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by dr alek nikolic

introduction

Chemical peels have become one of the most popular cosmetic treatments performed by aesthetic medical practitioners, skincare therapists and cosmetic dermatologists. Excellent results can be achieved, depending on the ingredients used and the depth of penetration into the skin. Chemical peels are a great tool for treating hyperpigmentation, fine lines and wrinkles, textured skin, dull or uneven skin tone, acne, oily and pored skin. They can also help to prevent or delay ageing skin changes.

Interestingly chemical peels have been used for millennia. The earliest recorded 'chemical peel' was by Ancient Egyptian queen Cleopatra who bathed in milk. This progressed to using mild forms of acids derived from fermented milk and grapes. Today, chemical peels have become very popular. They are the third most requested skin treatment in the USA.

We have a range of superficial chemical peels for professional use – sk.in ProPeel.

what are chemical peels?

Chemical peels are solutions containing different types of ingredients depending on the type of the chemical peel and formulated at various concentrations and acid levels (pH). The aim is to resurface or remove certain layers of the skin which initiates a healing response. It is this response that improves the appearance of the skin.

The main reason for the popularity of chemical peels is that the ingredients used - such as glycolic acid, citric acid, lactic acid - have been extensively studied. The depth of penetration, degree of skin removal and results are well-established. They provide a safe and predictable treatment for the skin.

When specific chemical peel ingredients and concentrations are used for the correct indication and with an appropriate treatment technique, nearly all peeling agents have shown excellent clinical results with a high safety profile.

are you a good candidate for a chemical peel?

Are you wondering if you are a good candidate for a chemical peel?

The quick answer is that almost everyone can benefit from a chemical peel. However, this is dependent on skin type and skin concern. Some peels are contraindicated in darker skin types due to their depth of penetration, while others may have a better indication for pigmentation and others for ageing skin concerns.

When deciding if you are a good candidate for a chemical peel, we also need to consider budget, what you would like to achieve, your expectations for the treatment and what degree of downtime is expected.

The main indications for a chemical peel are cosmetic and can be divided into three main groups:

  • ageing prevention and treatment of intrinsic skin ageing
  • acne
  • hyperpigmentation

what can chemical peels treat?

There are several indications that chemical peels target and treat:

  • Skin ageing prevention
  • Ageing skin concerns caused by intrinsic skin ageing and UV induced ageing
  • Fine lines and wrinkles
  • Hyperpigmentation
  • Acne and oily or pored skin
  • Rough skin texture
  • Sallow and uneven skin tone
  • Combinations of the above

types of chemical peels

Chemical peels are divided into three categories depending on the depth that the chemical peel solution will reach into the skin - superficial, medium and deep chemical peels.

superficial chemical peels

These have become the commonest chemical peel treatments performed worldwide. Superficial peels only affect the most outer layer of the skin known as the epidermis and to a mild extent, the dermal layer is reached and typically uses low to medium concentrations of alpha-hydroxy and beta-hydroxy acids. Examples include glycolic acid 20% to 50%, lactic acid 20% to 50%, mandelic acid 30% to 40%, citric acid 10% to 25%, and salicylic acid 30%. Considering that superficial peels only target the outer layer of the skin one can achieve good results with hyperpigmentation in the superficial layer, texture concerns, fine lines and wrinkles, and with acne and oily skin concerns. Application of these types of peels tends to produce a mild burning and discomfort on the skin which in most cases is tolerable without any necessary anaesthesia or pain control. Superficial peels are left on the skin for two to five minutes before they are neutralised with an alkaline solution.

medium depth chemical peels

These peels tend to affect the outer superficial layer and the middle layer of the skin known as the dermis. Considering these chemical peels have a deeper effect than the above-mentioned superficial peels, one can expect good results with deeper set hyperpigmentation, deeper wrinkles, and with acne scarring. Commonly used ingredients include glycolic acid 70% and TCA (trichloroacetic acid) 50%.

