Surgery Overview
In a chemical peel, a chemical solution is applied to the skin and
allowed to soak in. Over the next 1 to 14 days, depending on how deeply the
chemical penetrated the skin, the skin peels off. This procedure destroys parts
of the skin in a controlled way so that new skin can grow in its place. The
chemicals used are sometimes called exfoliating or wounding agents.
The types of chemical peels differ based on how deeply the chemical
penetrates and what type of chemical solution is used. Things that may affect
the depth of a peel include the acid concentration in the peeling agent, the
number of coats that are applied, and the amount of time allowed before the
acid is neutralized. Deeper peels result in more dramatic effects as well as
higher risks, increased pain, and longer healing time. There are three basic
types of peels:
- Superficial peels are the mildest type of
chemical peel and can be used on all skin types. Superficial peels usually use
liquid containing a mild (dilute) acid, most often glycolic acid. Dry ice
(solid carbon dioxide) is sometimes used.
- Medium peels penetrate
the skin more deeply than superficial peels and cause a second-degree burn of
the skin. Trichloroacetic acid (TCA) is the main peeling agent used for medium
peels, though the peel may also be done in several steps using a different
chemical solution followed by TCA.
- Deep peels penetrate several
layers of skin and cause a second-degree burn of the skin. They are used only
on the face. A chemical called phenol is usually used for a deep peel. Deep
peels may not be used on darker skin types, because they tend to bleach the skin
(hypopigmentation). Even in lighter-skinned people, phenol peels—or any type of
deep resurfacing—may bleach the skin. A deep peel can be done only once in most
cases.
Before the peel
Your doctor can help you decide what depth of peel and what type
of chemical solution is most appropriate, based on your skin type, which areas
you want peeled, what kind of results you want, how much risk you are willing
to take, and other issues. A small "test spot" may be peeled to get a better
idea of the results, especially for people who have darker skin.
Two to three weeks before the peel, you will need to begin
preparing your skin by cleansing it twice a day, applying a special moisturizer
or cream once or twice a day, and using sunscreen every day. In some cases,
daily use of
tretinoin (Retin-A), a topical medicine usually used
to treat acne, is also recommended and may speed healing. This skin care
regimen will help the skin peel more evenly, speed healing after the peel, and
may reduce the chance of infection and other complications, especially uneven
color changes in the skin.
For medium and deep peels of the face, you may be given a short course of medicine (such as
acyclovir) to prevent viral infection. This is especially likely if you have had cold sores before and if the peel will be in the areas
near the mouth or eyes.
How a superficial peel is done
Right before the peel, the skin is cleaned. The chemical (usually
a liquid or paste) is then applied to the skin with a small brush, gauze, or
cotton-tipped applicators. The chemical is left on the skin for several minutes,
depending on the type of chemical used. Water or alcohol may be used to neutralize the
acid and end the chemical reaction, then it is wiped off. You may feel a little
burning while the chemical is on your skin. A handheld fan can help cool the
skin and relieve any discomfort.
How a medium peel is done
The technique used to do a medium peel is similar to that used
for a superficial peel, but the chemical may be left on for a longer period of
time. Medium peels are more painful than superficial peels, because the
chemicals are stronger and they soak deeper into the skin. You may be given a
pain reliever and an oral
sedative to reduce pain and anxiety during the
procedure. Cool compresses and fans can be used to cool the stinging and
burning caused by the chemical. The procedure takes about 40 minutes. There is
little or no pain after the peel is finished.
How a deep peel is done
Deep peels take the most time and are the most painful type of
chemical peel. The procedure for a deep peel using phenol is also more
complicated than for other types of peels.
- You may be given an oral sedative and pain
relievers. This is usually in the form of a shot or intravenous injection. General anesthesia may also be used.
- You may be put on a heart monitor and receive
intravenous (IV) fluids during the procedure, because
phenol is toxic when absorbed into the body's systems in large doses. These
measures may not be needed if only a single, small area is being
peeled.
