If
You're Considering Chemical Peel …
Chemical peel uses a chemical
solution to improve and
smooth the texture of the facial skin by removing its
damaged
outer layers. It is helpful for those individuals with facial
blemishes, wrinkles and uneven skin pigmentation. Phenol,
trichloroacetic acid (TCA) and alphahydroxy acids (AHAs) are
used for this purpose. The precise formula used may be
adjusted to meet each patient's needs. Although chemical peel
may be performed in conjunction with a facelift, it is neither
a substitute for such surgery, nor will it prevent or slow the
aging process. This brochure provides basic information about
certain types of chemical peel treatments and the results you
might expect. It won't answer all your questions, since a lot
depends on your individual circumstances. Once you and your
plastic surgeon have decided on a specific peel program, be
sure to ask about any details that you do not understand.
Deciding if Chemical Peel Is Right
for You
Chemical peel is most commonly
performed for cosmetic reasons — to enhance your appearance
and your self-confidence. Chemical peel also may remove
pre-cancerous skin growths, soften acne facial scars and even
control acne. In certain cases, health insurance may cover the
peel procedure. Be sure to check your policy and contact your
insurance company before the procedure is performed.
Alphahydroxy acids (AHAs), such as
glycolic, lactic or fruit acids, are the mildest of the peel
formulas and produce light peels. These types of peels can
provide smoother, brighter-looking skin for people who can't
spare the time to recover from a phenol or TCA peel. AHA peels
may be used to treat fine wrinkling, areas of dryness, uneven
pigmentation and acne. Various concentrations of an AHA may be
applied weekly or at longer intervals to obtain the best
result. Your doctor will make this decision during your
consultation and as the treatment proceeds. An alphahydroxy
acid, such as glycolic acid, also can be mixed with a facial
wash or cream in lesser concentrations as part of a daily
skin-care regimen to improve the skin's texture.
Trichloroacetic acid (TCA) can be
used in many concentrations, but it is most commonly used for
medium-depth peeling. Fine surface wrinkles, superficial
blemishes and pigment problems are commonly treated with TCA.
The results of TCA peel are usually less dramatic than and not
as long-lasting as those of a phenol peel. In fact, more than
one TCA peel may be needed to achieve the desired result. The
recovery from a TCA peel is usually shorter than with a phenol
peel.
Phenol is the strongest of the
chemical solutions and produces a deep peel. It is used mainly
to treat patients with coarse facial wrinkles, areas of
blotchy or damaged skin caused by sun exposure, or
pre-cancerous growths. Since phenol sometimes lightens the
treated areas, your skin pigmentation may be a determining
factor as to whether or not this is an appropriate treatment
for you. Phenol is primarily used on the face; scarring may
result if it's applied to the neck or other body areas.
All chemical peels carry some
uncertainty and risk. Chemical peel is normally a safe
procedure when it is performed by a qualified, experienced
plastic surgeon. However, some unpredictability and risks,
such as infection and scarring, while infrequent, are
possible.
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| Chemical
peel is especially useful for the fine
wrinkles on cheeks, forehead, around the eyes
and the vertical wrinkles around the mouth. |
|
AHA peels may cause stinging,
redness, irritation and crusting. However, as the skin adjusts
to the treatment regimen, these problems will subside.
With a TCA peel, your healed skin
will be able to produce pigment as always; the peel will not
bleach the skin. However, TCA-peel patients are advised to
avoid sun exposure for several months after treatment to
protect the newly formed layers of skin. Even though TCA is
milder than phenol, it also may produce some unintended color
changes in the skin.
With a phenol peel, the new skin
frequently loses its ability to make pigment (that is, tan).
This means that not only will the skin be lighter in color,
but you'll always have to protect it from the sun. Phenol may
pose a special risk for patients with a history of heart
disease. It's important that you make your surgeon aware of
any heart problems when your medical history is taken.
It also is possible that phenol will
cause some undesired cosmetic results, such as uneven pigment
changes. Certain modified phenol peels are gentler and may be
preferred in some circumstances.