Typically, with a medium depth peel, one may want to consider a mild pre-treatment sedative with pain killers such as non-steroidal anti-inflammatories (NSAID) as the depth of these peels do produce a fair amount of discomfort and pain when compared to superficial peels. Furthermore, the NSAID will also help to reduce the degree of swelling and inflammation experienced after the peel treatment has been completed. It is particularly important that when your clinician applies a medium depth peel that they follow a strict application protocol which usually starts on the forehead and temples, then progresses to the cheeks and chin and lastly to the lips and in certain cases even the eyelids. It is also recommended that these peels are applied and extended lightly into the hairline and below the jaw to allow a smoothing effect between the treated and non-treated areas.

deep chemical peels

Deep chemical peels are not used that often today, mostly because there has been a rapid progression in laser technology and applications. In particular, fractional ablative and ablative lasers offer less potential for side effects and a more precise tissue ablation when compared to deep chemical peels.

Common ingredients used for deep chemical peels include TCA concentrations greater than 50% and the phenol peel. The main indication for a deeper chemical peel would be for those suffering from moderate to severe intrinsic and environmental or UV skin ageing including deep wrinkles and furrows and severe hyperpigmentation.

The Baker-Gordon phenol peel that was developed nearly 50 years ago is the most common phenol peel used for deep chemical peel treatments. These types of peels should only be performed by a trained medical doctor and will require sedation and an in-office or procedure room setting that includes cardiac monitoring during the procedure.

One can expect a prolonged downtime of around 2 weeks that will include swelling, scabbing and oozing skin before complete healing has taken place.

a closer look at superficial chemical peels

what to expect during a superficial chemical peel

preparing the skin for the peel

We start by removing all make-up, cleansing with the appropriate cleanser for your skin followed by applying a thin layer of pre-peel on the treatment area. Vaseline may be applied to any exposed wounds, abrasions, piercings or broken skin.

peel application

The peel solution is applied evenly to the skin using a fan brush and typically to the entire treatment area within one minute. Layering or additional applications of the peel can be applied to target specific skin concerns.

The chemical peel solution is left on the treatment area between 1 to 5 minutes depending on the skin’s response, whether this is your first chemical peel treatment, and the concentration strength being used. A tingling and burning sensation will be felt and this is 100% normal so do not panic. One may even feel a heat sensation on the skin surface for the duration of the peel application.

neutralisation

A neutralisation solution that typically contains bicarbonate of soda is applied to the entire treatment area to stop the action of the chemical peel. Typically your clinician will start on the areas that have reacted the most and areas where the skin is the thinnest. One can expect foaming as the neutralisation solution is applied. This may be followed by a cold mask to help with any discomfort and mild swelling in the skin.

superficial chemical peel aftercare

After the mask has been removed one should apply a vitamin C based serum such as sk.in gloss and a barrier repair serum such as sk.in marvel or cream. This will help to protect the skin against free radical damage and help to accelerate the healing. This must be followed by the application of SPF 30 or higher, that contains zinc oxide and/or titanium dioxide.

One should not actively tan and avoid the sun as much as possible in the 2 weeks following a superficial chemical peel treatment.

contraindications

There are specific exclusions to performing superficial and deeper chemical peels:

  1. Any medical history of autoimmune diseases, collagen diseases, uncontrolled systemic conditions (such as diabetes, thyroid, cancer, etc.).
  2. History of keloid scarring.
  3. Do not apply the peel to any areas that have a wart. This can cause the spread of the virus with new outbreaks.
  4. Peels should not be performed on skin that is sunburned, recent prolonged exposure to the sun or sunbed, or comprised in any way including aesthetic medical treatments such as Dermapen, laser, IPL, etc.
  5. Do not perform the peel treatment on patients that plan to actively tan following the procedure.
  6. A specific allergy to any of the ingredients in the peel is a direct contraindication to treatment.
  7. The treatments listed below can increase the sensitivity and reactivity of the skin to chemical peels. Allow the skin to completely heal before considering a chemical peel treatment:
    1. Allow at least 2 weeks for the skin to heal from any previous chemical peel, laser and IPL treatments, microdermabrasion, granular or hard mechanical exfoliation, Dermapen, needling, hair removal or bleaching procedures.
    2. Allow at least 6 months for the skin to heal following any surgical procedure or radiation treatment.