- After the skin has been thoroughly cleaned, the chemical
will be applied and allowed to penetrate. After one area of the face is
treated, there will be a 15-minute break before the next area is treated to
avoid getting too much phenol in your system.
- Tape or ointment may be applied to the area after the peel to treat deeper problem areas.
When tape is used, it is removed after 2 days. Ointment is washed off with
water after 24 hours and then reapplied as needed.
Depending on how large an area is being treated, the entire
procedure may take 60 to 90 minutes.
What To Expect After Surgery
Recovery time after a chemical peel depends on what kind of peel
was done and how deep it was. With all types of peels, proper care of the skin
after the peel is very important to speed healing, help results last longer,
prevent infection, and avoid color changes in the treated area caused by sun
exposure. Proper skin care after a peel is very similar to the care used to
prepare for a peel and typically involves:
- Cleansing the skin frequently with
water or a special wash that your surgeon tells you to use.
- Changing the dressing or ointment on the wound (for medium
and deep peels).
- Moisturizing the skin daily.
- Avoiding
any sun exposure until peeling has stopped and sunscreen can be used. After
peeling has stopped, sunscreen should be used every day. New skin is more
susceptible to sun damage.
Some doctors may also recommend using tretinoin cream nightly,
usually starting 2 to 3 weeks after the peel.
Superficial peels
Superficial peels are done on an outpatient basis, do not require
anesthesia, and cause only slight discomfort afterwards. Most people can return
to their normal activities immediately. The skin heals quickly after a
superficial peel. The skin may turn pink, and usually only minimal peeling
occurs. You can use makeup to hide any redness until it fades.
Medium peels
Medium peels are usually done on an outpatient basis, but you may
need to take a few days off work to recover. A medium peel causes a
second-degree burn of the skin. The skin takes 5 to 7 days to heal to a point
where you can use makeup to hide the redness caused by the peel. There is
little or no pain after the peel, but there may be some swelling, especially if
the area around the eyes is treated. The skin will turn reddish brown in 2 to 3
days, become crusty, and then flake and peel over the next few days.
Deep peels
A deep peel causes a deeper second-degree burn of the skin. Skin
regrowth takes between 10 to 14 days after a deep peel. The skin remains
extremely red for 3 weeks, up to 2 months for some people. Most people take about 2 weeks off from
work. Complete healing of the skin may take several months.
- Oral pain relievers may be given to reduce
pain after the peel.
- Some people have severe swelling, especially
around the eye area. Elevating the head may reduce the swelling to some extent,
and corticosteroids may be used for more severe swelling.
- You may
be given a short course of antiviral and antibiotic medicines to prevent
infection after the peel.
- Proper wound care is extremely important
after a deep peel to speed healing and prevent infection of the wound. You may
be asked to shower several times a day to reduce crusting. And you may have to
return to the doctor's office frequently to have the wound cleaned and
checked.
Why It Is Done
- Superficial peels are used to improve the
appearance of pigment changes in the skin, acne scars, mild sun damage, or fine
wrinkles in all skin types. They can be done on the face and on other parts of
the body. A superficial peel may also be used to prepare the skin for a deeper
peel.
- Medium peels are used to treat mild to moderate wrinkles,
long-term sun damage, pigment changes, and precancerous lesions of the skin
(usually caused by sun exposure). Medium peels are used most often on the
face.
- Deep peels are used to treat severe wrinkles, long-term sun
damage, pronounced pigment changes, and lesions and growths on the skin. They
are done only on the face. Deep peels are not done on darker skin types, because
they bleach the skin.
Chemical peels are sometimes done with dermabrasion or laser
resurfacing for a more dramatic overall effect.
A chemical peel (except for a superficial peel) may not be done if
you have:
- Recently used isotretinoin (a
drug used to treat acne).
- Had recent facial surgery or facial
radiation therapy. This can make regrowth of the skin more
difficult.
- An active
herpes infection affecting the area to be
treated.
- An
impaired immune system. This can delay healing and
increase the risk of infection and skin color changes after the
peel.
