Background:

Skin peeling involves an application of a chemical solution to sun-damaged, unevenly pigmented, and finely wrinkled facial areas. The procedure is meant to diminish imperfections by peeling away the skin’s top layers. It has proven to be a very popular nonsurgical cosmetic procedure; see current American Society for Aesthetic Plastic Surgery (ASAPS) statistics. Chemical peels vary according to their specific ingredients and their strength. Depth of peeling action may also depend on factors such as how long solutions remain on the skin and whether they are lightly applied, or more heavily or vigorously applied.

Technique: The surgeon will select the best chemical or chemical mix for the individual patient. A solution is applied—using a sponge, cotton pad, cotton swab or brush—to the areas to be treated (or the entire face, avoiding the eyes, brows and lips). Generally, the most superficial peels are those using alpha hydroxy acids (AHA), such as glycolic, lactic or fruit acid. Various concentrations of an AHA may be applied weekly or at longer intervals to obtain the best result. A trichloroacetic acid (TCA) peel is stronger, and has a greater depth of peel compared to AHA’s.

Benefits:

AHA:

• No anesthesia or sedation is needed, and the patient will feel only a mild tingling or stinging sensation when the solution is applied.


• Sometimes a single treatment will give skin a healthier, radiant look.


• No downtime—patient can immediately resume normal activities.


• Can be mixed with a facial cream or wash in milder concentrations as part of a daily skin-care regimen.

TCA:

• TCA is especially effective in treating darker-skinned patients.


• Can possibly be used to achieve some effects of a deep peel, depending on the concentration and manner of application.


• Generally shorter recovery time than with a deep (phenol) peel.

Both:

• Short, safe procedure.


• No covering or after-peel ointment is necessary.

Other Considerations:

AHA:

• May require multiple treatments.

TCA:

• May require pretreatment with AHA or Retin-A creams.


• Repeat treatment may be required.


• Deeper TCA peel may result in 2-3 days of restricted activity.

• Sun block is strongly recommended, especially with TCA treatment. Skin pores may appear larger, and the skin may not tan evenly following a chemical peel.


• Some facial skin disorders do not respond to chemical peeling.