• Purpose:
• Who is suitable?
• The treatment
• Superficial Peels
• Medium Peels
• Deep peels
• The results
• Complications of Chemical peeling
• What is the procedure and aftercare?

Purpose:

The procedure known as chemical peeling (or chemexfoliation to give it its proper name) involves the application of a chemical solution to the surface of the skin to produce the careful removal of its outer layers. The amount of skin removed will depend on the type of chemical used, the strength of this product and how long it is left on the skin.

A chemical peel removes the outer layers of the skin. This freshens the skin, removes some sunspots and rough scaly patches, and reduces freckles and irregular pigmentation. It also reduces fine wrinkles. The regenerated skin is usually smoother and less wrinkled than the old skin.

Peels can also be used for reducing uneven pigmentation, acne and acne scarring.

People are advised to seek professional help from a doctor with qualified on a specific type of chemical peel before a procedure is performed

Who is suitable?

Fine wrinkling can be reduced, though deeper lines will remain, (some of which can be improved by other methods) with chemical peeling.

Most brown marks, freckles and pigmentation can be removed or lessened, especially age and liver spots (lentigines). However, pigment changes can be caused by a peel in people prone to this complication due to their skin type. Those known to develop brown discolouration after injury such as a mild burn should have a test area peeled first before undergoing a full face chemical peel.

Scaly patches and rough skin (keratoses) can be removed. Very thick keratoses may need additional treatment for complete removal. Skin that is thin and fragile eg sun-damaged skin, bald scalpskin, can be significantly rejuvenated.

Chemical peeling is not:

• A substitute for a facelift.
• It does not tighten sagging skin, stimulate collagen production or remove broken capillaries.
• Chemical peeling is not appropriate for people who will continue to have excessive sun exposure
• Chemical peels cannot change pore size, tighten loose skin or remove deep scars.

Before you start:

Make sure you know what to expect from a chemical peel.

Some doctors prescribe a pre-treatment skin regime (for four to eight weeks), to prepare a patient's skin and speed the healing process.

You should avoid electrolysis and sunbeds for a couple of weeks before treatment and wear a sunblock after treatment.

The treatment:

A chemical peel is designed to accelerate the removal of old, dead skin cells at the surface of the skin to promote new cell growth, and can be used to treat a particular area (such as lines around the eyes or mouth), or all over the face, arms, hands and neck.

How you prepare: Several weeks before your chemical peel procedure, you will need to prep your skin by cleansing it two times a day, applying a moisturizer once or twice daily, and applying sunscreen everyday. Prepping the skin before the procedure will help your skin peel more evenly, reduce the risk of infection and other complications such as uneven skin color, and amp the healing process after the peel. It is important to consult with your qualified cosmetic docotor to determine your precise skin care regiment prior to a chemical peel.

The Procedure: Most chemical peel procedures begin with prepping the skin either with skin care treatments or with microdermabrasion. The doctor a licensed professional will scrub your skin and use a mild toner to remove any oils before gently applying layers of an acidic solution to peel away the aged surface of the skin. Depending on the procedure, the solution is left on your face for a certain period of time before the product is removed. Then your skin will be wiped clean and an antibacterial cream will be applied to help with comfort and healing.

Chemical peels can take anything from just a few minutes to over thirty minutes, depending on the type of peel that you are having.

Chemical peels are usually described according to how deep they work on the skin. Below are some examples of the type of peels and the kind of language you can expect to hear used when discussing chemical peels.

There are three types of peel: superficial, medium, or deep.

With all types of peel you may need to use specified homecare products before your peel. These products will help to prepare your skin and ensure that it is in optimum condition prior to the peel.

You may also need to use specified homecare products after your peel.

Superficial Peels

Superficial peels remove skin cells from the epidermis (the top layer of the skin).

These peels usually use combinations of alphahydroxy acids (AHAs) and betahydroxy acids (BHAs) eg glycolic acid, lactic acid, salycilic acid and maleic acid.

Treatment takes only a few minutes, and your skin may feel pink and feel tight for a couple of hours after the treatment.

As superficial peels only affect the top layers of the skin you may need to have regular treatments to maintain the effect.

It can help to lessen rough skin texture, dry or flaking skin, fine lines due to sun damage, mild acne marks, "age spots" (brownish patches which can be caused by sun damage) and balancing irregular skin tones (i.e. skin which may be uneven in colour.)

These are the commonest types of peel used.

You might want to have a peel prior to a special occasion when you want your face to look alive and glowing.

Medium Peels

Medium peels can remove skin cells from both the epidermis and upper part of the dermis (the middle layer of the skin).

