The Ultimate Guide To Chemical Peels

There’s a reason chemical peels have been around for millennia — they treat a wide array of skin concerns without any fancy equipment. Here’s what you need to know.
Aesthetics
Written by Krista Smith
02.15.2021
The Ultimate Guide To Chemical PeelsPablo Merchán Montes/Unsplash

Chemical peels are making a comeback. After years of taking a backseat to high-tech, high-priced lasers and the social media-fueled microneedling craze, the humble (yet oh so powerful) peel promises a relatively quick, affordable, and versatile alternative for correcting a cadre of complexion woes.

Chemical peels have been around for millennia. An ancient Egyptian medical text known as the Ebers Papyrus (1550 BC) describes the technique, and Cleopatra herself is said to have bathed in sour donkey milk (which contains lactic acid) to smooth her skin. The Greeks and Romans, meanwhile, used corrosive limestone and grapes (tartaric acid) for the task.

From the first use of trichloroacetic acid (TCA) in the 1880s to the fine-tuning of the phenol peel in the early 2000s, peeling techniques have come a long way. In the current climate of DIY and discreet downtime, we wanted to explore — yep, layer by layer — the possibilities the modern peel provides.

What Is a Chemical Peel?

Just as it sounds, chemical peeling (a.k.a. chemexfoliation or chemical exfoliation) uses a solution (typically an acid) to strip away the skin’s outer layers in a controlled manner. This destruction to part or all of the epidermis and, sometimes, part of the dermis stimulates the skin’s regenerative process, including the production of collagen and elastin. Some peels are self-neutralizing, meaning that they lose all their potency on their own, while others require intervention to stop the action of the ingredients. Over time (usually within a week) the skin begins to peel and flake off, revealing smoother skin beneath.

How deep a peel goes depends upon several factors:

  • Acid type
  • Acid concentration
  • Application technique
  • Skin thickness
  • Sebum production
  • Skin barrier health

Generally speaking, the higher the concentration of acid or other active ingredients, the stronger the peel. Similarly, applying more solution to the skin, leaving it on longer (in some cases), and overlapping in certain areas will typically result in more layers of skin cells being removed. Professional chemical peels can be classified into one of three categories depending on their potency:

  1. Superficial chemical peels
  2. Medium chemical peels
  3. Deep chemical peels

Below, we’re breaking down everything you need to know about each type.

Superficial Chemical Peels

Also known as ‘lunchtime peels’ or ‘light peels,’ superficial chemical peels remove only the layers of the epidermis — you know, those dead skin cells that build up and can make skin look dull. Depending on their makeup, some very superficial peels only remove the stratum corneum of the epidermis, while others go deeper to reach the basal layer. These treatments can be performed by an aesthetician, board certified physician, or even at home (though it’s best to consult your dermatologist beforehand when going the DIY route).

Superficial peels are used to treat a variety of complexion concerns, including:

  • Fine lines
  • Acne and acne scarring
  • Pigmentation (both hypo and hyper)
  • Uneven texture
  • Dullness

There are many types of superficial peels. Depending on your Fitzpatrick skin type and the concerns you are looking to correct, you may receive one of the following:

  • Alpha Hydroxy Acid (AHA): Most commonly lactic or glycolic acid, but also citric, malic, mandelic, and tartaric, concentrations of AHAs vary from 10 to 70 percent. Neutralization with a basic solution is required. Depending on formula and technique, may be suitable for Fitzpatrick types I to VI.
  • Trichloroacetic Acid (TCA): Used for over 100 years, a concentration of about 6 to 25 percent produces a superficial TCA peel that’s self-neutralizing. Lower potencies are typically suitable for all Fitzpatrick types.
  • Salicylic Acid: This beta hydroxy acid (BHA) is often used to treat acne and also has anti-inflammatory properties. Concentrations usually range from 20 to 30 percent and is typically suitable for Fitzpatrick skin types I to VI.
  • Modified Jessner’s Solution: The first blended acid peel, it originally contained 14 percent lactic acid, 14 percent salicylic acid, and 14 percent resorcinol (later replaced by TCA). The self-neutralizing peel can address a range of concerns — from acne to aging — for Fitzpatrick types I to VI.
  • Blended Acid Peels: These peels are popular because they combine different acids at lower concentrations to address a myriad of concerns with (potentially) fewer side effects. The makeup of blended peels varies to accomodate a patient’s specific needs and goals.
  • Retinoids: You might not realize it, but these vitamin A compounds — commonly known as retinol (in lower potencies) and tretinoin (prescription-strength) — are considered peeling agents because they induce cell turnover. Though suitable for Fitzpatrick skin types I to VI, higher concentrations can cause irritation and dryness.

With so many options to choose from, consulting with your provider or aesthetician will ensure you receive the best treatment for your needs.

Medium Chemical Peels

Medium chemical peels penetrate the entire epidermal layer to exfoliate cells within the papillary dermis. Though some states allow aestheticians to perform moderate peels, it’s important to consult with a board certified dermatologist or plastic surgeon beforehand to avoid possible complications and unwanted outcomes.

Medium peels produce more noticeable results than light peels, making them well suited for:

  • Acne scars
  • Fine lines and wrinkles
  • Sun damage (like liver spots)
  • Uneven skin tone
  • Actinic keratoses (rough patches that can lead to skin cancer)
  • Skin laxity

The most commonly used types of medium peels include:

Deep Chemical Peels

As the name suggests, deep chemical peels go the deepest and provide the most dramatic results. That also means they carry the highest risks. These peels remove the entire epidermis and the papillary dermis and may also penetrate down into the reticular dermis. Deep dermal peels may only be performed by a highly trained, board certified provider.

