All about chemical peels
Chemical peel is a treatment that improves the quality of the skin and renews the skin surface by adding acid into it. The acid stimulates and loosens the old skin so that your body forms a new healthy skin in the area.
How much skin is removed by a chemical peel depends on how strong the exfoliating acid is and how long it stays on the skin. There is superficial, medium depth or deep chemical peels to choose between.
Chemical peel can through its function regenerate skin with a wide range of applications. It is primarily used on the hands, decolletage, face and neck in order to refurbish, reduce superficial fine lines remove pigmentation scars and unevenness.
The different peels effect and uses
A chemical peel involves removal of old skin cells and stimulates the skin to a new formation. The main advantages of using chemical peel are to remove and stimulate regeneration of the skin are:
- Chemical peels come in different strengths and can be used either aggressively for a big and rapid effect or gently for successive improvements
- You can control how deep the peel is going
- It has an even effect over the whole treatment area
Chemical peels are performed with different techniques and acids. The final outcome of treatment depends on three factors: the strength of acid that is used, the amount that is used and how long it stays on the skin.
Product names of the various acids used for chemical peel are many but you can divide them into four different categories; AHA and BHA acids, Trichloroacetic acid (TCA) and Phenol acid.
Some mild chemical peels can be purchased over the counter. The more concentrated ones are only used at beauty clinics while the strongest ones are only used by doctors and nurses at medical clinics.
1. AHA and BHA acids – superficial peel that refreshes skin
AHA or BHA peels are beauty treatments that are used to refresh the skin on the face, hands or decolletage.
The term AHA stands for Alpha Hydroxy Acid which is a group of acids derived from natural sources such as milk, sugarcane and various fruit acids. AHA-acids has also a sibling called Salicylic acid – a so-called BHA acid (Beta Hydroxy Acid).
AHA and BHA acids have two effects. First, an exfoliating effect which means that they remove the skin’s outermost layer, the so-called epidermis. However, AHA-acids also stimulate increased production of collagen and hyaluronic acid, and improve moisture balance of the skin.
The BHA acid has except from the exfoliating affect also an anti-bacterial and anti-inflammatory and at the same time a drying effect. This treatment can be a good option for those who suffer from acne but not as suitable for people with dry skin.
AHA and BHA peels are primarily used for active acne and mild sun damages such as pigmentation changes, unevenness in the skin’s texture, melasma and keratosis pilaris.
The acid solution is applied on the skin and the area to be treated. It may take 5-10 minutes before being neutralized. The treatment may cause stinging but is performed without anesthesia. After being treated, you can return to your normal daily activities. You may also wear make-up after an AHA or BHA treatment.
When being treated with mild acids, you need 2-4 treatments a week apart to achieve noticeable results. Thereafter, monthly peels are recommended for maintenance. A good way to see these treatments as is part of an “advanced skin care program”.
2. TCA – medium depth medical peel that rejuvenates
TCA peel is a medical treatment that is used to smooth and rejuvenate the skin on the face, hands or decolletage. It is especially popular for treating signs of aging associated with sun exposure.
TCA (Trichloroacetic acid) is based on chlorinated acetic acid and in its pure from a highly corrosive acid. When being treated with chemical peels, TCA is used with a maximum of 50% concentration but usually solutions of 25-35% are used for medium depth peels. There is a 50% risk of scarring in use of TCA.
TCA peels are used when you want to treat pigment changes, skin damage and uneven skin texture. However, TCA peel with strength of +25% is a powerful treatment that makes the old skin to flake off which is replaced by new and healthy skin.
The results of a TCA peel is usually clear. You get a smoother skin with a more even colour and healthier surface. As the old skin eventually goes away and is replaced by “newborn” skin, you will also look naturally younger.
The acid is applied on the skin for 10-30 minutes. You will feel stinging when the skin dissolves and gets a white/frosted surface. If necessary, pain killers and sedative is given to aid relaxation.
During day 1-2 after treatment, the skin becomes first pink, red and then brown. Your skin will be swollen and it will feel leathery. After 3-7 days your old skin will flake off and your new baby pink skin will be shown. In some cases, this healing process may take several weeks.
After treatment, on day 1-2, the skin becomes first pink, red and then brown. It will also swell and the skin will feel leathery. During days 3-7 peel the old skin off and a new baby pink skin is shown. In some cases, this “healing process” may take several weeks.
You should take a couple of days off work after a TCA treatment. You can go back to work after 3-7 days as long as you don’t mind answering questions about your skin colour changes and flaking. From day 8 you are ready for “social viability” again.
TCA peels with concentrations above 15% have a relatively powerful effect and should therefore be performed by staff with medical skills to avoid risk of scarring pigmentation spots.
3. Phenol peel – deep peel with a strong acid that smooths out skin imperfections
Phenol peel is a qualified medical treatment with a very powerful effect. It should therefore be performed at medical clinics where they have staff that has at least medical expertise
Phenol acid is only used on the face where it removes superficial wrinkles, pigment changes, unevenness and wrinkles. Phenol peels has a very limited effect on scars. Many people think it’s a good treatment for acne scars. But it’s not. It is however an effective treatment for wrinkles caused by changes in the skin’s deeper layers (dermis).
Phenol peel may lighten the skin. If skin lightening occurs, it can be so powerful that you can get a ghostly skin colour. You should therefore be prepared for that after a phenol peel and make-up may be necessary when being shown in public. Patients with dark skin tone should avoid phenol peel.