Peel Formulas at a Glance
Alphahydroxy Acids (AHAs)
Uses:
- Smooths rough, dry skin
- Improves texture of sun-damaged
skin
- Aids in control of acne
- Can be mixed with bleaching agent
to correct pigment problems
- Can be used as TCA pre-treatment
Considerations:
- A series of peels may be needed
- As with most peel treatments,
sunblock use is recommended
Trichloroacetic Acid (TCA)
Uses:
- Smooths out fine surface wrinkles
- Removes superficial blemishes
- Corrects pigment problems
Considerations:
- Can be used on neck or other body
areas
- May require pre-treatment with
Retin-A or AHA creams
- Treatment takes only 10-15 minutes
- Preferred for darker-skinned
patients
- Peel depth can be adjusted
- Repeat treatment may be needed to
maintain results
- Sunblock must be used for several
months
- Healing is usually quick, much
quicker than with a phenol peel
Phenol
Uses:
- Corrects blotches caused by sun
exposure, birth-control pills, aging
- Smooths out coarse wrinkles
- Removes pre-cancerous growths
Considerations:
- Used on the face only
- Not recommended for dark-skinned
individuals
- Procedure may pose risk for
patients with heart problems
- Full-face treatment may take one
hour or more
- Recovery may be slow - complete
healing may take several months
- May permanently remove facial
freckles
- Sun protection, including sunblock,
must always be used
- Results are dramatic and
long-lasting
- Permanent skin lightening and
lines of demarcation may occur
Planning for a Chemical Peel
In some states, no medical degree is
required to perform a chemical peel — even the strongest
phenol peels. Many states have laws that permit non-physicians
to administer certain peel solutions, but regulate the
strengths that they are permitted to apply. You should be
warned that phenol and TCA peels have been offered by
inadequately trained practitioners claiming "miracle
techniques" to rejuvenate the skin.
It is very important that you find a
physician who has adequate training and experience in skin
resurfacing. Your plastic surgeon may offer you a choice of
peel techniques or suggest a combination of peels to obtain
the best result for you.
During your initial consultation, it
is important that you discuss your expectations with your
plastic surgeon. Don't hesitate to ask any questions or
express any concerns that you may have. Expect your plastic
surgeon to explain the planned procedure in detail, including
its risks and benefits, the recovery period, and the costs. If
you have a history of herpes, you should inform your physician
prior to the procedure. Remember, chemical peel treatments
usually are not covered by medical insurance unless they are
performed for medically related problems.
Preparing for Your Chemical Peel
Your plastic surgeon will instruct
you on how to prepare for your peel treatment.
Sometimes Retin A — a prescription
medication derived from Vitamin A — is used to pre-treat the
skin. This thins out the skin's surface layer, allowing the
TCA solution to penetrate more deeply and evenly. If your skin
won't tolerate Retin-A pre-treatment, an AHA cream may be used
instead. Hydroquinone, a bleaching agent, is sometimes used in
conjunction with Retin-A or AHA pre-treatment, especially if
you have blotchy skin areas or pigmentation problems. You may
have to spend a month or more in the pre-treatment phase
before the doctor will schedule your actual peel.
You will need to arrange for someone
to drive you home and help you out for a day or two if you are
having a phenol or deeper TCA peel. You probably won't need
any extra assistance if you're having an AHA peel or
superficial TCA peel.
Where Your Peel Will Be Performed
Most chemical peels may be safely
performed in a plastic surgeon's office, office-based surgical
facility or outpatient surgical center. Your plastic surgeon
may want you to stay overnight in a facility or hospital if
other cosmetic procedures are performed simultaneously.
Types of Anesthesia
Anesthesia isn't required for phenol
or TCA peels because the chemical solution acts as an
anesthetic. However, sedation may be used before and during
the procedure to relax you and keep you comfortable.
No anesthesia is needed for AHA peels
since they cause only a slight stinging sensation during
application.
The Peel
AHA Peels/Treatments: Your
doctor will apply the AHA solution to your cleansed facial
skin, a process that usually takes no more than 10 minutes. No
"after-peel" ointment or covering is required.
