Chemical peels are tried and true
Everything old is new again, and chemical peels are experiencing a rebirth of sorts as growing numbers of cosmetic doctors turn to these oldies but goodies to address a wide range of skin concerns and conditions. In 2015, there were 603,305 chemical peels performed, up nearly 25 percent from 2014, the American Society for Aesthetic Plastic Surgery reports. And according to statistics released by the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) this month, more than half of facial plastic surgeons polled say that chemical peels are in high demand. “What’s great about chemical peels is that they’re low tech and not intimidating when compared to lasers, and they address the same problems—skin discoloration, texture, and wrinkles,” says Jessie Cheung, MD, Director of the Jessie Cheung MD Dermatology & Laser Center in Willowbrook, Illinois. So just how far back do they go? “Women have been using peels for over 2,000 years! Cleopatra soaked in milk baths to smooth her skin. The active ingredient in milk is lactic acid (an alpha hydroxy acid, or AHA) and these acids (along with beta-hydroxy acids or BHAs) are still among the most commonly used types in modern peels,” says Erin Gilbert, MD, PhD, a dermatologist in Brooklyn, New York.
Why get a chemical peel
“These days, the term ‘chemical peel’ applies to so many different formulations ranging from weaker glycolic peels that can be done at home to the strongest Phenol peels that often require sedation or general anesthesia,” says chemical peel enthusiast Mark H. Schwartz, MD, a New York City plastic surgeon. These workhorses can correct acne, age spots, discoloration, tone, fine lines (especially under the eyes and around the mouth), freckles, melasma, sun damage, and more, according to the American Academy of Dermatology (AAD). “Some peels produce changes that are relatively light and freshen the skin through exfoliation,” says Fred G. Fedok, MD, a facial plastic surgeon in Foley, Alabama, and the President of the American Academy of Facial Plastic and Reconstructive Surgery. “Moderately deep peels will help various kind of pigmentation issues. The deeper peels are effective at correcting wrinkles.” Peels tend to cost less than laser skin resurfacing, averaging anywhere from $100 to $400 per treatment based on practice location and the depth of the peel.
A series of mild chemical peels—on the face, neck, and/or chest—every few weeks is great for busy people, because they get significant results with minimal downtime. The weaker peels are the AHA peels or fruit acid peels, most commonly Glycolic Acid, Citric Acid, and Lactic Acid, and can help improve acne scars, skin tone and texture, diminish fine lines and wrinkles, and reduce the effects of sun damage. One such treatment is the “No Peel Peel” that Manhattan-based plastic surgeon Gerald Imber, MD, offers at his Youth Corridor Clinic. “The No Peel Peel is ideal for anyone looking to boost skin’s appearance or jumpstart a new skin care routine,” Dr. Imber says. “Our exclusive formula uses a 70 percent glycolic acid peel to remove dead cells and debris to regenerate skin cells without the traditional flaking and redness or discomfort associated with more intense formulas, so you get results similar to an intense peel, but without the downtime or side effects.” Other light peels are Glytone Professional By Enerpeel Mandelic Acid 40 and PCA skin peels. Here’s what you can expect: After a thorough cleansing of the face, the peel is applied with either a brush, a pad, or a cotton swab. “You may feel a slight tingling that lasts for the duration of the peel,” Dr. Schwartz says. “With the weaker AHA peels, there is a very short-term pinkish or ruddy glow to the skin,” he says. The before-and-after difference is pronounced. “You will look brighter right away with gradual improvement in fine lines, texture, and pigmentation.” A series of mild or superficial peels is often needed for optimal results. Aftercare matters too. Apply lotion or cream until the skin heals, and use sunscreen daily. It’s OK to wear makeup immediately.
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What makes peels a medium strength is the percentage of active ingredients. Medium-strength peels use some of the same acids in mild peels, just at a much higher level. For example, trichloroacetic acid (TCA) peels when used at more than 25 percent are medium strength, but anything lower would be considered superficial or mild, explains Chérie M. Ditre, MD, Director of the Skin Enhancement Center and an Associate Professor of Dermatology at the University of Pennsylvania School of Medicine in Philadelphia. Examples include ZO Medical 3-Step Stimulation Peel and the Obagi Blue Peel. Here’s what you can expect: Since these peels are deeper, your skin will be red and swollen after application, and blisters may form and break open. Your skin crusts and peels off in one to two weeks, according to the AAD. Your doctor may suggest taking an antiviral medication for 10 to 14 days before or after the peel if you have a history of cold sores. Other aftercare instructions include applying a lotion or cream to the treated area and avoiding the sun until healing is complete. Makeup is OK after about one week. “It is usually one and done for a while because there is downtime with these medium-strength peels,” says Dr. Ditre. Look to a medium-depth peels—such as the 35 percent TCA and Jessner solution—to remedy hyperpigmentation and moderate wrinkles, according to Dr. Fedok. You may also be a candidate if you have heavy sun damage, leathery skin, and coarse wrinkles that are visible even at rest, Dr. Ditre adds. Medium-strength chemical peels may also help correct acne scars. Don’t miss these non-peel methods to get rid of acne once and for all.
Deep chemical peels
Phenol peels are the strongest chemical peels out there, and they target deep wrinkles, sun damage, and uneven tone. “They are helpful in treating vertical lines around the mouth, the so-called smokers lines,” Dr. Schwartz says, and they work best on lighter skin, since there is less of a risk of hypopigmentation or bleaching.” Phenol peels are ordinarily used on the face only, since the skin of the neck and hands tends to be thinner and more delicate. Here’s what you can expect: Given the strength of these peels, anesthesia may be required. There is some real downtime with phenol peels. “Crusting and post-procedure redness occur across the board and can last for weeks,” Dr. Schwartz says. The trade off is dramatic and long-term results. “These deep peels will do things that a face lift will not—improve the quality of environmentally damaged skin,” he says. Phenol based peels can be used for more severe skin changes and wrinkles, but as Dr. Ditre notes, these deep peels have fallen out of favor given the availability of lasers as well as phenol’s possible link to heart issues.
Many peels are available over the counter at the drugstore or your doctor’s office, and these tend to have the same ingredients as in-office peels but at much lower concentrations, such as Glytone Rejuvenating Mini Peel Gel and Exuviance Daily Acne Peel. At-home peels take about 10 minutes—you apply gel or pads to the area, and then wash it off. “Some people do it weekly,” Dr. Ditre says. It’s important not use any retinoid products after a peel because they can irritate freshly exfoliated skin. Also, consider doing a skin patch test first. “I always tell my patients to take the time to perform a small test area before putting a product on their entire face,” says Dr. Gilbert. “Some products may be too strong for your skin type and cause redness, stinging, and irritation that is not only unpleasant and but can actually be dangerous.” It’s also essential to wear a high quality sunscreen of SPF 30+ after any peel, whether it’s being done at a doctor’s office, a spa, or at home, she stresses. (Watch that you’re not making these common sunscreen mistakes.) DIY peels are best for veterans of peels who want to do them at home for acne or fine lines, according to Dr. Ditre. “They give skin a great glow.”