Appropriate for Fitzpatrick types I to III, deep peels address the most significant skin concerns, including:

  • Acne scars
  • Fine lines to deep wrinkles
  • Sun damage
  • Uneven skin tone
  • Pre-cancerous growths
  • Skin laxity

Though TCA in concentrations of 50 percent or more are capable of inducing a relatively deep peel, the most powerful chemexfoliating treatment is the Baker-Gordon Peel. Developed in the 1960s, the formula was composed of phenol (an acid) mixed with croton oil (an ancient purgative derived from the seeds of the croton tiglium plant) to resurface the skin. The results were impressive, but it sometimes resulted in unwanted hypopigmentation and a waxy, unnatural appearance to the skin.

Modern Baker-Gordon formulations adjust the amount of croton oil used to give practitioners more control over peel depth. Combined with pre-treatment regimens designed to mitigate pigmentation problems, this new generation of deep peel is experiencing a resurgence of sorts thanks to its effectiveness and relative ease (no bulky, expensive laser necessary!).

How to Prepare for a Chemical Peel

Depending on the type and degree of chemical exfoliant being applied, chemical peel prep can vary from a simple cleanse to weeks of pre-treatment prescription skincare. A good rule of thumb is that the more intensive the peel, the more involved the regimen beforehand. Here’s a general breakdown of what your provider may suggest pre-peel:

  • Skincare: Your doctor may recommend switching to a mild cleanser and increasing your moisturizer application to keep skin calm and hydrated.
  • Retinoids: A vitamin A exfoliant — either over-the-counter or a prescription like Retin-A — will help slough off dead cells to provide a more even peel result.
  • Bleaching Agent: Suppressing the skin’s melanocytes with a topical bleach like hydroquinone can help mitigate post-procedure pigmentation problems.
  • Sunscreen: Keeping your skin protected from the sun is crucial both before and after a chemical peel.
  • Medication: Certain drugs (including oral contraceptives, some antibiotics, and Accutane) can make skin more prone to pigmentation problems and sun sensitivity, so you may need to temporarily stop taking them pre-and post-treatment.
  • Preventative Antivirals: Whether you can recall having a history of cold sores or not, most of us have been exposed to the herpes simplex virus (HSV), so many docs prescribe a course of antiviral meds to ward off a possible outbreak.

Your provider should provide all of this pre-op care information during the consultation and booking process.

What It’s Like to Get a Chemical Peel

Before beginning your chemical exfoliation procedure, your practitioner will prep your skin by cleansing and degreasing it, usually with alcohol, acetone, or both. To make the procedure more comfortable, numbing cream may be applied. Some superficial peels don’t require any topical numbing at all, while deeper peels require local anesthetic, IV sedation, or general anesthesia. It all depends on the depth and area being treated.

Once your skin is prepped, your provider will brush on the solution as evenly as possible. Self-neutralizing peels like TCA quit working in a matter of seconds, while continuous peels like glycolic acid must be timed and neutralized when necessary. When the peeling agent is applied, the skin begins to take on a white, frosted appearance. The degree of frost is an indication of the depth of the peel. Your doctor may reapply the peeling solution in certain areas (around the mouth, for example) where wrinkling is deeper. The frost makes it difficult to discern exactly how deep the peel is penetrating, so the provider’s experience and skill here is critical.

Recovering from a Chemical Peel

With just about any type of chemical peel, you can expect to experience some degree of burning, itching, redness, swelling, and flaking afterwards. Recovery from a superficial peel may only last a couple of days, whereas a medium peel can take about a week. Deeper peels require about two weeks of downtime, with some swelling and redness hanging around for weeks (if not months) longer.

“You can have a peel where your skin doesn’t truly peel off but rather flakes very unnoticeably, or you could do a deep peel where your skin sheds to the point where you may have to trim some of the dead skin from your face,” explains Julie Russak, MD, a board certified dermatologist and founder of Russak Dermatology in New York City. “It all depends on your personal goals, what issue we are treating, and your at-home care — we can customize all treatments for your needs.”

Taking care of your skin during the healing process is crucial to achieving a successful result. Follow your provider’s post-treatment instructions exactly, keeping skin clean and hydrated. And, however tempting, don’t poke, pick, or peel your fragile skin. For medium and deep peels, stay out of the sun until your wounds are healed. At that point, it’s safe to apply a sunscreen with SPF 30 or higher and a color-correcting concealer formulated for post-procedure skin.

Chemical Peel Risks

Although it may seem like a simple procedure (hey, all you have to do is brush on a little fruit acid!), chemical exfoliation carries serious risks. Your chance of having a successful outcome depends heavily on the skill and knowledge of your provider, as well as your skin type and medical history. Many peels are not suitable for darker skin tones. Discussing your complete medical history during a thorough skin exam can help decrease your chances of experiencing complications, including:

  • Infection (viral, bacterial, and fungal)
  • Prolonged erythema (a.k.a. redness)
  • Increased sun sensitivity (sunscreen is a must!)
  • Exacerbation of skin conditions (psoriasis, eczema, rosacea, melasma)
  • Dyschromia (both hypo- and hyperpigmentation)
  • Scarring (if skin is too damaged to repair itself normally)
  • Blistering
  • Milia (white, cyst-like bumps)
  • Lines of demarcation (when peel solution is applied unevenly)
  • Cardiac complications (though rare, phenol peels can cause temporary heart arrhythmia)

And for those who need another reason to quit, both smoking and vaping inhibit healing and cause wrinkling — especially around the eyes and mouth — which defeats the purpose of getting a peel in the first place.

If you’re considering a chemical peel, talk to your doctor before taking the plunge.

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KRISTA SMITHis a freelance writer for AEDIT.

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