Chemical
Peel
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.
Chemical peel is especially useful for the fine wrinkles
on cheeks, forehead, and around the eyes, and the vertical
wrinkles around the mouth.
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.
The chemical solution can be applied
to the entire face, or to a specific area - for example,
around the mouth - sometimes in conjunction with a facelift.
At the end of a phenol peel, a thick
layer of petroleum jelly may be applied to the treated
area.
A protective crust may be allowed
to form over the new skin. When it's removed, the skin
underneath will be a bright pink.
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.)
After healing, the skin is lighter
in color, tighter, smoother, and younger looking.
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. Contributions or
inquiries may be directed to the PSEF Development Officer,
444 East Algonquin Road, Arlington Heights, IL 60005-4664,
847-228-9900.
--------------------------------------------------------------------------------
Taken from
American
Society of Plastic Surgeons
