Chemical peels can help reduce the appearance of facial folds, wrinkles, and "crow's feet" by removing damaged outer layers of skin.  Because there are different chemicals available for exfoliation, your individual needs will determine the type and specific formula for your peel.  Peels of various formulas can be used for purposes ranging from the basic smoothing of dry skin to correcting sun blotches and removing pre-cancerous growths.

How It's Done

After the face is thoroughly washed to remove any excess oil, the chemical solution is painted on.  The peeling agent is left on the skin for several minutes.  All patents experience a stinging sensation, the severity of which is determined by the type of peel used.  A fan is set up and pointed toward the patients to help alleviate some of the discomfort.

For the deeper, more intense peels, a mild sedative can be administered, but in general, and especially for mild and superficial peels, no special preparations are necessary.  Peels usually last 15 minutes or less except for the most intense type which can last 1 - 2 hours.

Technology

There are three different categories of chemical peels.  Increasing in strength and epidermis penetration, they are alphahydroxy acids (AHAs), trichloracetic acid (TCA), and carbolic acid (phenol).  When choosing a peel consider the following:

AHAs

•  Mildest peel
• Corrects minor problems like rough or dry skin and sun damage
• Is sometimes used to pre-treat skin before TCA peel
• More than one treatment may be necessary

TCA

• Smoothes wrinkles, removes blemishes, and corrects pigmentation problem
• No anesthesia is necessary, but mild sedatives are often used
• Requires pre-treatment with Retin-A or AHA
• Works well on dark skin tones
• Results are less dramatic and shorter in duration than with phenol peels
• Formula can be adjusted for desired results
• Must avoid sun exposure for several months following peel

Phenol

• Correct blotches, smoothes coarse wrinkles, and removes pre-cancerous growths
• Not recommended for darker skin tones
• Full recovery may take several months

Recovery / Post Op Expectations

The type of peel that a patient undergoes will determine the recovery process, however, after any peel it is necessary to limit sun exposure and wear sunscreen with a high SPF when outside.  AHA peels can offer a quick recovery with little or no time away from work and normal activity, but most patients experience some redness, irritation, or flaking as the skin adjusts to the treatment.

After phenol and TCA peels a crust or scab will form over the treated areas, and will remain for a few days according to the physicians instructions.  With TCA peels patients experience some swelling an irritation and should subside enough within 7 - 10 days to allow patients to return to normal activity.  With phenol peels, swelling is usually severe and skin takes on a red hue that gradually fades to pink. Return to work after phenol peels can take 2 weeks or more. 

Complications

Complications with AHA peels are minimal and include irritation, excess flaking and soreness, which can be treated with medication.  Complications for TCA and phenol peels include scarring, cold sores, fever blisters, and change in skin color.  Some patients with phenol peels develop a lighter skin tone in treated areas and may need to wear make up to disguise lines of demarcation.

Am I a Candidate?

Chemical peels are used mainly for cosmetic reasons.  Patients with a history of herpes, taking birth control pills, or with a predisposition to brownish discoloration of the face may be at a greater risk for postoperative complications.

Cost

The national average of surgeon fees for chemical peels was $607 in 2003 according to the American Society of Plastic Surgeons (ASPS), but can range as high as $6,000 for full phenol peels.