Going a little deeper with chemical peels

February 9, 2018 by Shari Twigg, MD
Going a little deeper with chemical peels
For many, chemical peels are done using an agent that allows for a very quick recovery time.  These types of peels are considered a light/superficial peel and penetrate the epidermis.  These peels are best done in a series of 6-8 peels for optimal outcomes, with continued treatments for maintenance.  Many patients do light/superficial chemical peels every 4-6 weeks for years.  Doing one peel alone typically will do very little to maintain the skin or help certain issues the patient would like to correct or improve, such as hyperpigmentation, fine lines and wrinkles, or acne and scarring.  For others, a more suitable chemical peel may be a medium depth peel.  These peels extend into the dermis.  There are many classifications for medium chemical peels based on the extent it penetrates into the dermal layer of the skin. A medium peel usually requires 7-10 days for full recovery, although some may be slightly less or more depending on individual healing times and depth of penetration.   For even further depth, deep chemical peels extend to the deepest layers of the dermis and have to be done under anesthesia.

The medium depth chemical peel is designed to address more extensive skin problems:  advanced age-related damage, skin laxity, and deep acne scars.  They must be done by a medical professional fully trained in chemical peels.

Pre-treatment and post-treatment therapy is necessary for medium chemical peels.  Therapies such as using topical products prescribed by the physician to accelerate regeneration of the skin cells and to prevent hyperpigmentation are usually recommended and performed for several weeks prior to doing a medium depth peel.  Typically, for accelerating wound healing and re-epithelialization the products used may be alpha hydroxy acids, salicylic acid solutions, or a retinoic acid product.  These stimulate the outer epidermis to shed and restoration of the epidermis.  In addition, retinoids act on cell differentiation, reduced cell cohesion and other mechanisms.  This increases the speed of healing after a peel is performed.  Many require a topical medication to help prevent hyperpigmentation.  The most common medication used is hydroquinone, but others also exist.  Hydroquinone works by inhibiting an enzyme the pigment cell uses to make melanin (the darker pigment produced).  After some healing time, these agents are restarted as a post-treatment therapy as well.

In addition to the above pre-treatment medications, those patients that have ever had a history of cold sores are prescribed a prophylactic medication, as any type of disruption of the skin layer can cause an eruption.  This is taken until the skin has healed completely.

With medium chemical peels, pain relief can be provided with pre-treatment of the skin with a numbing agent as well as over-the-counter pain relieving preparations.  Many need none, however, but will feel an intense stinging during the procedure.  A hand-held fan is often utilized to decrease the stinging sensation during the procedure.

Following completion of a medium chemical peel, the skin will be red, will likely be swollen for several days, and then develop a crust and dry layer of skin.  The peeling skin will feel and look tight and appear grayish to brown, particularly in areas of preexisting pigmented lesions.  Some scabbing may also occur.   Particular care is necessary during this phase and most patients require time off to heal.  Particular products need to be used during the healing phase for optimal healing.  In addition, no make-up can be worn and strict sun avoidance must be followed until complete healing.  Strict sun avoidance, via using a broad spectrum sunscreen and hat-wearing (wide-brimmed to cover the entire face) must be continued for 6 months.  I recommend this be done daily for the rest of your life.  There’s no sense in re-damaging the skin you just took considerable measures to improve.  During healing, the skin that is going to shed after the rough, scaly period should never be pulled off manually.  This should be left to desquamate on its own naturally, as pulling it can cause hyperpigmentation and scarring to occur.   You will also be required to return to the office for regular visits and may be as often as every 2 days during the initial healing phase for supervision.

Peels of this type should not be repeated for a period of 6 months, until the phases of healing are completed.