What is a Chemical Peel?
Chemical peels are a procedure in which a chemical solution is applied directly to the skin to remove the top layers so that new, smoother skin may begin to appear. They are most often used to treat wrinkles, discolored skin, and scars; most typically located on the face. Chemical Peels can be a standalone procedure or be combined with other cosmetic techniques like Micro-needling. Peels are known to provide remarkable results for a drastic range of skin conditions and have a great many anti-aging rejuvenation benefits.
Peels can be done at different depths — light, medium or deep — depending on desired results. Each type of chemical peel uses a different chemical solution
Light chemical peel. A light (superficial) chemical peel removes the outer layer of skin (epidermis). It can be used to treat fine wrinkles, acne, uneven skin tone and dryness. We offer light chemical peels every two weeks for the treatment of acne and anti-aging.
Medium chemical peel. This type of chemical peel removes skin cells from the epidermis and from portions of the upper part of your middle layer of skin (dermis). A medium chemical peel can treat wrinkles, acne scars and uneven skin tone.
Deep chemical peel. A deep chemical peel removes skin cells from the epidermis and from portions of the mid to lower layer of your dermis. Your doctor might recommend a deep chemical peel if you have deeper wrinkles, scars or precancerous growths. A deep chemical peel can only be performed once and must be performed under the direction of a doctor.
Benefits of Chemical Peels:
- To remove dead skin buildup
- This will improve the effectiveness of their at-home topical products by allowing them to permeate the skin more efficiently since they will no longer struggle to get through a layer of dead skin
- To drastically reduce the chance of acne breakouts : By removing the old, decaying skin cells from the surface of the skin the pores will no longer be clogged or infected-the main sources of acne.
- To improve the appearance and texture of the skin : Chemical exfoliants can produce numerous anti-aging benefits such as reducing the appearance of pigmentation, fine lines, scars, and wrinkles.
- They also help to bring new, smooth, supple skin to the surface.
Am I a Candidate?
Generally, fair-skinned and light-haired patients are better candidates for chemical peels. If you have darker skin, you may also have good results, depending upon the type of problem being treated. But you also may be more likely to have an uneven skin tone after the procedure.
Skin sags, bulges, and more severe wrinkles do not respond well to chemical peels.
Pre Care Instructions:
Pre- treatment protocol (that should begin a minimum of two weeks before the appointment date) is as follows :
1. An AHA from 8% to 12%. This could be a gel, lotion, cleanser, or cream. It should be used daily or as tolerated for more sensitive skin. By using a low-dose acid in the weeks leading up to the peel, you can acclimate the skin to higher strength acids. It will also help remove the barrier of dead skin cells.
2. A melanin tyrosinase inhibitor, or pigment inhibitor to be used twice daily. This step is especially important for darker skin tones or those with Fitzpatrick’s numbers four and five. The ingredients in these inhibitors will help reduce and prevent unwanted pigment by calming the melanin in the skin.
days leading up to the peel.
antiviral (prescribed by a doctor) for one day before the peel and about seven days after the peel.
While a good pre-treatment protocol can help mitigate the chance of adverse reactions, it is not a total guarantee that no reactions will happen.
- No Accutane in the last 6 months. (There are no exceptions.)
- No microneedling in the last four weeks
- 12 hours before treatment, no autoimmune therapies or products.
- 3 days before treatment, avoid Retin-A (retinoids), topical antibiotics, hydroquinone, and benzoyl peroxide.
- The client should not use any acids or exfoliants for at least 24 hours before the treatment
- Any topical that has the potential to dry or irritate the skin. (For example, Alpha Hydroxyl Acid (AHA) or Beta Hydroxy Acids (BHA))
- No sun exposure to the area being treated for at least 24 hours before the treatment.
- No freshly tanned skin two to four weeks before your peel. Freshly tanned skin contains more melanin and could lead to a higher risk of PIH.
- For 7 days before treatment, no IPL/Laser procedures. (CO2 must wait three months before proceeding.)
- 7 days before the treatment, no waxing, depilatory creams, or electrolysis.
- There will be no shaving on the day of the procedure.
- Avoid wearing makeup on the day of the treatment.
- If there is history of cold sores, an antiviral agent should be prescribed and begun two days before treatment.
- If active or severe breakouts occur prior to treatment, they can be treated, but the infected area must be avoided or the procedure must be rescheduled.
- To reduce the risk of bruising, abstain from alcohol, aspirin, NSAIDs (ibuprofen, Aleve), garlic, gingko biloba, fish oils, and vitamin E for 5-7 days prior to treatment, unless otherwise directed by your doctor. These are not contraindications to carrying out the treatment.
Post Care Instructions:
It is always important to follow a specific manufacturer’s post-peel protocol if one is available, but this is a general protocol to help give you an idea of what you should be doing post-treatment.
- For one to two weeks after treatment gently cleanse the area twice a day with a gentle cleanser and cool water. DO NOT scrub face while cleansing.
- There should be no direct sun exposure for four to eight weeks post peel. The skin is extremely sensitive after a chemical peel even if it does not feel sensitive. Direct sunlight to the freshly peeled area could cause scarring or pigment issues and could ruin all the results you were trying to achieve.
- DO NOT not pick, pull, or rub at loose skin post treatment. You must let it come off naturally or it could cause infection, pigmentation, and/or scarring.
- No activities that produce heat or sweat in the body should be done for at least 4 days to one week post treatment. No hot tubs, saunas, heated or sweaty workouts should be undertaken during this time as sweat can cause irritation or blistering in the skin!
