Article medically reviewed by Dr. Gavin Chan (MBBS, cosmetic physician, liposuctionist)
Templestowe Lower and Berwick Clinics
Dr. Gavin Chan has a background in intensive care, anaesthesia, and emergency medicine. Since 2004, Dr. Chan has provided cosmetic procedures, including anti-wrinkle injections, dermal fillers, liposuction, fat transfer, skin needling, and laser treatments. He is a doctor trainer for various dermal fillers and anti-wrinkle injections.
What are chemical peels?
Chemical peels are a method of regenerating and resurfacing the skin by inducing a controlled wound to the skin. They remove the top layers skin to help induce collagen remodelling and therefore improve sun-damaged skin, skin pigmentation problems, wrinkles, skin texture, and the overall appearance of the skin. The strength of the chemical peel will determine its depth. Deeper peels will have a greater number of complications and a longer recovery, but also will result in a greater improvement in the skin.
What types of chemical peels are there?
Alpha-hydroxy acid (AHA) peels – lactic acid peel. Lactic acid is a naturally occuring acid in the body. These peels can be performed at various concentrations to vary the strength of the peel. It’s main role is to remove the top layers of the skin and induce new collagen formation. Because lactic acid is a natural human metabolite, there is less chance of an allergic reaction with this type of peel. Alpha-hydroxy acid peels work by removing the top layer of skin cells. These cells often hold surface pigmentation, are responsible for skin unevenness and contribute to fine lines. Each time a patient has a lactic peel these cells are exfoliated away and the skin is forced to generate new cells. A series of these peels increase the efficiency of cell regeneration and remove rough surface cells.
Beta-hydroxy acid (BHA) peels – salicylic acid is main ingredient found in these peels. These peels are generally used in oilier skins or acne prone skins as they are oil soluble and penetrate deeper in this type of skin environment. Beta-hydroxy acids are generally larger molecules than alpha-hydroxy acids and therefore may not penetrate as deeply in a normal (non-oily) skin environment. For active acne, there may be some post peel purging. As the acid exfoliates away the surface of your skin, it brings clogs you have underneath closer to the top, which may erupt as more active pimples. Salicylic acid works by penetrating the follicles removing trapped oils, dead cells and reducing inflammation within the skin.
Retinoic acid peels – retinoic acid is the ingredient found in well known skin products such as Retin-A or Stieva-A (tretinoin). Retinoic acid helps to increase the turn-over rate of the skin and make it behave more like a ‘younger skin’. They can also help to reduce DNA mutations caused from UV exposure on the skin. Retinoic works by making the skin cells behave ‘younger’ by increasing the cell turnover rate. It stimulates collagen production, inhibiting the growth of harmful bacteria, restoring the immune system, improving circulation, and sealing in moisture deep within the skin.
This peel is a little different to the others in the fact that the peel is left in situ on the skin for the next 6 – 10 hours. The peel will have a mild yellow tinge on the skin, hardly noticeable on many skins. The peel feels slightly tingly and a little itchy but very comfortable. The patient will rinse the peel from the skin with warm water themselves at home. A delay of 2 – 3 days will occur before the skin starts to peel. The peeling is soft peeling skin that usually lasts for 4 – 5 days.
Modified Jessner’s peel (a combination peel of salicylic acid, resorcinol, lactic acid and Kojic acid). This combination peel brings together a combination of alpha and beta hydroxy acids (see above) as well as resorcinol, Kojic acid and the effects of each of these ingredients. Resorcinol is a derivative of phenol (a very deep peeling agent) and is good for resurfacing the skin. The depth of the peel, which in most cases is superficial, is determined by the number of layers placed on the skin. The skin turns a frosty white colour after treatment for a short time. Kojic acid is a lightener/brightener used to reduce pigmentation in the skin.
This peel stimulates the deeper dermis level of the skin and causes new fibroblasts and collagen to develop, puffing out lines and wrinkles caused by ageing. It is also used to treat sun damaged skin, hyperpigmentation (melasma) and contributes to the healing of acne.
Trichloroacetic acid (TCA) 35% – at these concentrations, TCA peels can help with skin texture, wrinkles and pigmentation. A cost effective alternative to laser resurfacing.
