Chemical peels are treatments that aim to improve the skin of the face or body by using a chemical solution, resulting in controlled destruction at a specific level of the skin. The result is usually a sloughing off of dead skin with regeneration of newer healthier tissue. The regenerated skin is typically smoother, less wrinkled and has less pigmentation and blemishes than the old skin. Peeling solutions such as trichloroacetic acid (TCA) and alpha-hydroxy acids (AHAs) penetrate to different depths and elicit different results with an improved side effect profile and shorter recovery periods. The chemical peel is effective in reversing the cutaneous signs of ageing such as wrinkling, sallow complexion, pigmentation and laxity.
Classification of chemical peels
Chemical peels are currently classified according to the depth of penetration and injury caused. Superficial peels penetrate to any depth within the epidermis, medium depth peels penetrate through to the superficial layer of dermis, while deep peels penetrate down to deep dermis.
Preparation for chemical peeling
It is considered essential nowadays for patients to have a regime of skin preparation prior to undergoing any chemical peel. The purpose of this is to reduce the likelihood of undesired sequelae such as post-inflammatory hyper-pigmentation (PIH), to allow for a more effective rejuvenation and to identify any potential issues with products that may be used either during or after the peel. Typical regime will include a low concentration of a skin-lightening agent such as hydroquinone, kojic acid or similar. The use of a sunscreen is also included to aid the reduction of melanocyte excitability. Preparation of the skin is generally advised for a minimum of two weeks prior to peeling.
Medium depth chemical peels are indicated in the management of fine lines and wrinkles associated with photoageing, as well as pigmentary disorders and superficial atrophic scars. Effective redults are achieved using 35% TCA solutions in combination protocols, typically with Jessner’s, 70% glycolic acid or solid carbon dioxide.