Facial Peel Information


How do Facial Peels work?

In all chemical facial peels, a solution containing the active ingredient is applied to the skin. The skin subsequently peels off over a period of 1 to 14 days, depending on how potent the chemicals were.  This procedure removes parts of the skin in a controlled way so that new, healthier skin can grow in its place.  Facial peels are sometimes used in conjunction with microdermabrasion or laser resurfacing for a more dramatic overall effect.

Facial peels differ depending upon how deeply the chemical is needed to penetrate and the type of chemical solution that is used.  Factors that may affect the depth of a peel include: 1) the acid concentration in the peeling agent, 2) the number of coats that are applied, and 3) the amount of time allowed before the acid is neutralized.  Deeper facial peels generally result in more significant changes in the skin but are associated with higher risks, greater discomfort or pain, and a significantly longer healing time.

Facial Peels may be divided into three types:

Superficial Facial Peels

Superficial facial peels are the mildest type of facial peeling and can be used on a wide variety of skin types. Superficial chemical peels usually use a solution containing a mild acid, most often glycolic acid.  Dry ice (solid carbon dioxide) can also be used.  Aestheticians can perform only superficial peels.  A superficial facial 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 facial peels are often needed to produce the desired effect.

Superficial facial 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 facial peeling occurs.  You can use makeup to hide any redness until it fades.

Immediately before a superficial facial peel, the skin is cleaned. The chemical (usually a liquid or paste) is applied to the skin with care using a small brush, gauze, or cotton-tipped applicators. The chemical is left on the skin for 2 to 7 minutes, depending on the type of chemical used. Water is often used to neutralize the acid and end the chemical reaction. The facial peel solution is then wiped off. You may feel a small burning sensation during facial peeling. A handheld fan can help cool the skin and relieve any discomfort.

Medium Facial Peels

Medium facial peeling penetrates the skin more deeply than a superficial facial peel and can cause a reaction similar to a second-degree burn. Trichloroacetic acid (TCA) is the main peeling agent used for a medium facial peel. Sometimes the facial peeling is performed in several steps using a different chemical peel solution, such as resorcinol followed by TCA. Medium facial peels should only be performed by a physician. A medium facial peel can be very effective in smoothing and blending pigment differences and in reducing fine wrinkles and signs of sun damage. Repeated treatment is often needed after 3 to 6 months to produce the best effect.

Medium facial peels are usually done on an outpatient basis, but you may need to take a few days off from 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 facial 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.

The technique used to do a medium facial peel is similar to that used for a superficial facial peel, but the chemical is either in a slightly higher concentration or may be left on for a longer period of time.  A medium chemical peel is more painful than a superficial facial peel, as the chemicals are stronger and penetrate deeper into the skin.  You may be given a pain reliever and/or oral sedative to reduce any pain and anxiety during the procedure. Cool compresses and fans can be used to cool the stinging sensation caused by the chemical peeling. The facial peel procedure takes approximately 20 minutes. There is little or no pain once the facial peeling is finished.

Deep Facial Peels

Deep facial peels are used only for intense facial peeling and should only be performed by a physician. The most common agent used in deep facial peeling is called phenol.   Deep facial 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 cause hypopigmentation. A deep facial peel is usually performed only once. A single deep facial peel eliminates wrinkles and may tighten the skin. The effects are often dramatic. In general, a person cannot have repeated deep phenol facial peels.

A deep facial peel also causes a second-degree burn of the skin. Skin re-growth begins within 10 to 14 days after a deep peel. The skin remains extremely red and tender for up to 3 weeks. Most people take this time off from work.  Complete healing of the skin may take several months. Oral pain relievers may be given to reduce pain after deep facial peeling. 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 after facial peeling. You may be given a short course of antiviral and antibiotic medications to prevent infection after the facial peel. Proper care is extremely important after a deep facial 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.

Your skin type, skin care before and after the facial peel, the doctor’s level of experience, and your lifestyle after the procedure can all have an effect on 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 with darker skin and those who continue to spend lots of time in the sun.

Before you decide to have a facial 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. Facial peeling is not a permanent solution for these problems.

Deep facial peels take the most time and are the most painful type of facial peel. The procedure for a deep facial peel using phenol is also more complicated than for other types of facial peels. You may be given an oral sedative and pain relievers. General anesthesia is occasionally used but runs increased risk of possible complications.

During a deep facial peel, you may be put on a heart monitor and receive IV (intravenous) fluids, because phenol is toxic when absorbed into the body’s system in large doses. These measures may not be necessary if only a single, small area is being peeled.

After the skin has been thoroughly cleansed, 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 is often applied to the area after the facial peel to increase its effectiveness.  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 facial peel may take 60 to 90 minutes.

Sun protection

During the early healing period after a facial peel (before the skin has finished peeling), you will need to avoid sun exposure. Once 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.

Other Options for Facial Rejuvenation

Facial peeling, microdermabrasion, and photofacials 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 re-growth.

No one technique is necessarily better than another. When performed by an experienced technician, photofacials may be slightly more precise than facial peeling or microdermabrasion. However, 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 factors. Some people may get the best results using a combination of techniques.

References:

  1. www.webmd.com
  2. Drake LA, et al. (1995). Guidelines of care for chemical peeling. Journal of the American Academy of Dermatology, 33(3): 497-503.
  3. Branham GH, Thomas JR (1996). Rejuvenation of the skin surface: Chemical peel and dermabrasion. Facial Plastic Surgery, 12(2): 125-133.
  4. Matarasso SL, et al. (1997). Cutaneous resurfacing. Dermatologic Clinics, 15(4): 569-581.
  5. Sherris DA, et al. (1998). Comprehensive treatment of the aging face—Cutaneous and structural rejuvenation. Mayo Clinic Proceedings, 73: 139-146.
  6. Brody HJ (1999). Skin resurfacing: Chemical peels. In IM Freedberg et al., eds., Fitzpatrick’s Dermatology in General Medicine, 5th ed., pp. 2937-2946. New York: McGraw-Hill.

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