Chemical Peel

Surgery Overview

A chemical peel is a treatment to improve the look of the skin. A chemical is applied to the skin and allowed to soak in. Over the next 1 to 14 days, depending on how deep the chemical soaks into the skin, the skin peels off. This process destroys parts of the skin in a controlled way so that new skin can grow in its place. The chemicals used are sometimes called exfoliating or wounding agents.

There are different types of chemical peels, based on how deep the chemical soaks in and what type of chemical is used. Things that may affect the depth of a peel include the strength of the acid in the peeling agent, the number of coats that are applied, and the amount of time allowed before the acid is neutralized. Deeper peels give more dramatic results. But they also have higher risks, cause more pain, and have a longer healing time. There are three basic types of peels:

• Superficial peels are the mildest type of chemical peel. They can be used on all skin types. In most cases, they use liquid containing a mild (dilute) acid, most often glycolic acid. Dry ice (solid carbon dioxide) is sometimes used.
• Medium peels soak deeper into the skin than superficial peels do. They cause a burn of the skin. Trichloroacetic acid (TCA) is the main peeling agent used for medium peels. The peel may also be done in several steps using a different chemical liquid followed by TCA.
• Deep peels soak into several layers of skin and cause a burn. They are used only on the face. A chemical called phenol is usually used for a deep peel. Deep peels may not be used on darker skin types, because they tend to bleach the skin. Even in lighter-skinned people, phenol peels-or any type of deep resurfacing-may bleach the skin. A deep peel can be done only once in most cases.

Before the peel

Your doctor can help you decide what depth of peel and what type of chemical is best for you. This decision is based on your skin type, which areas you want peeled, what kind of results you want, how much risk you are willing to take, and other things. A small "test spot" may be peeled to get a better idea of the results, especially for people who have darker skin.

You will start to prepare your skin 2 to 3 weeks before the peel. You will clean it 2 times a day, apply a special moisturizer or cream 1 or 2 times a day, and use sunscreen every day. This skin care routine will help the skin peel more evenly and heal faster after the peel. It may also reduce the chance of infection and other problems, especially uneven color changes in the skin.

In some cases, daily use of tretinoin (Retin-A) is also suggested. This is a medicine you apply to your skin. It is most often used to treat acne, but it may speed healing after a peel.

For medium and deep peels of the face, you may get a short course of medicine (such as acyclovir) to prevent viral infection. This is most likely if you have had cold sores before and if the peel will be near the mouth or eyes.

How a superficial peel is done

Right before the peel, the skin is cleaned. The chemical (usually a liquid or paste) is then applied to the skin with a small brush, gauze, or cotton-tipped applicators. The chemical is left on the skin for several minutes, depending on the type of chemical used. Water or alcohol may be used to neutralize the acid and end the chemical reaction, then the chemical is wiped off. You may feel a little burning while the chemical is on your skin. A handheld fan can help cool the skin and relieve any discomfort.

How a medium peel is done

The technique used to do a medium peel is like that used for a superficial peel, but the chemical may be left on longer. Medium peels are more painful because the chemicals are stronger and they soak deeper into the skin. You may get a pain reliever and an oral sedative to reduce pain and anxiety during the procedure. Cool compresses and fans can be used to cool the stinging and burning caused by the chemical. The peel takes about 40 minutes. There is little or no pain after the peel is finished.

How a deep peel is done

Deep peels take the most time and are the most painful type of chemical peel. The process for a deep peel using phenol is also more complex than for other types of peels.

• You may get an oral sedative and pain relievers. This is usually in the form of a shot or intravenous injection. General anesthesia may also be used.
• You may be put on a heart monitor and get intravenous (IV) fluids during the procedure. This is because phenol is toxic when absorbed into the body in large doses. But these measures may not be needed if only a single, small area is being peeled.
• After the skin has been thoroughly cleaned, the chemical will be applied and allowed to soak in. After one area of the face is treated, there will be a 15-minute break before the next area is treated. This is to avoid getting too much phenol in your body.
• Tape or ointment may be applied to the area after the peel to treat deeper problem areas. When tape is used, it is removed after 2 days. Ointment is washed off with water after 24 hours. It is then reapplied as needed.

Depending on how large an area is being treated, the entire process may take 60 to 90 minutes.