Chemical peels have been performed to rejuvenate the skin since the days of ancient Egypt, when lactic acid from sour milk was used to treat nobles. In Europe in the Middle ages, citric acid or tartaric acid from old wine was used to perform chemical peels to help women achieve smoother, younger skin. These old agents have been replaced by modern agents such as glycolic acid and trichloroacetic acid (the alpha hydroxyacids) and salicylic acid (a beta-hydroxyacid), which are used by our skilled dermatologists to perform chemical peels for the treatment of a variety of skin conditions.

Chemical peels work by producing a controlled injury to the top layers of the skin, which is followed by a healing response that produces smoother, softer, more youthful skin. Chemical peels are useful for decreasing the signs of aging such as fine lines, but can also be used to treat brown spots, melasma, acne, acne scarring, and keratoses.

Glycolic Acid Peels

Glycolic acid peels have been used for decades. Treatment with 20-70 percent glycolic acid solution provides a superficial chemical peel which is effective for treatment of acne, rough skin, melasma, or other discolorations on the face. Usually, a series of peels is required for optimal improvement.

Salicylic Acid Peels

20% and 30% salicylic acid peels, also called “beta peels,” are a save and excellent treatment for common skin problems such as melasma, acne, and brown spots. The potential benefits of this procedure also include the improvement of fine lines, thinning of keratoses, and softening of the skin. The salicylic acid peel performed in our office is a program of treatments where the best possible result is usually achieved with a series of peels.

Jessner’s and Trichloroacetic Acid (TCA) Peels

Jessner’s and Tricholoroacetic Acid (TCA) are used to perform medium depth chemical peels. Medium-depth peels are a tried and true method of improving the signs of aging such as wrinkles, irregular texture, and brown spots. Scars from acne or other trauma can be improved by peels as well. Because the injury to the skin is deeper than with the superficial peels, the recovery time is slightly longer.

CROSS technique (Chemical Reconstruction of Skin Scars)

The CROSS technique is a technique where a much higher strength TCA solution is applied with a toothpick or fine paintbush directly to acne scars without treating the rest of the skin. A small wound is created in the base of the scar. As the wound heals, new collagen is laid down underneath the skin, and the surface of the skin becomes more smooth. A series of treatments is often required.

What should I do before the procedure?

Your dermatologist should know about all oral and topical medications which you are using. You may be instructed to stop using certain creams prior to the procedure or to prepare your skin with pre-conditioning creams. If you have a history of developing cold sores, your dermatologist may prescribe an antiviral medication. You may wish to plan your peel during a time when you do not have important social events, as the skin may be noticeably irritated for 2-7 days after the procedure, depending on the depth of the peel.

What will happen on the day of the procedure?

The skin will be cleansed with an agent that removes excess oils from the skin. Then the peel will be applied in repeated coats to the skin with a gauze pad or an apploicator. During a chemical peel most patients experience a warm to hot sensation, which usually lasts 5-10 minutes. Occasionally more significant stinging occurs. Deeper peels can be more painful and require medication during or after the procedure.

How should I take care of my skin after my chemical peel?

After your procedure a calming protective moisturizer will be placed on your skin. You will receive detailed instructions on how to care for your skin, along with recommendations of specific products to use. Following the post peel instructions exactly is necessary to maximize the improvement of the skin. In general, a mild non-abrasive facial cleanser can be used. Your skin will feel tight in the first 3-4 days after the procedure, and frequent application of moisturizer will aid in your comfort.

In 3-6 days after the procedure your skin will begin to peel, which can be either mild flaking of the skin for superficial peels or large sheets of skin that slough off during medium depth peels. It is very important to not pick or pull at any of the skin that is sloughing off, as this can pull of skin that has not healed and lead to scarring. Gentle cleansing and the application of moisturizer is the best way to aid the skin while it is peeling.

How often should I have a chemical peel?

Several peels may be required to achieve the best possible results, especially when superficial (glycolic or salicylic acid) chemical peels are used. Usually each patient is given a program of treatments where peels are done every 1-3 weeks for a total of 2-5 sessions. The degree of improvements is dependent upon many different variables and cannot be guaranteed.

Medium depth and deep chemical peels usually are a one-time treatment. Many patients wish to have a repeat peel in 1-3 years to maintain improvement.

What are side-effects of chemical peels?

The vast majority of patients tolerate chemical peels exceptionally well. Occasionally your face may become red and slightly itchy as the skin starts to peel, which is usually controlled with moisturizer but occasionally will require a brief prescription of a topical steroid.

Rare side effects include swelling, redness, infection, cold sores, prolonged sensitivity to wind and sun, and areas of persistent increased or decreased pigmentation.