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 not 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
may also 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, can also 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.
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 may also 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
is also 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 which
they are permitted to apply. You should be warned that
phenol and TCA peels have been offered by inadequately
trained practitioners claiming "miracletechniques" 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 are usually 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 treatmentsmay 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.
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 ten 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 ten 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. (For makeup
tips, ask your plastic surgeon for the ASPS brochure
on camouflage cosmetics.)
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.
Research
in plastic surgery assures continued advances in effective
patient treatment. You may support research in plastic
and reconstructive surgery with a tax-deductible contribution
to the Plastic Surgery Educational Foundation Research
Fund.
