Chemical Peels - Appalachian Spring Dermatology

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. It will be no surprise for those who know me 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!!!. Panic started to set in. What was I thinking? I was lying 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 YouTube 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.

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.
What are the different types of peels? Peels are generally characterized based on the depth that the acid penetrates the skin. Usually, the deeper the acid penetrates, the thicker the layer of skin peels off and the more impressive result. However, deep 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 downtime, and has a high risk of scarring, but impressive results. In comparison, a superficial chemical peel is comfortable, minimal downtime, 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 a while 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.

What kind of peels do you do at Appalachian Spring Dermatology? To be honest, I haven’t done the old-fashioned, paint the acid on your face, sort 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.
To address uneven and dull skin texture, enlarged pores, mild discoloration, and fine lines – A ZO 3 Step Peel uses a cocktail of acids follow by 6% retinol and anti-inflammatory cream. The cocktail of acids includes five percent lactic acid, ten percent TCA, and seventeen percent salicylic acid. Improvement in skin texture can be seen with each peel, but improvements in discoloration and fine lines may require 4-6 peels one month apart. 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 then rinsed off. I generally recommend removing the peel when it starts to feel “tingly” or “itchy.” Use this 1-2 times per week as needed.
Dull appearing skin and sun damage – You can also obtain an impressive at-home chemical peel by using retinol. A well-studied at-home peel regimen used ZO Advanced Radical Night Repair containing 1% retinol for 3-5 days.

What changes do I need to make to my skincare regimen before and after a chemical peel? Before a peel, it is best to begin using Tretinoin/retinA and sunscreen for 4-6 weeks, which 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 skincare 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 six weeks after a peel. For those with darker skin, Dr. Rosenberger sometimes recommends using a bleaching cream containing hydroquinone post-peel to reduce the likelihood of discoloration.

A chemical peel can be a nice refresher and addition to a great at-home regimen. However, it is best to invest in a daily skincare regimen, including a retinoid and Zinc Oxide sunscreen, prior to jumping to a chemical peel.

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