Chemical Peels are seeing a resurgence in use. Popular since the 1960’s and 70’s they took a backseat for a while with all the innovation in the laser and light industry but they are now making a comeback, due in large part to their safety and the large variety of peels available to treat all skin types. The word chemical peel brings to mind images of a horrid chemical being applied on the skin to produce benefit by peeling off the top layer through burning. Historically speaking this was true, but now with the array of peels available to a dermatologist the procedure can be tailored to a patients specific needs, and many peels have virtually no down time – patients come in for peels in their lunch breaks and go right back to work after.
So lets get into it. Peels are of three types – superficial, medium and deep. These terms reflect how deep the peel penetrates into the skin. The skin has two layers that are of importance to us to understand peels – the epidermis and dermis. The epidermis is the thin superficial layer of the skin while the dermis is the thicker deeper layer. Think of it like a potato – the epidermis is analogous to the potato skin and the dermis to the inner bulk. As explained in my post on dermal fillers that bulk is made up of structural proteins like collagen and elastin and ground substance consisting of proteins known as mucopolysaccharides.
The outermost layer of the skin, the Stratum Corneum, has an important bearing on how the skin looks. If the cells in this layer are more in number than normal or are disorganized, the skin will look rough, scaly or dull. Cells below this layer contain skin pigment scattered through them and the average turn over time of these cells is about a month. Pigment is produced by the basal layer of the skin and rises up through other cells of the skin as they move towards the surface ultimately dying and becoming cells of the Stratum Corneum.
The principal of ‘controlled damage’.
So how do we get the skin to turn back the clock and look younger? Is there a way to get it to make more structural proteins since these are lost with age and are the main cause of problems like skin wrinkling, enlarged pores and skin sagging, and if so what? This is where the principal of controlled damage comes into the picture. The trick is to make the skin believe it has been injured. This makes it put into place skin healing mechanisms normally recruited in recovery from injuries, like when a cut is healing for example. Principally this involves increased cell turnover and the production of new collagen, the all important dermal component. Luckily its easy to trick the skin and it doesn’t take much to make it turn on the repair mechanism.
A peel helps in two ways – a) it breaks the bonds between the cells of the Stratum Corneum thereby making them easier to shed, and b) it increases cell turnover by encouraging the production of new skin cells; these cells are less pigmented and better organized than the older cells and as long as they are protected from UV light with regular sunscreen use they will remain lesser pigmented thereby causing skin lightening. At higher concentrations peels also stimulate collagen formation.
So what does a peeling session entail?
A typical session takes just 10-15 minutes and consists of cleaning the skin followed by application of the peeling agent. There are various types of peels and the two most basic ones are glycolic acid peels and salicylic acid peels; the former being better for skin pigmentation and the latter for acne. The peeling agent is then left on for about 5 minutes (this will vary depending on your skin sensitivity and the number of peels you have had), and then neutralized with either water or a sodium bicarbonate solution (the salicylic peel is self-neutralizing and just needs to be wiped off). This is followed by the application of a skin recovery agent, typically a soothing cream, followed by a sunscreen.
Can I get a peel on my first visit to a doctor?
Yes you can but I prefer to prime the skin for about 14 days before starting peeling since this maximizes benefit. Also your doctor may want to do a test peel and wait 7 days before performing a full face peel. A test peel involves the application of a small amount of peel to the area behind the ear and is done to check for any sensitivity or allergy to the peeling agent. This is essential with TCA peels.
How many peels does it take to see a difference?
This varies from patient to patient and the indication being treated, but expect to see visible improvement by the 3rd or 4th peel. Typically 4-6 peels are done at regular intervals of 10-14 days followed by maintenance peels every 4-6 weeks for a few months. I encourage my patients to think of peels as a lifestyle modification and not so much a treatment course.
I have heard that peels cause thinning of the skin, is this true?
No, quite the contrary. Regular peels cause an increase in the overall thickness of the living part of the epidermis and a decrease in thickness of the dead cells of the stratum corneum. Both of these are good things and overall the skin thickness is increased.
What skin problems can peeling help?
Peeling can help a number of problems – active acne, post-acne pigmentation and erythema, blackheads, open pores, fine lines, uneven skin tone, freckles, melasma, other superficial skin pigmentation, dark circles, and dull skin.
Can peeling help scarring?
I see quite a lot of patients who have read or heard that chemical peeling can help scarring, particularly acne scarring. It is true that certain deep peels (as were popular in the west for caucasian skin) can markedly improve acne scars, however these peels actually burn the skin and have a significant down time (4-6 weeks). These peels are not safe in darker skin types and are therefore almost never done in India and other Asian countries. Even for white skin these peels have been replaced by laser and other treatments due to more consistent results and less downtime. On occasion very superficial acne scars might improve but this is often because of the scars become lighter on account of the peels. So to answer the question – No, the most commonly used peels today have no significant benefit on acne scarring.
Are there any peels I can do at home?
Yes there are a few peels made for home use. These are typically low power peels with limited benefit and are best used as maintenance after 4-6 sessions of traditional peeling with your doctor. Home peels are available as lotions, soaked pads and masks. Glycolic acid is also available as leave on creams or gels which can be left on overnight.