FOURTH QUARTER 2001, VOLUME 15, NO 4

When Chemicals Are Good for You ..Types of Peels

IN THIS ISSUE

What Men Want …with facial plastic surgery

When Chemicals Are Good for You ..Types of Peels

Ask the Surgeon / Health Tip / Whats New

Healthy Radiant Skin at Any Age

We are all interested in rejuvenating the appearance of our skin. Applying chemicals to your face – although that sounds unthinkable – is the foundation for a very popular cosmetic procedure known as the chemical peel. Whether you want to rid your face of a few wrinkles or take off years, there is a wide range of varying chemicals and strengths used to meet the individual’s needs. If you are considering this procedure, check with your facial plastic surgeon regarding indicators, expectations, and types of peels.

Indicators

Your physician will evaluate your skin (including imperfections and skin type) to determine if you are a good candidate for a peel or if you would benefit from a different nonsurgical rejuvenation procedure such as, microdermabrasion, Botox, filler injections, or laser resurfacing. If you and your physician agree that a peel would best meet your needs, then he or she will discuss what type and strength of peel would be optimal for you. Typical indicators for this procedure include uneven texture, mild scarring, wrinkles, or discoloration spots (from the sun or aging).

Layers of the Skin

Your skin is composed of two layers, the epidermis and the dermis. The epidermis is on the surface. Underneath the epidermis, the dermis is composed of long fibers, called collagen, that stretch and relax with age and sun damage. Within the dermis are two layers: the papillary layer (upper) and the reticular layer (lower). The papillary layer can heal from injuries without scarring. When the reticular layer is damaged, scars may result.

How Does a Chemical Peel Work

All chemical peels work the same, though each produces a different result: A chemical solution is applied to remove the damaged outer layers of the skin so that new, regenerated skin can replace it. The active ingredient and the concentration of the chemical will determine what layers will be eradicated. If you have deep scars (down to the reticular layer) then you might be a candidate for a stronger peel that will reach that layer.

There are several types of chemicals used. Your physician may apply one or a combination of chemicals to the skin to strip away the epidermis depending on what the facial plastic surgeon is trying to achieve. Glycolic acid is the mildest. TCA, trichloroacetic acid, gives a moderate peel that provides longer-lasting results than the glycolic peel. The deepest peel is the phenol peel; it is extensive with a longer recovery time and longer lasting results.


This depicts the result of a combination facelift and chemical peel. Photos courtesy of The Face Book, published and sold by the American Academy of Facial Plastic and Reconstructive Surgery.

Expectations

If you have poorly textured skin, acne, or discoloration from sun damage you can expect that a facial skin peel will improve your appearance. The chemicals induce shedding of the outer layer of skin and increase smoother collagen deposition in the dermal layer.

The stronger the peel, the deeper it will permeate. Therefore, deeper peels work to reconstitute the lower, collagen and elastin layers of the skin to remove the deeper wrinkles. There is minimal crusting associated with the peel, which clears within three to 10 days. As the crusting clears, the pigmentation of the skin is removed. Your skin may not have the ability to tan as well, so it is extremely important to wear sunblock and a wide-brimmed hat.

Chemical peels may be combined with other cosmetic or reconstructive procedures, depending on the individual’s needs and goals.

You cannot expect chemical peels to remove or to reduce the appearance of blood vessels on the skin. Peels can diminish most superficial scars, but not keloidal scars. If you have a dark skin tone, this procedure may not be appropriate for improving discoloration.

A chemical peel may be the procedure to help you achieve brighter, younger looking skin. Check out your options by visiting your facial plastic surgeon today.

Types of Peels

AHA Chemical Peels
Alphahydroxy acid (AHA) is a mild chemical solution that includes glycolic, lactic, or fruit acids that gently peel the epidermis and can peel a portion of the papillary dermis as well. The purpose is to eliminate rough, dry skin and produce fresher, smoother skin. The AHA peel is not a permanent answer and is often repeated weekly. There may be temporary reddening or dryness after the peel, however, most patients resume normal activities immediately following the procedure.

TCA Chemical Peel
Trichloroacetic acid (TCA) infiltrates the epidermis and into the papillary dermis. This peel treats moderate sun damage, fine lines, weathered skin, and pigment problems. The chemical may be applied along with a sedative; recovery involves moderate discomfort and mild swelling for about a week. The TCA peel is often repeated over a period of weeks and effects smoother, fresher looking skin.

Phenol Chemical Peel
The phenol peel can remove extensive wrinkling, marked discoloration, scarring, and pre-cancerous growths. It is the strongest of the chemical solutions and causes a deep peel. The patient is sedated before the carbolic acid is applied, which may take from one to two hours. The convalescence period is approximately two weeks of redness and mild discomfort.