These medium/deep chemical peels have been replaced at Victorian Cosmetic Institute with laser skin resurfacing which can achieve better results with more control over the depth of treatment and can cause more collagen remodelling.
Chemical peels for acne case study
This patient presented to Victorian Cosmetic Institute with a long standing history of acne. After a course of Chemical Peels and the Synergie Anti-Blemish at home skin care kit he has been able to stop his breakouts and can now begin repairing his acne scarring.
4 salicylic acid chemical peels were performed spaced 4 weeks apart.
Chemical Peels Case Study
This is a picture of a patient who has had a 20% TCA chemical peel. The concerns with her skin were melasma (hormonal pigmentation) on her cheeks and forehead, acne, and she just wanted to improve the overall quality and texture of her skin. The post photograph shows a picture of her one week after the peel.
Which chemical peel is right for me?
As a rule, the deeper the peel, the more side effects, potential complications, and recovery are needed. Another rule of thumb is that the darker the skin type, the more problems that may be encountered post-peel, especially pigmentation problems such as post inflammatory hyperpigmentation where the treated skin may become darker than the untreated skin. Therefore, deeper peels in darker skin types must be considered with caution and sometimes it may be better to perform a series of more superficial peels rather than one deep peel.
The degree of skin ageing will also determine which peel to use. For younger patients with less sun-damage, pigmentation and wrinkles, only superficial peels may be required. The opposite is also true.
Different skin problems also respond to particular peels. Acne, for example, responds well to Jessner’ s peel and salicylic (beta-hydroxy acid) peels. Salicylic acid peels and Jessner’s peels (which also contains salicylic acid) are very oil soluble and are able to penetrate deeper into pores and remove oil and sebum and are anti-inflammatory. Both alpha-hydroxy acid and beta-hydroxy acid peels help exfoliate the skin. TCA peels, alpha-hydroxy acid peels, and Jessner’s peels are suited to pigmentation problems and sun-damage.
Wrinkles can be best treated with TCA peels, or any medium to deep chemical peel. These peels can be a cost effective alternative to laser resurfacing.
How can I prepare myself for a chemical peel?
Skin priming can be achieved by commencement of a skin care products containing retinoic acid such as Refine 4% from Cosmedix or Retin-A/Stieve-A (available by prescription only), as well as a topical lightening agents such as hydroquinone, kojic acid or arbutin. This needs to be commenced at least 2 weeks prior (preferably more) to peeling to help with uniform penetration of the peel, accelerated healing, and to reduce post-peel complications such as post-inflammatory hyperpigmentation. Use of alpha-hydroxy acid cleansers/exfoliants in the weeks prior to chemical peeling can also help the peeling agent (especially in evenness of penetration), but do not reduce the risk of post-inflammatory hyperpigmentation.
How are chemical peels performed?
In our opinion, chemical peels are best performed by an experienced Skin Therapist. The skin is thoroughly cleansed with an appropriate cleanser first. A masking agent is sometimes used to protect the peel from entering the eye. A fan may be present to help cool the skin for comfort during the peel. Your eyes should be closed during the procedure.
The chemical peel solution is then applied to the face. The procedure is timed, and you will be asked about your comfort level. Neutralisation of the peel occurs at the end of the treatment. This ensures the chemical peel does not stay active on the skin for longer than necessary.
The chemical peel is completed usually by placing sunscreen and a soothing balm on the face.
Are there any medical problems that your doctor should be aware of prior to having a chemical peel?
Patients with a history of, or a current infection of herpes simplex virus (cold sores) should ensure that their doctor is aware of this before chemical peeling. If there is an active infection present, you may be asked to wait until it has passed prior to having a chemical peel. Also if you have a history of cold sores, you doctor may place you on anti-viral medication as a prophylaxis to an outbreak during your treatment.
If you have a history of keloid (thick, pigmented scars) you may also be excluded from all but the most superficial of peels.
Patients with HIV/AIDS or immunosuppression should avoid chemical peels because this may impair wound healing and increase the likelihood of infection and scarring.
Also those who have recently had a course of oral isotretinoin or Roaccutane should avoid chemical peels for at least 6 months before undergoing medium or deep chemical peels. Similarly, patients who have had a recent face or browlift should wait at least 6 months.
