While chemical peel performed with a chemical solution is useful for removal of fine facial wrinkles and certain types of hyperpigmentation, dermabrasion which is a surgical treatment is an accepted method for deeper lines and acne scarred skin. Both are effective methods for removing layers of skin to improve dermatological defects.
The chemical peel procedure (chemabrasion) is the procedure of choice for the eradication of fine wrinkles and has been much refined since 1960. It achieves the desired prolonged effect. Moderate tightening of the forehead skin may also be achieved for some patients without the risk of hair loss or obvious scars. It can be useful performed in conjunction with other procedures like the facelift procedure. Chemical peel removes the upper portion of the skin and stimulates the patient's own collagen formation beneath the treated area. This rejuvenates the skin giving it a fresh, smooth appearance. Generally, the ideal candidate for peels is one with minimal facial sag and finely wrinkled skin that has been constantly exposed to the elements - a patient who desires improvement but is not quite ready for a facelift.
Patients with fair complexions are better candidates than those with olive toned skin because with the latter it is more difficult to blend the demarcation line (where the peel begins and ends). Every effort is made to "feather" (blend) this line in all patients. The different colour and texture from one area to the other can be a permanent effect, even if ever so slight. Patients with darker skins are more likely to have irregular pigment changes. Women are better candidates than men because their skin is thinner and there is no heavy hair growth.
Chemical peels involve applying a mild acid solution to the skin that exfoliates the upper layers of the skin. The depth of exfoliation depends on the type and strength of the solution from mild to moderate to deep. Chemical peels are in-office treatments. Healing times vary depending on the peel used.
Examples of chemical peels are glycolic, lactic, salicylic, TCA, and phenol.
AHA's (Alpha Hydroxy Acids) are a group of fruit acids, which are naturally occurring. Examples are glycolic, lactic, citric, tartaric, and malic. These acids are found in home care products and used in higher concentrations as in office-peels. These peels will assist in exfoliating the skin allowing the newer, healthy skin to emerge quickly.
The popularity of fruit acids is their exfoliating properties. Exfoliation helps to keep the top layer of skin free from dead cells, which in turn keeps the skin clear of both blemishes and fine lines. They are found in a variety of products from cleansers to moisturizers to peeling treatments. Home care products with AHA's assist in the penetration of topical skin products. Keep in mind, while home care AHA products can be beneficial to all skin types, it is important to consult your skin care specialist to determine what type of peel would be beneficial for you.
Trichloracetic Acid (TCA) Peels:
A TCA peel is a common treatment used for medium to deep peels. It can be used for all skin types and is highly effective for fine lines and wrinkles, as well as sun-damaged skin. The depth of penetration of the TCA peel varies depending on the concentration and amount of solution applied. It can therefore be used as a mild, moderate, or deep peel. In general, TCA peels tend to peel deeper than AHA peels. It is an office procedure that can be done by your esthetician or physician. The recovery time depends on the depth of the peel. The deeper the peel, the longer the recovery time. The healing time is usually five to ten days. The Blue Peel, marketed by Obagi is a TCA peel.
TCA and less often used Phenol are chemical agents of choice. TCA has renewed interest and advantages. It is not absorbed by the skin like Phenol and therefore is free of the systemic side effects of phenol which can not be taken lightly. TCA does not burn as deeply so one is more likely to avoid total loss of pigmentation and hypertrophic (thickened) scars. Weaker chemical agents are more available but also with less strength comes less effectiveness. TCA can be applied repeatedly in one to three month intervals and its effectiveness is compared to Phenol with a much improved safety record. TCA is wonderful for the neck area and the tops of hands. A distinct advantage is that the strength can be altered to the needs of the patient.
The inflammatory reaction is red and crusty, peaking in 48 hours lasting at least 10-14 days. Frequently a slight pink discolouration may last up to 3-4 weeks. The epidermal skin regeneration actually begins the second day after application and that is completed usually by two weeks.
Although this is not a surgical procedure, it can be quite uncomfortable for several days, especially when the entire face is treated at once.
Depending on your particular skin condition, the doctor may want to "prime" your skin with retinoic acid cream for a few weeks prior to the chemical peel. This would serve to make your skin more receptive to the forthcoming treatment. At the time of the procedure, pre-medication is a matter of surgeon's preference.
Application is section by section. It is necessary to come to the lip border; lips may blister but it is better than to leave a band of untreated skin and in the end you will have a nicer result.
Glycolic Acid Peel:
The glycolic acid peel is a popular and widely used AHA peel. It is a light treatment that gently penetrates the uppermost layer of skin to reduce aging, sun damage, unclog pores, and produce a healthy glow. The newer types of glycolic peels can be found with buffered solutions to reduce redness and irritation. This peel is done in the office taking approximately twenty minutes. You may return to work/school immediately after.
Salicylic acid is a beta hydroxy acid that is found in many home care acne products, and can be used as a superficial in-office peel. The benefit of salicylic acid is its fat solubility and ability to break down sebum. This characteristic makes it beneficial for patients who have acne.
J essner's Peel:
A Jessner's peel is a superficial consulting room peel consisting of a combination of lactic acid, salicylic acid and resorcinol.
Phenol peels are most commonly used in deep peels. It is a coal tar derivative and the strongest peeling agent. It is recommended for fair skin, severely sun damaged and deep wrinkled skin. Your new skin will emerge in a few days, and the pink color should fade in a few months. Makeup may be applied after healing is complete. You may resume work within one to two weeks.
Post operatively there will be a burning sensation for a few hours after application although vaseline will likely have been applied to reduce some of the burning and irritation. Medication may be prescribed to control intense itching the first few days if needed. After healing of the skin is complete, facial lubrication with moisturisers and retinoic cream is continued for 2-3 months and may be considered for continuous daily use.
It is important to remember that exposure to sunlight within 8 weeks following treatment may result in unfavourable discolourisation. Hyperpigmentation is directly related to the sun's rays. All patients are strongly urged to stay OUT of the sun for this length of time. Hyperpigmentation may be permanent.
At approximately 2 weeks post operatively you will be allowed to apply an emollient sunblock cream.
Your sunblock needs to be at least SPF 15 and must be used DAILY. In your interest, we highly recommend you wearing sunblock cream daily under any makeup used forver.
Streaking and missed spots may occur in spite of every technical effort to avoid them. Any blotchy pigmentation is minimised by having had a thorough and even cleansing of the skin prior to the original procedure. There can also be the darkening of preexisting nevi (moles). It is suggested to remove concerning nevi prior to surgery in a separate procedure.
People who carry the herpes simplex virus (and who are susceptible to cold sores) run the risk of aggravating that condition and special precautions are taken to avoid any problems.
Persistent redness is a possible annoyance and may even last months. It is suggested that alcohol intake increases erythema (redness) and for that obvious reason we say "do not indulge" .
Hypertrophic heavy scar formation and keloids (thickened scars) are relatively rare. Experience dictates that scarring is likely to occur around the lips in patients with an active recurrent history of herpes simplex. It is for reasons like this that we need and request a thorough medical history prior to any cosmetic procedure.
Chemabrasion reduces the aged appearance of the skin and is often a substitute for a facelift. It is also done in conjunction with the facelift. One must consider all options.