Chemical Peels
When I was in residency, a group of us residents wanted to start doing chemical peels. So, we were given permission and the “recipes” for chemical peel solutions. At that time, we had a hospital pharmacy where we could take a prescription and they would make up the chemical peel solutions for us. We had them made, but we had very little clue what we were doing. For those who know me, it will be no surprise that I volunteered to be the first guinea pig. I laid down, closed my eyes tight (acid is NOT GOOD for your eyeballs) and hoped for the best. My co-residents cleansed my face and began applying the chemical peel solution. It was HOT!!!. This is where the panic started to set in. What was I thinking? I was laying there allowing someone who had no clue what they were doing to apply acid to my face. Sure we had read the instructions in textbooks, but there wasn’t even You Tube back then to watch a video on how to do it. We had no clue what we were doing. Well as you may have guessed, it was all fine. I survived, and my face looked better in the long run. All this to say, chemical peels are not for sissies and they shouldn’t be done without clear instructions and knowledge of the skin.
Chemicals peels aren’t quite as popular now as they were back then either. Now, we have so MANY choices and so many voices telling us how to improve our skin. Are chemical peels still a viable treatment option? Let’s explore.
What exactly is a chemical peel? A chemical peel is a procedure that uses a chemical, usually an acid, to interact with the outer layer of the skin to rejuvenate the skin. In most cases, the chemical applied causes damage to the structure of the outer layer of the skin, destroying it and causing subsequent “peeling” of the injured skin as the new healthy skin grows up from underneath.
What are the different types of peels? Peels are generally characterized based on the depth that the acid penetrates in the skin. Generally, the deeper the acid penetrates the thicker the layer of skin peels off and the more impressive result. However, the deeper the acid penetrates also greatly increases the risk. Deep chemical peels have a high risk of permanent scarring and/or temporary or permanent discoloration. A deep chemical peel is painful, requires extensive down time and has high risk of scarring, but impressive results. In comparison, a superficial chemical peel is comfortable, minimal down time, low risk and gives a refreshing glow to the skin.
How do you differentiate chemical peels from other skin rejuvenating procedures? The story that opened this post occurred in 2003. Yes, I know I am dating myself, but I have been at this for awhile now. Chemical peels were the pinnacle of skin rejuvenation at that point. Most lasers and/or IPL were not yet in common use for skin rejuvenation. Fractionated lasers and microneedling weren’t even invented yet. Although chemical peels still have a place, more advanced procedures have generally replaced chemical peels for skin rejuvenation. A deep chemical peel is necessary to have real, long lasting effects, and most doctors and patients are unwilling to assume the downtime and risks associated. What kind of peels do you do at Appalachian Spring Dermatology? Well, to be honest, I haven’t done the old-fashioned, paint the acid on your face, kind of chemical peel for a long time. These peels involve using straight glycolic, salicylic and trichloracetic acid and are much riskier and much easier to mess up than some of our newer options.
How do I know if a chemical peel is right for me? To answer this question, sometimes it is best to look at specific skin conditions and see what might best meet your goals. For deeper wrinkles and acne scarring, a superficial chemical peel is unlikely to produce impressive results. For deeper wrinkles and acne scarring, Dr Rosenberger recommends microneedling or laser. For discoloration, Dr Rosenberger recommends topical bleaching creams and RetinA for brown discoloration and IPL for red discoloration. For those with extensive sun-damage, photodynamic therapy is most effective. The best option is to discuss what your desires are and ask your dermatologist how you think you can best meet your goals.
Here are a few options, Dr Rosenberger commonly recommends:
To address uneven skin texture and peeling from retinoid use – At home ZO Enzymatic Peel contains glycolic acid and other fruit acids to give a gentle at home peel. The peel is applied and left on for 1-3 hours thin rinsed off. I generally recommend removing the peel when it starts to feel “tingly” or “itchy”. This is used 1-2 times per week as needed. There is no downtime.
Dull appearing skin and sun damage – An impressive at home chemical peel can also be obtained by using retinol at home. There is a well-studied at home peel regimen used ZO Advanced Radical Night Repair containing 1% retinol for 3-5 days. This can be repeated up to monthly, but it is unlikely it would be necessary. This can give some impressive results, but it’s gonna look red and chapped for about two weeks.
For a little pampering and a refreshed look– We offer ZO Facials which include a mild chemical peel. These no-down time facials employ a scientifically proven series of ingredients to refresh your skin. They can be repeated monthly. Long term changes are best seen when used in combination with RetinA and a good skin care regimen.
What changes do I need to make to my skin care regimen before and after a chemical peel? Before a peel, it is best to begin using Tretinoin/retinA and sunscreen for 4-6 weeks prior to a peel. This accelerates the results of the peel and reduces the likelihood of dyspigmentation from a peel. After a peel, Dr Rosenberger recommends pausing most of your regular skin care regimen until all peeling is resolved. Applying zinc oxide based sunscreen to the skin reduces the tendency for dyspigmentation or discoloration and aids in the healing process. Zinc oxide sunscreen should be applied daily and every two hours when outside for 6 weeks after a peel. For those with darker skin, Dr Rosenberger sometimes recommends using a bleaching cream containing hydroquinone pre and post peel to reduce the likelihood of discoloration.
A chemical peel can be a nice refresher and a nice addition to a great at home regimen. However, it is best to invest in a daily skin care regimen including a retinoid and Zinc Oxide sunscreen prior to jumping to a chemical peel. To learn more about chemical peels and the ZO facials we offer, check out our website and ask your dermatologist what is the best option for you.
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