What are the complications or side effects of chemical peels?
Swelling – usually lasting up to three days, but it is usually only associated with the deeper peels.
Pain – again, this is only really seen with the deeper peels and may last for a few hours only.
Redness – most superficial peels produce a mild amount of redness that persists for a few days only. Medium to deep peels can cause redness that can persist for up to a month.
Itchiness – This is only common after medium and deep chemical peels.
Ocular injury – Care must be taken during the procedure to avoid the peel from entering the eye.
Allergic reactions – uncommon, although peels such as the Jessner peel have a higher rate of allergy. Anti-histamines may be taken before, if an allergy is known, or after.
Folliculitis /acne – this occurs commonly as a result of the emollient creams used during healing. Antibiotics may be required to heal these eruptions.
Bacterial/fungal infection – is uncommon. It can, however, lead to scarring. This is usually only associated with medium to deep peels.
Herpes simplex recurrence – is common and needs to be treated with anti-viral medication to prevent spread and scarring.
Hyperpigmentation – dark patches over the peeled areas. This usually occurs over the deeper parts of the peel and is a result of inflammation causing release of melanin/pigmentation from the skin (post-inflammatory hyperpigmentation). This is usually temporary, although it can last for up to 2 years. Treatment usually involves a lightening agent such as hydroquinone.
Hypopigmentation – is a loss of pigmentation and usually occurs in darker skin types after peeling. This can be permanent sometimes.
Telangiectasia – are small red vessels under the skin and can become more prominent with peeling. The vessels are easily treated with lasers such as the Gemini laser.
Milia – this are small white cysts that form about 2 to 3 weeks after the skin has re-epitheliased (grown over). It can be due to blockage of the skin due to emoillent creams used after chemical peeling. They can be removed with a needle or lancet.
Demarcation lines – this is usually a result of medium to deeper peels, and the line of where the peel was used and the untouched skin is noticeable even after the skin has healed.
Scarring – a very uncommon complication of chemical peels. This is usually associated with a history of poor healing or keloid scarring. Scarring is more likely the deeper the peel. A early sign of scarring is persistent redness and itchiness. This needs to be treated with a topical steroid.
How can I minimise the complication rate from chemical peels?
Patient selection is a very important part of reducing the rate of complications. By choosing the right peel for each particular skin type, whilst considering the needs of the patient, complications can be minimised. Darker skinned patients in particular, especially those of European, Asian, Indian, Sri Lankan, or African backgrounds are more prone to pigmentation problems (either a gain or loss of pigmentation) after a medium to deep chemical peel. It is possible to prepare the skin beforehand with hydroquinone and tretinoin which help to reduce the rate of post-inflammatory hyperpigmentation (dark areas) post peel. This is particularly important for the medium/deep peels and in darker skinned patients. This regime can be continued after the peel (2 weeks after) to further reduce pigmentation problems.
Similarly, sun exposure pre and post peel should be avoided or at least minimised. Sun exposure can lead to an increase in pigmentation problems also.
Why should I choose Victorian Cosmetic Institute as my provider of chemical peels?
Our team of Skin Therapists are led by a department director with many years of Skin Therapy experience. Our Director of Skin Therapy regularly educates and trains our Skin Therapists on the latest techniques and treatments.
To book a skin consultation and begin your skin journey with Victorian Cosmetic Institute call our customer care team on 1300 863 824.
If you are requiring deeper treatment using the TCA chemical peel or skin lasers you will require a consultation with one of our Cosmetic Doctors or Cosmetic Nurses. Our Cosmetic Doctors and Cosmetic Nurses are highly skilled in skin treatments and will be able to give you the proper advice on the right treatment for you. We have a wide range of chemical peels available which increases the likelihood of finding the best chemical peel for your skin.
The first step is simply contacting us for your initial consultation, where we will discuss with you what is a realistic and achievable outcome, and what to expect from your treatment.
Making that first phone call can be a confronting task – many of our patients have preferred filling out our online enquiry form. We can then contact you with an understanding of the results you are hopeful of achieving and ensure the treatment is appropriate.