23 Dec The Truth About Chemical Peels
What is a chemical peel?
A chemical peel is a medical treatment that uses exfoliating acids to improve the appearance of the skin on your face, hands and neck. The exfoliating acids gently remove the top layer of dead skin cells, clogged pores and grime on the skin, allowing newer skin to reach the surface. This newer, regenerated skin looks younger and feels smoother with lesser wrinkles.
In Singapore, chemical peels are commonly used to treat acne and signs of aging such as pigmentation and wrinkles.
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What are the benefits of a chemical peel?
1. Lighter hyperpigmentation
2. Lighter pimple/acne scars (post inflammatory hyperpigmentation)
3. Removal of comedones (blackheads and whiteheads)
4. Smoother skin texture
5. Even skin complexion and brighter skin
6. Improvement in acne
7. Reduce fine lines and wrinkles
How does a chemical peel work?
As its name suggests, chemical peels make use of exfoliating acids to cause controlled peeling of the skin, to remove the top layer of dead and dull skin, hyperpigmentation, comedones and dirt. The chemical peel also causes collagen remodelling in the skin on top of allowing the newer skin underneath to reach the surface.
What are the types of chemical peels available? Are the results the same with each chemical peel?
Different types of chemicals peels have different properties. One of the easiest way to understand this is to classify chemical peels is according the depth of the skin that the chemical peel reach- superficial, medium or deep1. Factors such as the concentration of the chemical and duration that the chemical peel is left on the skin will also determine the depth of the chemical peel’s reach.
Superficial; medium and deep chemical peels and the depth of the skin that they act on.
Superficial chemical peels (“light peel”) e.g. AHA, BHA, Jessner’s solution
Superficial chemical peels exfoliate the epidermal layers of the skin without going beyond the basal layer of the skin
Medium depth chemical peels e.g. 35-50% TCA
Medium depth chemical peels reach the upper layer of the dermis (down to the papillary dermis)
Deep chemical peels e.g. >50% TCA
Deep chemical peels reach all the way down to the reticular dermis.
What are the advantages and disadvantages of each type of chemical peel?
The deeper the chemical peel reacts, the greater the skin resurfacing effects of the chemical peel. Deeper chemical peels are more ideal for conditions that affect the deeper part of the skin (e.g. pigmentation or wrinkles that extend deeper in older patients), with more collagen remodelling in the skin
If deeper peels are more effective, why does it remain unpopular?
Deep chemical peels have higher risks of complications and longer recovery time compared to superficial chemical peels. Deep chemical peel are usually performed under sedation or general anaesthesia (because of the severe discomfort) and the immediate end result is akin to a burn with obvious redness, raw skin blistering and peeling3. The healing time can take as long as 2-3 months for the skin colour to normalise and the risk of complications such as worsening hyperpigmentation, scarring, hypopigmentation and skin infections are significant3. In contrast, superficial chemical peels cause exfoliate with very fine peeling Patients can resume their daily routine, skincare and makeup after a superficial chemical peel. There is no obvious redness or downtime required2.
Are superficial chemical peels alone safe and effective?
Chemical peels are a useful and effective treatment for a range of dermatological conditions including hyperpigmenation, acne and skin rejuvenation. However, one session of chemical peel alone is rarely sufficient for removal of all hyperpigmentation or all skin wrinkles. Combining chemical peels with other modalities of treatment, for example, lasers, biostimulators and neuromodulators may be advised to achieve synergistic results without downtime.
How is a chemical peel performed?
In Singapore, chemical peels should only be performed by doctors with the requisite qualifications. There are non-medical personnel like therapists that offer chemical peels in spas and beauty salons. Please beware that these personnel do not have accredition required to perform these medical procedures.
Step 1: Cleaning
The face is first cleaned to remove makeup, dirt and sweat that would impair the penetration of the chemical peel.
Step 2: Application of the chemical peel
The chemical peel is applied to the skin either using soaked cotton pads or a brush. A clock timer is started to time the chemical peel. The doctor continues to monitor your skin for the reaction.
Step 3: Neutralisation of the chemical peel
Once the skin reached its clinical end point, the chemical peel is terminated. Different types of chemical peels cause different types of endpoints. For some types of chemical peels, it is erythema (redness) of the skin; for some, it is frosting on the skin. The doctor performing your chemical peel will determine the appropriate endpoint for your skin condition.
The chemical peel is terminated by neutralising the peel with the application of neutralising cream or gel to the skin.
What are the risks and side effects of a chemical peel?
