General Concepts of Chemical Peeling

What Is Chemical Peeling?

Chemical peeling refers to the application of a chemical agent to the skin to cause a controlled chemical burn. It should be deep enough to cause exfoliation of skin layers and superficial enough to allow regeneration with subsequent resurfacing and remodeling of collagen and elastic fibers. A chemical peel works like a snake shedding its skin. So, several layers of damaged skin cells are shed, and a new fresh layer of skin is formed, which has a more even texture and color. They are used to improve the appearance or texture of the skin.

When Is Chemical Peeling Required?

• Chemical peeling is often used to treat melasma, freckles, fine lines under the eye and around the mouth, and mild to moderate photodamage.

• Mild superficial scarring and certain types of acne can also be treated with a chemical peel.

• In addition, skin that is dull in texture and color may be improved with chemical peeling.

• Uneven skin tone.

• Sagging skin.

Which Are the Chemical Agents That Are Commonly Used for Peeling?

For chemical peeling, the most commonly used chemicals are

• Trichloroacetic acid (TCA).

• Alpha-hydroxy acid - Glycolic acid (AHA-GCA).

What Are the Various Types of Chemical Peels?

There are various types of chemical peels available, which include:.

• Superficial Peels:

Superficial peels penetrate only the outermost layer of the skin. Mild acids like alpha-hydroxy acid are used to gently exfoliate the skin.

• Medium Peels:

Medium types of peels are known to be more effective in removing dead and damaged skin cells. Trichloroacetic or Glycolic acid is used to reach the middle layers of the skin.

• Deep Peels:

As the name suggests, it deeply penetrates the middle layer of the skin to exfoliate the dead skin cells. Most often, Phenol or Trichloroacetic acid is used.

How Should One Prepare for a Chemical Peel?

Before Procedure:

• Tell the doctor if having a prior history of scarring, cold sores, or any other medical illnesses. Mention all the drugs the person is taking. Sometimes, the doctor may ask to stop certain drugs before the procedure.

• After collecting a thorough medical history, the doctor may examine the skin type to determine the type of chemical peel that can be used.

• Sometimes, antiviral medication may be recommended before and after the treatment to prevent infections.

• Retinoid creams like Retin-A may be suggested for better healing.

• Prolonged unprotected sun exposure should be avoided as it can cause permanent irregular pigmentation in the treated areas.

How Is Chemical Peeling Procedure Carried Out?

After cleaning the face, the eyes and hair are protected with gauze, tape, or goggles.

• Superficial Peel:

In this procedure, a brush, cotton ball, gauze, or sponge is used to apply the chemical solution. The person may experience a slight burning or stinging sensation on their skin. The treated skin starts to whiten. The doctor will use a neutralizing solution to remove the chemical solution from the skin. Superficial peels require seven days to heal.

• Medium Peel:

During a medium peeling, procedure chemical solution containing Trichloroacetic acid is applied using a cotton-tipped applicator. And a few minutes of cold compresses are given to soothe the treated skin. In this, no neutralizing solution is used. The patient may feel a stinging or burning sensation for 20 minutes. The treated skin starts to whiten. Medium peeling takes 7 to 14 days to heal.

• Deep Peel:

During a deep peeling procedure, intravenous fluids (IV) will be administered, and heart rate will be monitored. Then, the doctor will apply phenol using a cotton-tipped applicator. However, the exposure to phenol should be limited, so the doctor should apply it in portions at 15-minute intervals. The full procedure takes around 90 minutes. Deep peeling takes around 14 to 21 days to heal.

How Should Skin Care Routine Be Post Superficial Peel?

Aftercare for superficial peel:

• Restriction of emollients to the treated skin for 24 to 48 hours.

• Tretinoin should not be applied for the first 3 to 7 days.

• Sun avoidance is mandatory.

• Sunscreen use may have to be temporarily discontinued for 3 to 7 days after a superficial peel if stinging occurs on application.

Peeling skin should not be picked, or scarring could result. The skin should be allowed to come off naturally.

What Form of Follow-up Care Is Required After a Chemical Peel?

The frequency of follow-up after the chemical peeling depends on the depth and severity of the condition. The skin will be sensitive after a chemical peel, so it is essential to avoid sun exposure.

Can Chemical Peeling Be Combined with Other Procedures?

Chemical peeling can be combined with other procedures to improve the texture and contour of the skin. Procedures like laser treatment and injectable filling agents can be combined with chemical peels.

What Are the Limitations of a Chemical Peel?

• Pitted scars will not respond to peeling, nor will deep scars with severe atrophy.

• Chemical peels cannot tighten loose skin.

• Chemical peels cannot remove the broken blood vessels on the face.

• And chemical peels cannot always totally remove hyperpigmentation in dark-skinned people.

Will the Daily Routine Be Affected Post-Treatment?

The day-to-day activities can be resumed immediately after the treatment. Intense exercise and excessive sweating should be avoided during the treatment.

What Are the Side Effects of Chemical Peeling?

Some of the common side effects of chemical peeling include:

• Redness.

• Dryness.

• Swelling.

• Burning sensation.

These side effects are commonly reported and are temporary. But there are also some severe side effects reported following chemical peels, which include:

• Changes in skin color. There can be either darkening or lightening of the skin color, particularly in people with darker skin.

• There can be permanent scarring.

• Infections.

• The chemical phenol used in deep peeling can damage the heart muscle, kidney, and liver.

What Are the Contraindications of Chemical Peels?

Contraindications can include:

• Active infections or open wounds on the skin.

• History of keloid scars.

• Use of certain medications that may affect skin sensitivity.

• Pregnancy or breastfeeding.

• Recent use of other skin treatments like waxing, laser therapy, or dermabrasion.

• Skin conditions such as eczema, psoriasis, or rosacea.

• Allergy to the peel solution or its components.

Conclusion:

Patients having active herpes, unrealistic expectations, open cuts, a tendency for keloid formation, and patients undertaking Isotretinoin therapy are not suitable for chemical peeling. So, it is wise to analyze if chemical peeling will suit us before going through the procedure.