These peels should be performed by doctors.

These peels usually contain trichloroacetic acid (TCA) and this is sometimes used in combination with glycolic acid. The peel remains on your face for a few minutes before being neutralised.

A burning or stinging sensation may be felt during the application of the peel and the skin may go brown or red in the days after the peel. It can take up to six weeks for the skin to return to normal.

Medium peels may need to be repeated every 6 - 12 months to maintain the effect.

Medium peel can reduce small wrinkle lines, some acne scars, and certain pigmentation problems (again, making different coloured skin more even.).

This type of peel may be repeated monthly until the desired effect is achieved. Thereafter, maintenance peels every 6 – 12 months should keep your skin looking good.

Recovery time can take a week or so depending on how well you heal, your age (older skin tends to heal less quickly) and any post-treatment complications.

Deep peels

This procedure should be carried out by a docotor with relevant skills and experience in an establishment registered with the Healthcare Commission.

Deep peels go deeper into the lower part of the dermis. They are performed using phenol (a strong form of TCA) and may require a local anaesthetic and sedative. The peel is applied to the face, and the treatment feels as if the face is 'freezing'. The peel may be left on the face for up to 30 minutes or more, depending in the desired affect.

Post-peel pain is treated with painkillers.

There will be some peeling, redness and discomfort for a few days depending on the type of peel used.

You should use the recommended cleanser and cream, wear no make up for the first 24 hours and use sunscreen. Most of the swelling should disappear within 14 days, although there may be some redness of the skin for some time after that - up to three months in some people.

Can help to reduce the appearance of deeper lines, wrinkles and scars.

A deep peel is a 'one-off' treatment with lasting effects it can produce dramatic improvement in patients with sun damaged skin. These effects can last for 10 years or more.unlike superficial and medium peels.

The results:

As described above, the result will depend on what chemicals are used, how deep the peel is and any special requirements you may have.

Complications and risks:

While side effects are rare, chemical peels are associated with some risk. Deeper peels generally increase the chances of side effects and complications including:

• Redness – Some redness is expected after a peel, but severe redness may occur and last for several months
• Hypo or hyperpigmentation – Skin discoloration resulting in darker or lighter patches around the treated areas
• Swelling
• Crusting or scaling of the skin
• Scarring
• Infection – People who have oral herpes are more prone to infection
• Allergic reaction
• Increased sunlight sensitivity
• Heart, liver, or kidney failure – Rarely, phenol (deep) chemical peels can cause severe organ complications

The treated skin may appear darker or be tight or swollen for a time.

You will need to avoid exposure to the sun for some time after your peel, but your practitioner or clinic should give you full information on this and other aftercare, depending on the strength of your peel.

Scarring can occur with strong acids, but is unusual with weaker ones. The most common causes of scarring are infection, and pulling off the skin before it is ready to peel. Both of these are avoidable.

Cold sores can be activated in those prone to this kind of condition. Anti viral medication can prevent this. Increased pigmentation may occur, and resolves with time. It can be largely prevented by religious use of sunscreen for three months after the peel.

What is the procedure?

1. The skin may have had preparation with Vitamin A, Alpha Hydroxy Acid or other preparations.
2. Firstly the skin is thoroughly cleansed with acetone or other cleanser.
3. The acid is then painted onto the face and monitored.
4. If burning or stinging is a problem, a cold pack may be helpful.
5. Usually the treatment is carried out in sections.
6. Patients who find it particularly uncomfortable may choose intravenous anaesthetic, but then would not be able to drive a car for several hours.

What happens afterwards?

• The skin will go red and swollen over the next 24 hours.
• Once the initial burning has worn off it is not painful, but feels tight.
• Over the next few days the skin dries and looks like a brownish leather.
• Vaseline should be applied several times a day to prevent cracking.
• Water will do no harm but soap should be avoided.
• The skin will begin to peel between 5 and 7 days later, and must be left to come off at its own pace.
• As soon as the skin has healed, make up may be applied over the new, pink skin.
• Sometimes a secondary peel occurs during the second week in the form of dry scaling skin.
• Sunscreen is mandatory for at least three months, and moisturisers are helpful.

Chemical peeling can be repeated after three months, but this is not usually necessary. It can be repeated at any time in the future and will not harm the skin. The habitual use of sunscreen will prevent further sun damage and therfore maintain the improved skin quality.

Additionally, the use of vitamin creams, AHA creams or enzyme creams can continue to improve the skin texture and reverse some of the effects caused by years of sun exposure.