A superficial chemical peel is generally very safe with no downtime when performed safely by an experienced doctor. With superficial chemical peels, there may be initial redness and skin sensitivity, but this is temporary and it disappears in a day or two. With medium depth chemical peels, there is also the risk of post inflammatory hyperpigmentation or worsening of pigmentation if sunprotection is not adhered to. There is also a risk of skin infection with medium depth chemical peels.
My thoughts and experience with chemical peels
Chemical peels are extremely helpful and effective as a standalone or part of a combination of treatment modalities for a range of dermatological conditions in my practice in Singapore.
One common condition among my patients is clogged pores or comedonal acne, and I find chemical peels to be very useful in exfoliating these comdeones. Physical extractions or face steaming can also remove these comedones, but have a risk of causing scarring and sensitivity.
For women who may be pregnant or breastfeeding, chemical peels are still a safe option but please be sure to check with your doctor on his/her choice of chemicals- some chemicals have not been proven to be safe for pregnant or breastfeeding mothers. My practice is to stick to chemicals that are safe for pregnant or breastfeeding mothers.
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FAQs about chemical peels
What should I expect after a chemical peel?
After a superficial chemical peel, there may be temporary redness and discomfort, which lasts for 1-3 days typically. There may also be very transient skin sensitivity, especially to acids or exfoliating skincare. You can resume your skincare and makeup after a superficial chemical peel.
Do I need special skincare after a chemical peel?
For a superficial chemical peel, a simple facial wash; moisturiser and a broad-spectrum sunscreen is all that is required. You can resume makeup on the same day of the superficial chemical peel too.
How often can I have a chemical peel
My practice is to have a 4-week interval between each chemical peel.
Our skin’s natural cycle of production and replacement takes 28 days. The outermost layer of our skin is made up of dead skin cells called the epidermis. The cells in the epidermis are constantly removed by flaking or rubbing off. The cells in the epidermis are constantly replaced by newer skin cells that are formed deeper in the skin, which gradually move towards the topmost layer of the skin.
By allowing sufficient time for your skin’s natural cycle of production and replacement, sequential chemical peels can be performed safely.
Do chemical peels thin the skin?
Chemical peels, when performed at the correct intervals do not thin the skin if there is an interval of 28 days between each chemical peel. Chemical peels actually have an added benefit of enhancing collagen formation in the skin, which adds a slight increase in the skin thickness microscopically.
Is there anything that I need to avoid with a chemical peel?
After a chemical peel, minimise your sun exposure to prevent worsening of pigmentation. Acids such as AHA and BHA in skincare can also be more irritating so avoidance of acids in skincare is advised.
Harsh, physical scrubs and astringent skincare should also be avoided in the first few days after a chemical peel to minimise skin irritation.
Can;laser treatments be treated with chemical peels?
Flat, dark acne marks or pimples marks can be treated with chemical peels to lighten them. When combined with Q-switched laser, there is faster removal of these marks.
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Depressed acne scars, however, do not benefit greatly from chemical peels. Fractional CO2 laser is still regarded as the gold standard for resurfacing depressed acne scars. TCA cross peels (a deep chemical peel where 100% TCA is used) were used to treat these depressed acne scars but due to the high rate of complications and side effects of deep chemical peels; TCA cross peels are less commonly done now and fractional CO2 laser is now the standard of care for most types of depressed acne scars.
Related post:
My review and personal experience with Fractional CO2 laser in How to Get Rid of Large Pores: Myths and Truths
Am I suitable for a chemical peel?
Unless you have an ongoing skin infection or eczema flare or isotretinoin therapy for the last 6 months. If you have a history of autoimmune skin conditions such as psoriasis and atopic dermatitis you may experience protracted healing and prolonged erythema.
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If I have dark skin, can I still have a chemical peel?
There has been concern that patients with darker skin have a higher risk of complications such as increase in pigmentation (post inflammatory hyperpigmentation) or complete loss of pigmentation (hypopigmentation). This concern applies mainly to deep peels. In fact, patients who belong to ethnic groups with darker complexions respond well to superficial chemical peels2.
Patients with darker skin complexions respond well to superficial chemical peels. When treating patients with darker complexions, I usually use a lower concentration of chemicals when doing superficial chemical peels and this has been effective in treating a variety of conditions such as pigmentation and acne without incurring any downtime or complications for patients.
REFERENCES
1. Chemical peels. Monheit GD, Chastain MA. Facial Plast Surg Clin North Am. 2001; 9: 239–255.
2. Chemical peels. Jackson. Facial Plast Surg 2014;30:26– 34.
3. Deep-depth chemical peeling. Maloney BP and McCollough EG. Facial Plast Surg. 1995 Jan;11(1):30-8.
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