It is a technique in which a substance (solution, cream or paste) is applied to the skin that will remove the outermost layers of the skin (exfoliation). This phenomenon produces a renewal of the external part of the skin and can increase the synthesis of collagen in its intermediate layers (dermis): the aim is to improve the appearance of the skin by minimising open pores and fine wrinkles. If the peel is deep, it reduces skin sagging and eliminates wrinkles and deep furrows.
How is a chemical peel performed?
First of all, the skin must be prepared for two weeks before the peeling itself, applying a preparation to the area to be treated that contains active ingredients that enhance the action of the peeling: salicylic acid, glycolic acid and/or tretinoin, among others. Prior preparation will allow the peeling to penetrate evenly, increasing its effectiveness and the performance of the procedure.
Once the preparation has been made, the superficial or medium chemical peels will be carried out in consultation with the dermatologist. Initially, the skin must be cleaned with a specific solution to remove excess sebum and debris from the skin surface. The peeling itself is then applied: depending on the type, one or the other substance will be used. Although each of the active ingredients must be applied with a specific technique, in general they are deposited repeatedly on the skin with a brush, swabs or gauze. Throughout this process, the patient experiences a sensation of increasing stinging (variable depending on the type of peel), which will disappear once the dermatologist neutralises the substance applied to end the act. The stinging experienced is perfectly tolerated the vast majority of the time and generally only lasts a few seconds or minutes.
The completion of the peeling includes the cleansing of the treated area and the subsequent application of a soothing and/or regenerating preparation.
Deep peels, which are currently rarely performed and will not be discussed in this post, must be done in an operating room under general anesthesia. The main one is phenol or trichloroacetic acid at a very high concentration.
What types of chemical peels are there?
Depending on the depth of action, only part or all of the outermost cutaneous stratum (epidermis), part of the intermediate stratum (up to the papillary dermis) or all of it (up to the reticular dermis) will be removed. Peels that only remove the epidermis are called superficial; the second, middle and deep third.
What type of chemical peel is ideal?
The deeper a peeling is, the more action it has and the better the aesthetic results , although potential adverse effects are also more frequent and the recovery period after it is carried out.
Superficial peels made with glycolic and/or pyruvic acid are indicated for the treatment of mild skin aging, for lentigines (sun spots), acne and its scars, melasma, comedones (pimples) and open pores, and as a prevention of skin cancer in areas where there are actinic keratoses as a result of accumulated solar radiation (for example on the scalp of alopecic men).
Salicylic acid superficial peel is especially effective for excess sebum, active acne and in combination with non-ablative fractional laser for the treatment of acne scars.
Intermediate peels with trichloroacetic acid are very useful for moderate or severe skin aging, and for deep (“ice pick”) acne scars.
Deep phenol peels will be used only for very ambitious goals in terms of skin aging or atrophic scars. They must be performed in the operating room, under general anesthesia and with cardiac monitoring due to the intense pain it causes and the risks of the procedure.
How many sessions are necessary?
The more superficial a peel, the more sessions are required to achieve the desired effect. Likewise, the deeper the fewer sessions are necessary, but the more aggressive the procedure and the more recovery time it requires.
As for superficial peels, it is recommended to repeat them every 2-6 weeks until the desired goal is achieved, or routinely every 1-2 months as a prevention of skin aging.
A single peel , unless deep or intermediate, produces a discreet improvement, and several sessions are required to perceive noticeable changes.
What does the skin look like after peeling?
In superficial peels there are usually no complications and only minimal flaking and/or redness are noticed, which are imperceptible with the application of a moisturizer or makeup. For this reason, they are the ones that are usually practiced and the ones that provide greater satisfaction to the patient, since they do not involve any period of sick leave or the formation of scabs or wounds. You only have to use sun protection on a regular basis and it is possible to use cream formulas that extend and enhance the effect of the peeling carried out in the Dermatology consultation.
Intermediate or deep peels cause a noticeable injury to the skin and crusts form that can become intense, in addition to no less noticeable pain. They also require prior oral treatment for herpes simplex to avoid possible infection, and it is necessary to rest and take time off work due to the appearance of the face for weeks. Nowadays it is rare to apply this type of peeling unless the patient’s preference and expectations suggest it.
Do I need to be out of work for a while to recover?
In the case of superficial peels (salicylic, glycolic and pyruvic acid) no recovery period is necessary as they usually do not cause any visible injury.
If intermediate or deep peels are desired, a period of low recovery is required while the wounds heal. For this reason, they are rarely used today.
What is the care that should be taken after having a peel?
After performing any aesthetic procedure, it is advisable to use an SPF 50 sunscreen, which should be oil-free formulation so as not to cause comedones or acne.
Likewise, the effects of peelings are more noticeable if after they are performed we regularly use a formula with certain active ingredients such as glycolic acid, salicylic acid, hyaluronic acid and/or tretinoin. It is the dermatologist’s job to dialogue with the patient, understand their priorities and personalize their treatment.
Will I notice a lot of change with a single chemical peel ?
No. Peeling is another tool for the treatment of the appearance of the skin. Its effectiveness is optimal (in the case of superficial ones) only when a previous preparation is carried out and a few treatment sessions are practiced. The peeling should be understood as an item of support and enhancement of the effects of a global treatment, not as a single maneuver that produces a great change in the skin.
You will notice noticeable changes if there is specific skin care and peels are performed occasionally every 2-6 weeks for a period of time, and especially if they are combined with procedures that act in a deeper way (such as non-ablative fractional laser or hyaluronic acid fillers).
If I have a social commitment and I have a peel a few days before, will it dramatically improve the appearance of my skin?
No. Although you would notice improvement, to achieve an excellent effect with peelings it is necessary to prepare beforehand by applying an exfoliating cream and perform a few treatment sessions (not just one). However, if the person is in the habit of having peels or uses appropriate cosmetics, it is possible that with a single session prior to the commitment there will be a notable improvement in appearance.
What advantages do chemical peels have over other aesthetic procedures?
Superficial peels are very comfortable for the patient; they are not aggressive; they have good results if adequate preparation and technique are performed; and they are not aesthetic acts of high cost. It is exceptional that complications occur after performing a peeling, and if they do occur they are usually minimal.
Bibliographic references
Zakopoulou N, Kontochristopoulos G.Superficial chemical peels. J Cosmet Dermatol. 2006 Sep; 5(3):246-53.
Fischer TC, Perosino E, Poli F, Viera MS, Dreno B. Chemical peels in aesthetic dermatology: an update 2009. J Eur Acad Dermatol Venereol. 2010 Mar; 24(3):281-92
