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Chemical Peels
What is a chemical peel?
Chemical peels are topically applied acids that help to rejuvenate the skin surface by creating an even and controlled shedding of the skin cells. This allows new layers to be exposed which creates a fresh appearance and smoother texture to the skin surface. In addition, new cells and collagen are stimulated, creating a more even tone.
A chemical peel involves a peeling agent being placed on the skin, which causes a superficial wound. The depth of the peel depends on the concentration and type of acid used and the duration of contact. Livingston and Warren Dermatology Associates performs superficial and medium-depth peels using glycolic, salicylic or trichloroacetic acid (TCA). Since glycolic and salicylic acid provide a more superficial peel than TCA peels, in order to achieve maximum benefit they will need to be repeated a number of times over several weeks to months. These light peels are also known as the "Lunch Time Peels".
What can a chemical peel do?
A light-to-medium depth chemical peel can improve sun damage, blotchy pigmentation, fine wrinkling and early actinic keratoses (pre-cancerous skin lesions). A peel can also improve acne-prone skin and clogged pores (whiteheads and blackheads).
What type of skin will benefit most from a peel?
Although a peel may benefit all skin types, the following guide may help you:
Type I -- no wrinkles
Type II -- wrinkles with motion only, such as smiling; early sun damage
Type III -- wrinkles at rest, especially around the eyes, mouth and forehead; blotchy pigmentation and dilated blood vessels
Type IV -- many deep wrinkles at rest
Patients with Type II and III skin will usually find the most benefit from superficial to medium depth peels. These peels do not remove deeper wrinkles.
How is a chemical peel performed?
Several weeks prior to the actual peel, your physician may recommend that you use a topical retinoic acid, glycolic acid or bleaching cream to prepare the skin. The peel begins with a thorough cleansing of the skin to remove all oil and debris. The peeling agent is then applied evenly to the skin with a foam applicator, Q-tip or sterile gauze. If you are having a glycolic acid peel another solution will be used to neutralize it. Finally, a moisturizer is applied and you can leave the office without bandages.
Does chemical peel hurt?
With glycolic acid or salicylic acid peels, a burning gradually develops soon after the solution is applied. A fan and cool compresses may help. If glycolic acid is used, the neutralizing solution removes most of the burning sensation immediately after it is applied. However, there may be several areas that continue to burn or sting over the next 24 hours.
With trichloroacetic acid (TCA) peels, a more intense burning is followed by a tightening sensation that lasts for 7 to 10 minutes. A fan and cool, wet compresses help alleviate much of this discomfort as well. Most patients do not require any anesthesia.
How will my skin look following the peel?
A patient's response to a chemical peel will vary and depends upon the skin type as well as the peeling agent. With glycolic acid, most patients develop redness and appear flushed; this decreases over the next 24 to 48 hours. Occasionally patients will develop mild facial swelling. The area beneath the eyes and the chin are most sensitive to this. Some areas may even develop crusting and superficial scaling.
With TCA peels of medium depth, the inflammation and swelling are more intense. Initially the skin is whitened by the acid and then gradually turns red in approximately 1/2 hour. The face increases in redness over the next 24 to 48 hours and then peels (as it would after a severe sunburn). This lasts for several days and a faint redness may persist for several weeks as the skin continues to rejuvenate.
Most patients that have undergone a glycolic or salicylic acid peel feel fairly comfortable continuing with their daily routine. Some patients with deeper TCA peeling feel more comfortable at home, especially during the heavy peeling time which usually lasts from the third to eighth days.
What should I do after a chemical peel?
Initially, the skin should be kept clean and moist. No dressing is required but you should apply a thin layer of Bacitracin or Vaseline with some frequency. You may wash or shower as usual. Avoid picking off any scaling skin. After healing is complete, use a sunscreen with an SPF of 15 or higher.
What are the risks?
Since Livingston and Warren Dermatology Associates only perform superficial and medium-depth peels, the risks are minimal. However, as with any procedure, a small number of patients do have adverse outcomes. The most common side effects include uneven pigmentation, persistent redness and infection. Scarring has been known to occur in rare instances.
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