special precautions

  1. Peels can reactivate previous viral infections including herpes simplex. Placing your patients on the appropriate antiviral medication several days before the peel may prevent flare-ups.
  2. Tobacco use and smoking can delay healing due to the vasoconstriction and this may prolong the healing process. Caution is advised with these patients.
  3. Retinoids increase the skin's sensitivity to peels. Stop oral retinoids 6 months before any peel treatment. Topical retinoids such as sk.in flash, sk.in bounce, sk.in avenge HPR, should be stopped 5 days before a peel is performed. Topical retinoids can be recommenced 5 days after the peel treatment.
  4. Certain medication such as immune suppressants or anticoagulants can delay healing. Caution needs to be taken with such patients.

potential side effects and complications

although rare there are several potential side effects when undergoing superficial chemical peels.

  1. Some of us may experience redness or erythema, stinging sensations, itchiness, burning, minor swelling, and even a mild peeling of the outer layer of the skin following the treatment.
  2. A tight sensation after or during the treatment is normal.

All of the above changes will settle over 2 to 7 days and the skin will return to its normal appearance.

3. All chemical peel treatments may reactivate or cause a flare-up of:

a. Acne and breakouts.

b. Viral skin infections e.g. herpes simplex. If you have a history of viral infections a course of prophylaxis anti-viral medication may be advised.

4. All chemical peels may cause perioral dermatitis; although not common, it is characterised by an inflammatory rash around the mouth area that may spread to the nose and even the eyes. Treatment should be started as soon as any symptoms develop:

i. Scaly or red bumpy rash around the mouth.
ii. There may be a clear fluid discharge.
iii. Redness and slight itching and burning can also occur.

5. Pigmentary skin changes may occur following the peel treatment and this can include both hyperpigmentation and hypopigmentation. Avoiding sun exposure and using an SPF 30 or higher that contains zinc oxide and/or titanium dioxide will help to reduce the chances of pigmentary changes. Hyperpigmentation should be recognised early and treated with a mild topical steroid to reduce any inflammatory effect is advised to seek medical attention if this side effect starts to develop following the chemical peel treatment.

6. If superficial chemical peels are left on for too long and/or penetrate too deeply there are some other potential side-effects:

a. Moderate to severe redness and heating of the skin.
b. Blistering and peeling of the skin.
c. Post-inflammatory pigmentary skin changes.
d. Sun sensitivity.
e. Scabbing and scarring of the skin.
f. Risk of infection.
g. Discomfort and uncomfortable sensations of the skin.
h. Swelling.
i. Sensitivity to other topical ingredients or treatments.

superficial chemical peels and pregnancy

Looking at the literature, glycolic acid, mandelic acid, citric acid, kojic acid and lactic acid are considered safe during pregnancy. However, you should clear any treatment, including superficial chemical peels, with your specialist doctor.

professional versus at-home chemical peels

There are several differences between professional chemical peels and at-home chemical peels but there are also some similarities.

The main difference is that professional peels penetrate deeper and contain ingredients that are prescription strength and require neutralisation to stop their activity.

similarities:

  • Contain the same ingredients found in professional superficial chemical peels.
  • Also targets skin texture and superficial pigmentation.
  • Improves fine lines.
  • Increases skin hydration.
  • Can be used in conjunction with active ingredient serums such as retinol and granactive retinol.

differences:

  • At-home peels typically require no neutralisation.
  • They need to be used several times before improvements are noticed.
  • At-home peels can only improve minor skin imperfections.
  • Professional peels need to be performed by a trained medical professional or skincare therapist.
  • Professional peels penetrate deeper and have a better result with pigmentation, wrinkles and deeper lines, texture, pores, and UV skin damage.
  • Typically with professional chemical peels, active ingredient serums that contain retinol should be stopped for 5 days before the treatment.
  • Professional peels have a much higher free acid content and a lower pH.
  • One should only have professional chemical peels every 4 to 6 weeks.

 

I hope you have found the above article interesting and informative and that you have a better understanding when deciding on adding chemical peels to your skincare treatment regime.

sk.in chemical peel recommendations

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