Written by Andrew Proulx, MD
What are chemical peels?
There may not be a fountain of youth, but there are a number of real-world anti-aging treatments that can help turn back time, leaving you feeling and looking more youthful and rejuvenated. One of the more popular anti-aging procedures available is skin resurfacing using chemical peels. Chemical peels – more formerly known as chemoexfoliation – involves applying caustic agents to the skin to ablate the skin to a desired depth in order to stimulate the regrowth of healthier, more youthful looking skin.
What can it treat?
Chemical peels are useful for treating four categories of skin concerns:
- Pigmentary disorders – such as melasma and age spots (solar lentigines)
- Inflammatory disorders – such as acne and rosacea
- Mild scarring – such as acne scarring, and scarring from trauma or surgery
- Aging effects – such as superficial and medium-depth fine lines (rhytides), and actinic keratoses (pre-cancerous sun-induced skin lesions).
Unfortunately chemical peels cannot be used to address all skin concerns, notably deep facial lines, severe scarring, skin sagging, or broken capillaries. Other facial treatments may be more appropriate for these types of issues.
Types of chemical peels
There are a wide variety of different chemical peels available to choose from, typically identified by the strength of the agent used. Chemical peels are classified according to the depth of the wound that is created by the peel, as follows:
- Light or superficial peel: these penetrate only the superficial aspect of the skin (the epidermis). This is sometimes referred to as a “lunchtime” peel because many people can return to normal daily activities soon after the treatment. Minor discoloration or rough skin are best treated with this basic peel approach.
- Medium peel: these penetrate the superficial layer and part of the underlying layer of skin (the epidermis into the papillary dermis). These are used for treating age spots, fine lines and wrinkles, and even some unwanted skin growths.
- Deep peel: The most aggressive approach to chemical peel, the deep peel is used to penetrate several layers of damaged skin (the epidermis, papillary dermis, and into the reticular dermis). Used for more stubborn scarring, skin discoloration, age spots, etc.
The depth of the peel is determined by a number of factors:
- The chemical agent
- The concentration of the agent (the same chemical agent in different concentrations will penetrate to different depths)
- Your skin type
- The number of layers applied (i.e. the depth of the “frosting”)
- The number of treatments applied, and the time between treatments
The most commonly used chemical agents include:
- Alpha-hydroxy acids (AHAs) – such as glycolic acid or pyruvic acid
- Beta hydroxyl acids (BHAs) – such as salicylic acid or beta-lipohydroxy acid (LHA)
- Alpha keto acids (AKAs)
- Trichloroacetic acid (TCA)
- Tretinoin – a vitamin A derivative
- Baker-Gordon phenol – a mixture of detergent, croton oil, phenol, and water
- Monheit’s combination – Jessner’s solution (salicylic acid, resorcinol, lactic acid, and ethanol)) mixed with TCA
- Coleman’s solution – glycolic acid mixed with TCA
Are you a candidate?
This is a question that can only be answered by a qualified and licensed practitioner. However, there are general guidelines for candidacy that can help you to identify whether or not it might be a fit for you.
People with a fair skin tone and light-colored hair often are excellent candidates, though that’s not always the case if you have other underlying considerations. If any of the following applies to you, you may not a candidate for chemical peel:
- You have red hair and pale freckled skin.
- You suffer from abnormal skin pigmentation.
- You are of Afro-Caribbean or Asian descent.
- You have facial warts.
- You are nursing or pregnant.
- You have a skin condition like eczema or psoriasis.
- You have used certain acne medications or certain other medications recently.
If you are considering a chemical peel, you should set up a consultation with a professional to evaluate your concerns and discuss your options. Your practitioner may wish to conduct a test-spot on your skin to test your reaction to a chemical peel agent.
A chemical peel is an outpatient procedure, usually done in an office/clinic setting, and generally lasts only about 15-60 minutes. The procedure is relatively simple:
- Depending on the condition of your skin and the type of treatment, your practitioner may ask you to pre-treat your skin with a pre-peel solution starting 2-4 weeks prior to and stopping 3-5 days before the treatment.
- On the day of the treatment, your skin is prepared by using a gentle cleanser to remove dirt, debris, make-up, and sunscreen. The skin is then thoroughly de-greased and debrided using a more aggressive cleanser (such as acetone or an alcohol).
- The patient is positioned and vulnerable areas (the inner corners of the eyes and the crease of the nose) are protected with petroleum jelly or gauze.
- The chemical peel agent is applied carefully to achieve the desired uniformity and thickness (known as the “frosting level”). The number of layers applied depends on the agent used and the desired depth of ablation.
- After the desired depth of ablation is achieved, the peel agent is neutralized by applying a sodium bicarbonate solution followed by cool saline compresses. Some peel agents are self-neutralizing and do not require this step.
Chemical peel recovery time
After your treatment, you will be asked to continue to apply cold compresses, an emollient (such as mineral oil or a moisturizer) and sunscreen.
For the first 24 hours, gentle cleansing with diluted vinegar (acetic acid) four times a day is recommended in order to prevent infection. This is followed by application of an emollient.
After the first 24 hours, care involves routine cleansing with a gentle cleanser followed by application of an emollient. Aggressive sun-blocking with sunscreen and broad-brimmed hats and sun avoidance is required until healing is complete.
Following a chemical peel, you can expect redness, swelling, and peeling skin to continue for 1-3 days for a superficial peel, and 5-10 days for a deeper peel. You must resist the temptation to scratch, pick at, or peel the treated area.
When will you see results?
Recovery time varies, but it typically takes one to three weeks before your results are fully realized. Depending on what you hope to achieve, you may require multiple treatment sessions. Results can last several months before the signs of aging begin to resurface. Ongoing sunscreen use is important for maintaining results.
Does it hurt?
Unfortunately there is no simple answer to that question because everyone has a different pain threshold. Naturally, you are stripping away a layer of skin using caustic agents, so there is some level of discomfort involved.
Pain management is accomplished through the use of fans, cold packs, and oral medications such as acetaminophen or anti-inflammatories.
Generally, anesthesia is not used, although some practitioners may use a local anesthetic, or – uncommonly – a general anesthetic. The use of phenol sometimes necessitates sedation and anesthesia.
Some discomfort and burning are common for 2-5 days following medium and deep peels in people with sensitive skin. Sometimes the sunscreens used post-treatment can sting.
Cost of chemical peels
As with any cosmetic treatment, there are a variety of factors determining the price. The type of peel, the agent used, the number of treatments required, and aftercare are just a few of the variables that can impact the cost of a chemical peel. Because of this, the cost of chemical peels vary widely.
Light peels generally average about $100 to $400, but medical-grade peels performed in a physician’s office can run as much as $5,000. According to the American Society of Plastic Surgeons (ASPS), the average cost of a chemical peel in the U.S. in 2019 was $644. (1) Chemical peels are considered cosmetic and therefore not covered by insurance.
The best way to get a better idea of cost is to schedule a consultation with a qualified and licensed practitioner and discuss your specific situation and goals.
Ready to take the next step?
To determine if you are a good candidate for a chemical peel, schedule a consultation with a doctor near you.