Chemical Peels

Alpha-hydroxy acids (AHAs) are naturally occurring carboxylic acids, such as glycolic acid, a natural constituent of sugar cane juice, and lactic acid, found in sour milk and tomato juice. This is the mildest of the peel formulas, producing light peels for the treatment of fine wrinkles, dry areas, uneven pigmentation, and acne. Alpha hydroxy acids 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.

There are five usual fruit acids: citric acid, glycolic acid, lactic acid, malic acid, and tartaric acid. Many other alpha-hydroxyacids exist and are used.

AHA peels are not indicated for treating wrinkles.

AHA peels may cause stinging, skin redness, mild skin irritation, and dryness. You will notice immediate results.

Jessner’s peel solution, formerly known as the Coombes formula, was pioneered by Dr. Max Jessner, a German-American dermatologist. Dr. Jessner combined 14% salicylic acid, lactic acid, and resorcinol in an ethanol base. The solution is thought to break intracellular bridges between keratinocytes. Due to the mild percentages associated with the acid combination, it is very difficult to over-peel the skin.

Retinoic acid is a retinoid. This type of facial peel is also performed in the office of a facial cosmetic surgeon or a dermatologist in a medical spa setting. This is a deeper peel than the beta-hydroxy acid peel and is used to remove scars, as well as wrinkles and pigmentation problems. It is usually performed in conjunction with a Jessner’s peel, which is applied right before opening the skin, allowing the retinoic acid to penetrate more deeply. The client leaves with the chemical peel solution on their face. The peeling process takes place on the third day. More dramatic changes to the skin require multiple peels over time.

Trichloroacetic acid (TCA) is used as an intermediate to deep peeling agent in concentrations ranging from 20% to 50%—the depth of penetration increases as the concentration increases, with 50% TCA penetrating the reticular dermis. Concentrations higher than 35% are not recommended because of the high risk of scarring.

For darker-skinned patients, trichloroacetic peels are preferred over Phenol. These peels smooth out fine surface wrinkles and superficial blemishes and correct skin pigment problems. These peels may require pre-treatment with Retin-A or AHA creams and may require follow-up treatments to maintain the results. Finally, it might take several days to heal and will require the use of sunscreen for several months.

Phenol is the strongest chemical solution and produces a deep skin peel. Some publications claim that the phenol peel effect may be due to the action of croton oil, suggesting that phenol would not be effective without this oil. Many phenol peel solutions exist that do not contain croton oil. This last is only a penetration enhancer, acting on the very superficial epidermal layers. Croton oil is not the only penetration enhancer available. The effects of a phenol chemical peel are long-lasting and, in some cases, remain readily apparent for up to 20 years following the procedure. Improvements in the patient’s skin can be quite dramatic. A single treatment usually achieves the desired result.

Phenol peels correct blotches caused by sun exposure or aging, smooth out deep wrinkles, and even remove precancerous growths.

Phenol peels may pose a risk of arrhythmia if applied without strict rules. They can also permanently remove facial freckles. Many formulas cause permanent skin lightening by reducing the ability to produce pigment. In the long term, these skin lighteners will require increased protection from the sun.