatic reactions that can weaken the skin and worsen the facial wrinkles. Clients who will be undergoing medium and deep chemical peels will be given a prophylactic dose of acyclovir to prevent viral infection from herpes.

Two to three weeks prior to peeling, pre-treatment creams will be applied to the face to facilitate gentle exfoliation of the skin for more even results. Such creams may include tretinoin, alpha-hydroxy acids, and hydroquinone. Sunscreens have to be applied for protection.

During The Peel

Superficial Peel

Sedation and anesthesia are usually not required for superficial peeling. The area to be peeled has to be cleansed prior to the application of peeling solutions to remove excess oils. The chemical will then be applied using a small brush, cotton-tipped applicator, or gauze.

It will be left to stand on the skin for a few minutes, depending on the concentration and type of agent used. Sodium bicarbonate or water can be used to neutralize the acid. A stinging or burning sensation may be expected but is generally well-tolerated. A cream will be applied afterwards.

Medium Peel

Oral sedative and aspirin will be given to lessen the pain and the swelling. Cleansing is done in similar fashion to superficial peeling. An even coat of the chemical is applied, turning the area whitish or frosted. The duration for the skin to be soaked with the solution may be longer and the agents used will be stronger. A fan may be used to alleviate the burning sensation. Neutralization will then follow.

Deep Peel

Since this is the most painful level of peel, sedatives and pain relievers will be given, often in intravenous form. At times, general anesthesia has to be administered. If the area to be peeled is large, intravenous fluids and a cardiac monitor will have to be attached. This is because phenol, the chemical often used in deep peels, can be toxic when absorbed in large amounts.

There will be a 15 minute interval between applications of phenol to different areas, to minimize its absorption by the body. Dressing with an ointment will be applied, which will be removed after 2 days. The process will take a little longer than the superficial and medium peel.

After The Peel

The downtime will depend on the depth of peel.

Superficial Peel

Clients can return to their usual activities right after the procedure. There will be redness and some stinging for the next 3 to 5 days. Peeling will be minimal and the redness can be concealed with makeup.

Medium Peel

The patient may have to take a few days off from work while recovering since medium peel causes a second degree burn to the skin. Expect the redness to turn brownish, with whitish streaks in between.

After 5-6 days, the skin will begin to peel with associated itchiness. The face will be bright red after the peeling, fading into pink as days and weeks go by, taking around 2 to 3 months to disappear.

Deep Peel

This produces a deeper kind of second degree burn, making the patient feel unwell a few hours after the procedure. She has to be driven home and is required to take in a soft diet, as chewing can be painful. Swelling will be at its worst after 2 days but will gradually subside.

On the way to recovery, itchiness will be evident. Healing may take 10 to 14 days, after which makeup may be used to cover the signs of treatment. It may take 3 to 4 months for the redness to completely subside.

How Risky is Chemical Peeling?

The deeper the peeling, the greater the risks.

• Generally redness, scaling, color changes, and swelling will be experienced but tolerated.
• The wounded skin will be at risk for infection, especially for those with a history of herpes outbreaks.
• Persons with allergies should be careful with the chemicals that they may react with. Usually, a spot test on the skin will be performed to prevent this.
• The newly exposed skin will be sensitive to light so protection with sunscreen and staying inside the house for the first few days will be beneficial.
• The toxicity of phenol used on deep peels will be dangerous for those with renal, cardiac and liver problems.

What Are The Contraindications to Chemical Peeling?

• Active herpes infection
• Active eczema
• Use of the acne treatment Isotretinoin within the last 12 months
• Skin malignancy
• Dark skin for medium and deep peels, because it can bleach the skin and result to uneven skin tone
• Cardiac, renal and liver disease for deep peels

Cost of Chemical Peeling

Superficial peeling is the cheapest, as it ranges from $150 to $300 per session. However, it may require multiple sessions for optimal results. Medium peeling may cost from $1,000 to $2,000 while the more complicated deep peeling could reach $2,500 to $2,600, inclusive of the anesthesia and follow-up treatment charges.