- Known allergies to certain medicines.
How Well It Works
The results of a chemical peel depend in part on the depth of the
peel.1
- A superficial peel may slightly reduce but does
not eliminate sun damage and signs of aging. The results may not appear for
some time, and when they do appear, they may be minimal. Repeated peels are
often needed to produce the effect the person wants.
- A medium peel
can be very effective in evening out pigment differences and in reducing fine
wrinkles and signs of sun damage. Retreatment may be needed after 3 to 6
months to produce the best effect.
- A single deep peel eliminates
wrinkles and may tighten the skin. The effects are often dramatic. In general,
a person cannot have repeated deep phenol peels.
Your skin type, skin care before and after the peel, the doctor's
level of experience, and your lifestyle after the procedure can also affect the
results. Some types of skin problems respond better to chemical peeling than
others. People with lighter skin who limit their sun exposure after the
procedure tend to have better results than those who have darker skin and those who
continue to spend lots of time in the sun.
Before you decide to have a chemical peel, talk to your doctor
about the kind of results you can expect.
Changes in the color and texture of the skin caused by aging and
sun exposure may continue to develop after a chemical peel. Chemical peels are
not a permanent solution for these problems.
Risks
In general, the deeper the peel, the greater the risk of side
effects and complications.1 Chemical peels can result
in:
- Redness (erythema). Expect some redness of the
skin after a chemical peel. With deeper peels or with certain skin types,
redness can be severe. It may fade within a few weeks, or it may last several
months.
- Color changes in the skin. Treated areas may be darker or
lighter than the surrounding skin.
- Crusting and
scaling.
- Swelling (edema), especially around the
eyes.
- Scarring.
- Allergic reaction to the
chemical.
- Infection. People who have a history of herpes outbreaks
are especially prone to infection after a chemical peel.
- Increased
sensitivity to sunlight.
Special concerns with deep peels
In rare cases, deep peels using phenol can cause more severe
complications during the procedure, including heart, liver, or kidney
failure.
What To Think About
Expectations
Chemical peels are designed to wound and remove the upper layers
of the skin. You need to prepare yourself for how your skin will look
immediately after the peel and throughout the healing process. You also need to
be prepared to use cosmetics to blend skin tones between treated and untreated
areas, such as between the face and jawline.
It is important that your doctor understands what you hope to
achieve and that you understand what results you can realistically expect. Even
with realistic expectations, you may not see results for several weeks or
months after a chemical peel.
Sun protection
During the early healing period after a chemical peel (before the
skin has finished peeling), you will need to avoid sun exposure. After the early
healing period has passed, you will need to wear sunscreen every day and limit
sun exposure as much as possible. New skin is more susceptible to damage and
discoloration from sunlight.
Options for skin resurfacing
Chemical peel, dermabrasion, and laser resurfacing are the most
commonly used techniques for improving the texture and appearance of the skin.
Although these techniques use different methods, they have basically the same
effect on the skin—they destroy and remove the upper layers of skin to allow
for skin regrowth.
No one technique is necessarily better than the others. When
done by an experienced surgeon, laser resurfacing may be slightly more
precise than chemical peeling or dermabrasion. But the choice of technique
is based on the site you want to treat, your skin type and condition, the
doctor's experience, your preferences, and other things. Some people may get
the best results using a combination of techniques.
Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.
References
Citations
-
Tanzi EL, Alster TS (2008). Skin resurfacing: Ablative
lasers, chemical peels, and dermabrasion. In K Wolff et al., eds.,
Fitzpatrick's Dermatology in General Medicine, 7th ed.,
vol. 2, pp. 2364–2371. New York: McGraw-Hill Medical.
Credits
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By
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Healthwise Staff |
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Primary Medical Reviewer
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Anne C. Poinier, MD - Internal Medicine |
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Specialist Medical Reviewer
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Keith A. Denkler, MD - Plastic Surgery |
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Last Revised
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July 31, 2012 |