However, phenol acid causes controlled chemical burns in the skin which in many ways is similar to laser peel procedure. The body heals the damage with the formation of new connective tissue fibers down into the skin and new cell layer on the surface. This tightens, increases elasticity, rejuvenates and smooths the skin and pigmentation.
Since a phenol peel causes burns, local anesthetic is applied when treating small areas of the skin, but larger areas are treated under general anesthesia.
Treating a full face can take up to an hour. When treating the whole face, the patient is closely watched during the procedure with cardiac monitoring and fluid supplementation since phenol can be toxic in excessive doses.
After being treated with phenol peel, you will get skin burns on the treated area and it will also swell properly. The wounds are bandaged or a special silicone mask is applied. In some cases, an open healing wound is used combined with Vaseline as lubricant.
The wounds are often healed within 10 days. However, you should expect severe redness in a few weeks time that will gradually disappear after three to six months. You should expect to be away from work 2-3 weeks after treatment.
The power of phenol peel and the extensive healing the body implements gives a whole new skin throughout the treated area. The difference in skin quality is often dramatic and results hold up in 10’s of years.
Risks of chemical peel
Chemical peel removes the skin. How deep it goes will decide what big changes can be expected. However, with deeper peels there are also increased risks. But with superficial peels there is barely anything that can go wrong.
For deeper peels, controlled burns are created. Therefore, by choosing the right treatment and taking care of your wound healing you will get a new and fresh skin. An improperly done chemical peel or misjudgment of the patient’s ability to heal properly will cause side effects.
Side effects that are associated with chemical peels are primarily uneven pigmentation and scarring. Here you can see a detailed summary:
- Being treated with Phenol it is common with hypopigmentation which means you lose the pigment in the skin. Some patients can feel that they are ghostly white without make-up. In cases when pigmentation becomes uneven, it may be difficult to apply make-up over.
- Phenol peel is so strong that treatment often must be performed under general anesthesia or intravenous sedation. Its toxicity can affect the function of the heart, liver and kidneys, that’s why even cardiac monitoring and intravenous fluids are recommended during treatment.
- When being treated with TCA peel, pigmentation in treated areas can change. Normally, the skin gets brighter but may also darken. In some cases, uneven pigmentation.
- Swelling and flaking will occur after treatment, sometimes dramatically, up to about 2 weeks. The skin will be flushing and red for up to 6 months.
- According to many it is important to start a pre-treatment 2-4 weeks before a deep chemical peel with a special cleanser and lubrication with a cream that lightens the skin and stimulates cell proliferation. If you not follow the instructions, you get worse results and the risk of side effects increases.
- There is a risk of scarring when being treated with TCA peels with strength over 50% and Phenol peels. Also lack of aftercare or poor wound healing can cause permanent scars.
- All peels make your skin sensitive to the sun. Therefore, you should always protect yourself with high sunscreen protection. Being treated with deep peels, you will be more sensitive to sun exposure and it can remain permanently.
- All wounds have a risk of infection. Chemical peel also increases the risk of relapse for those who have herpes. Sometimes preventive treatment is recommended.
Finally, it should be known that phenol acid that is used as deepest peels are toxic and can, if used improperly, or lack of security affect the function of the heart, liver and kidneys.
How you can reduce the risks associated with chemical peels
Chemical peel will always be a balance between the results you want to achieve against the risks, inconveniences, expenses you are willing to take. To choose a weaker peel is the most obvious way to reduce risk. But there are some more options:
- When being treated with medium depth peels or deep peels, choose a qualified medical clinic. Deep peels should be performed by dermatologists, plastic surgeons, or equivalent.
- Try a mild chemical peel before being treated just to see how your body reacts. Then you can gradually choose more powerful treatments.
- In some cases it is better to undergo several treatments with mild chemical solution than strong, because then you will have full control over the process.
Some people are advised to avoid chemical peel. These include: people who are on certain medications, are pregnant or breast feeding, has a light reddish skin with freckles, darker skin types, scarred easily and people with heart diseases.
Prices for chemical peel with AHA, TCA and Phenol acid
Cost of a chemical peel depends on what peeling is used and where the treatment is performed. However, superficial peels are cheaper and deeper peels more expensive.
Before undergoing a chemical peel, a consultation is needed to find out if you are suitable for treatment and what can be done. This usually cost £30-50.
When being treated with deeper chemical peels, it usually requires a pre-peel skin care program consisting of sunscreen, cleaning and lubrication. The cost varies between £100-200 and an additional cost of the treatment itself.
- Superficial peels such as AHA or BHA are done at beauty clinics and costs about £60. However, it often requires a series of 2-3 treatments to achieve desired results.
- A medium depth peel with TCA-acid of 25%-35% in strength cost around £600. After just one treatment you will see an obvious change but repeated treatments may be necessary to achieve desired results.
- A deep Phenol peel of the whole face costs about £2000. You get a significant rejuvenation, smoothing skin and pigmentation with only one single treatment.
It often happens that different acids in combination with each other are used to enhance the effect. Basically, chemical peel is about strength. Medium depth and deep peels are performed with TCA in strength over 25% or Phenol acid.
Additional information and options for chemcial peel
- Find clinics that perform chemical peel
- Learn more about laser peel as an alternative to chemical peel
- Read more about dermabrasion as an alternative to chemical peel
- Discuss chemical peel in our forum
- Ask a question or read answers about chemical peel in “Ask the Expert”
This information about chemical peel has been examined by dermatologist Tore Nilsen at Vaxjo Medical Center. It should be seen as guidance and cannot replace a visit at the doctors.