- If you are at a greater risk for PIH, have higher Fitzpatrick numbers, or are of Asian heritage, you should continue to use a melanin/tyrosinase inhibitor two times a day for one to two weeks.
- Keep the skin hydrated! Keep the skin extremely hydrated and never let the skin dry out. Hyaluronic acid, stem cells growth factors and high quality moisturizers are suggested. Hydration promotes proper healing! Use of an occlusive agent such as Aquaphor or Vaseline is called for after some treatments to insure proper hydration to the area. You should also be drinking six to eight glasses of water per day.
- If you have a history of cold sores, continue the use of their anti-viral for seven days post treatment.
- If at any time during the post-treatment downtime itching occurs, use a hydrocortisone cream. This is an over-the-counter cream that should relieve itching when applied properly. This should be used three to five times a day, but only for three consecutive days at a time.
- Finally, Sunscreen with an SPF of at least thirty should be worn daily for the first eight weeks after treatment. Even if you are just riding in the car to the grocery store, the sun’s rays will still be hitting you in the face. As much
protection as possible should be utilized to keep the sun from damaging the skin in this condition. A physical or mineral based sunscreen is greatly preferred over a chemical sunscreen because chemical sunscreens can cause irritation to the freshly peeled skin.
Most complications, if any, will be related to the chemical portion of the treatment. They rarely happen, but it’s important to understand and learn all the possible complications so you can be prepared. Even with the proper pre- and post-treatment preparation, there is still always a risk of adverse reactions.
Risks:
- Hyperpigmentation: Hyperpigmentation may be caused by a chemical peel that was too strong or improper pre- or post-care from the client. This complication can be treated with hydrocortisone cream, four to five times a day for three days at a time. If the skin has healed and the pigment remains, then a pigment inhibitor or skin bleaching cream (such as hydroquinone or retinoids) can help to speed up the cell turnover cycle.
- Hypopigmentation: Hypopigmentation is caused when a chemical peel is too strong for the skin type it was used on. This is seen mostly in higher Fitzpatrick numbers. Avoidance is KEY with this complication, but if it happens your client should be referred to an MD (preferably a dermatologist) right away. This complication can be irreversible.
- Hot spots: Hotspots are small areas on the face that have reacted more to the peel treatment than the surrounding tissue. These areas should be treated quickly because they can scar or cause hyperpigmentation in the area. To treat hot spots, you should apply hydrocortisone cream (or an emollient/repair balm) four to five times a day for three days. If the spot remains after a few weeks, they can continue to use a pigment inhibitor or bleaching scream to speed the cell renewal cycle.
- Chemical burns/blistering: Chemical burns are caused by chemical peels that have been left on the skin too long or are too strong for the client’s skin type. You should immediately use ice or a cold compress on the area but be sure there is a barrier between the ice and skin. You will need to refer to a doctor immediately after because there is a risk for infection or permanent scarring associated with chemical burns.
- Edema/swelling: Edema can happen to sensitive areas of the face, such as the under-eye area. This area can be susceptible to edema in general, so unless the swelling is extreme, this complication could be normal. Extreme swelling can be treated with ice. If it is persistent, refer to an MD.
- Infections: You will be able to tell that the skin is infected by looking for oozing, crusting, and the skin being warm to the touch. They can be cause by poor post-peel care from the client and using a peel that was too strong for the client. Infections should be immediately referred to a doctor, but while they wait you can apply an over-the-counter antibiotic ointment such as bacitracin or colloidal silver. Bacitracin is widely preferred over something like Neosporin because Neosporin is sulfur based and can cause more inflammation.
- Allergic reactions: Allergic reactions can be caused by any of the acids that make up a chemical peel treatment. The lighter form of this complication can be treated by applying a cold compress and hydrocortisone cream. If an allergic reaction occurs days after the chemical peel, stop all topical treatments and apply hydrocortisone cream to the area.
- Itching: Itching can be caused from either a topical agent or, more commonly, dry skin and/or the peeling process. If the itching includes pustules and papules (pimples), it is most likely contact dermatitis. To treat this, stop all topical products and apply hydrocortisone cream. Itching can cause post-inflammatory hyperpigmentation if left untreated, so an immediate response is indicated. If itching persists, you should refer to an MD.
- Persistent erythema (redness): Normal healing during a chemical peel can include pink coloring where the skin has already peeled. This normal healing usually lasts for about three to five days. If the skin is a deeper pink or red however, the peel could have burned the skin causing erythema. If this is the case, the area should be kept hydrated at all times.
- Acne breakout: Sometimes the combination of dead skin, the increased cell turnover, and inflammation from the procedure can cause an acne breakout of the skin. You should not put any active ingredient on the skin until it has finished healing.
Contraindications:
Contraindications to chemical peels must always be discussed with your skincare professional. If you have a concern, always ask your esthetician prior to receiving a peel.
- Use of Accutane®, Retin-A®, or other medications that exfoliate or thin the skin within 6 months
- Recent cosmetic surgery, laser resurfacing, deep or medium depth chemical peels or dermabrasion
- Severe rosacea or acne
- Easily scars or has hyper-pigmentation tendencies
- Pregnancy – always consult with your obstetrician prior to receiving chemical peels
- Breast-feeding
- Sunburn or irritated skin
- Open sores or lesions
- Infectious disease
- Active Herpes simplex
- Diabetes
- High blood pressure
- Heart disease
- Deficient immune system
- Permanent cosmetics–wait 7 days then cover with occlusive barrier