Depending on the strength of the peel, periodic treatments may
be necessary until the desired effects are achieved.
For some patients, the application of
an AHA-based face wash or cream, once or twice a day at home,
will be sufficient to accomplish the desired goal. Your
plastic surgeon may add Retin-A or a bleaching agent to your
at-home treatment schedule. After several weeks of at-home
use, your doctor will examine your skin to determine if your
regimen needs adjustment.
Phenol and TCA Peels:
Typically, the skin is first thoroughly cleansed. Then, the
surgeon will carefully apply the phenol or TCA solution. You
may feel a stinging sensation as the peel solution is applied,
but this feeling will quickly pass.
A full-face TCA peel usually takes no
more than 15 minutes. Two or more TCA peels may be needed to
obtain the desired result, and those may be spaced out over
several months. Mild TCA peels may be repeated as often as
every month.
If phenol solution has been used,
your plastic surgeon may coat the treated area with petroleum
jelly or a waterproof adhesive tape. With lighter peels, no
covering is necessary.
A full-face phenol peel generally
takes one or two hours to perform, while a phenol peel to a
smaller facial region (perhaps the skin above the upper lip)
may take only 10 or 15 minutes. A single treatment usually
suffices.
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| The
chemical solution can be applied to the entire
face, or to a specific area - for example,
around the mouth - sometimes in conjunction
with a facelift. |
|
 |
| At
the end of a phenol peel, a thick layer of
petroleum jelly may be applied to the treated
area. |
|
 |
| A
protective crust may be allowed to form over
the new skin. When it's removed, the skin
underneath will be a bright pink. |
|
After Your Treatment
After an AHA peel, it is common to
experience some temporary flaking or scaling, redness, and
dryness of the skin. However, these conditions will disappear
as the skin adjusts to treatment.
After a phenol or TCA peel, your
doctor may prescribe a mild pain medication to relieve any
tingling or throbbing you may feel. If tape was used to cover
your face, it will be removed after a day or two. A crust or
scab will form on the treated area. To help your face heal
properly, it is essential that you follow your doctor's
specific post-operative instructions.
A TCA peel may also cause significant
swelling depending on the strength of the peel used.
If you've had a phenol peel, your
face may become quite swollen. Your eyes may even be swollen
shut temporarily. You will need someone to help care for you
for a day or two. You may also be limited to a liquid diet and
advised not to talk very much during the first few days of
recovery.
Getting Back to Normal
With an AHA peel, the temporary
redness, flaking and dryness that you experience will not
prevent you from working or engaging in your normal
activities. A fresher and improved skin texture will result
with continued AHA treatments. Remember, protecting your skin
from the sun is also important following these mild acid
peels. Ask your doctor to recommend a sunblock with adequate
UVA and UVB protection and use it every day.
With a TCA peel, the moderate
discomfort and mild swelling you may experience will subside
within the first week. In about a week to 10 days, your new
skin will be apparent, and you should be healed sufficiently
to return to your normal activities. It is best to avoid sun
exposure unless you are adequately protected.
With a phenol peel, new skin will
begin to form in about seven to 10 days. Your face will be
very red at first, gradually fading to a pinkish color over
the following weeks to months. During this time, it is
especially important that you use a sunblock or blotchy,
irregular skin coloring may result.
About two weeks after treatment, you
may return to work and resume some of your normal activities.
Your skin will be healed enough for you to wear makeup.
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| After
healing, the skin is lighter in color,
tighter, smoother and younger looking. |
|
Your New Look
Improvements from AHA peels may be
very subtle at first. You may detect a healthier glow to your
skin. With continued treatments, you will notice a general
improvement in the texture of your skin.
The results of a TCA peel are usually
not as long-lasting as those of phenol peel. However, your
skin will be noticeably smoother and fresher-looking.
If you're planning a phenol peel, you
can expect dramatic improvement in the surface of your skin -
fewer fine wrinkles, fewer blemishes, and more even-toned
skin. Your results will be long-lasting, although not immune
to the effects of aging and sun exposure.
