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The glow and freshness of our skin is lost over time as sun, stress,
and gravity take their toll. Chemical peeling originated in Europe and
initially was introduced by lay practitioners into the United States.
How does the Chemical Peel work?
Peeling is done by swabbing the face with a carefully chosen chemical
solution that causes the skin to peel. The depth of the peel depends on
the mixture used. The stronger the solution, the deeper the peel, and
the greater the degree of improvement. As skin ages, its elastic-collagen
matrix Ithe upper and mid-dermis) fractures and clumps together like broken
rubber bands. The degree of damage to these supporting elements of the
skin is dependent upon skin type, amount of sun exposure, time and other
factors. The greater the damage, the more wrinkled and aged the skin appears.
The chemical solution injures or burns the skin, eliminating a part of
this sun damage. The degree of improvement in skin appearance will depend
both on the strength of the solution used and the extent of skin damage
before treatment. When the skin heals, new collagen-elastic tissue are
formed - proportionate to the strength of the peel, and these new tissues
are responsible for the smoother, tighter, and fresher appearance of the
skin.
What are my Options?
The most widely used formulas for chemical face peel include TCA (trichloracetic
acid) 15 to 50 percent: phenol 88 percent: and Baker's solution, a mixture
of phenol, water, croton oil, and septisol soap. Baker's solution is the
most potent of these solutions, and diluted TCA .. (trichloracetic acid),
used for superficial peels, is the mildest. Phenol falls in between.
Also see information on Beta-LIFTx® and Derma Peel® Micro Dermabrasion,
each a series of lighter peels that result in no time off from work, and
Ultra Pulse® laser resurfacing, the laser equivalent of phenol type
peeling.
What are the Benefits of these Procedures?
Lighter chemical peels help freshen skin, even tone, and help ameliorate
early signs of premature aging.
The main purpose of deeper peels is to improve and eliminate wrinkling,
especially around the eyes, cheeks, lips, forehead and generally tighten
the skin. The stronger the solution, the deeper the peel, and the greater
the improvement attained. Many individuals want to correct the fine line
wrinkles (crows feet and lip lines) that a face lift will not remove (a
face lift re-drapes and stretches sagging skin, but does not resurface).
Deeper facial creases will appear more shallow. This process will help
reduce or remove freckles and other blotchy pigmentation and even precancerous
growths, depending upon the skin type. A general skin tightening results
and drooping eyelids and sagging jowls may also be improved. Carbon dioxide
Ultra Pulse® laser resurfacing
results in the same kind of benefit and improvement.
How are Chemical Peels performed?
You are requested to wash the face thoroughly and arrive at the office
without makeup. The facial skin is then cleansed with acetone. In accordance
with your consultation and decision as to the type of peel selected, the
solution is applied to a small section of the face at a time until the
entire face is treated. Studies indicate that the body tolerates the phenol-based
chemical better if administered a little at a time, spreading the entire
peeling procedure over an hour and a half. This results in less absorption
of the phenol and few complications. As absorption from the skin surface
is not a problem with TCA (trichloracetic acid), milder chemical peels
will take less time. Upon application, you may feel a stinging sensation
for five to ten minutes for trichloracetic acid or up to thirty minutes
for phenol solutions.
Swelling of the face occurs after the solution has been applied, the
stronger the solution, the greater the swelling, and the skin will turn
a tan or brown color.
After the procedure, the goal is to keep the peeling areas soft, which
is done by applying a moisturizing ointment several times a day (bacitracin
or Vaseline is fine), and by frequently rinsing the skin with water in
a shower to remove debris and tissue fluids. The peeling must never by
picked or peeled off, to do so may cause pain, bleeding, and possible
scarring.
Healing time varies with a strength of the peel. The weakest peels heal
in about three days, intermediate peels in four to six days, and deeper
peels in seven to twelve days.
What are Regional Peels?
The upper lip in women is frequently a cause of concern; as these deep
wrinkles seem to draw lipstick upwards. A localized peel can be effective
when a full-face peel is not necessary. It is even possible to touch-up
deep crease lines if not improved enough by the original peeling by simply
applying a small amount of peel solution. Localized peels are less successful
in the very sun damaged and darker skinned persons~as a marked a change
in skin pigmentation between the peeled and unpeeled areas may occur.
It is possible to peel wrinkled necks, but the results are less dramatic.
Regional peeling of eyelids can greatly improve fine wrinkling and crows
feet that blepharoplasty (cosmetic eyelid surgery) can not improve.
Also see Laser Skin Resurfacing.
What to Expect and How to Protect Your New Skin
The peeled areas will appear pink - similar to a sunburn - for one to
twelve weeks, depending on the strength of the solution used, and then
gradually return to a normal hue. The new skin will be sensitive and delicate
and should not be rubbed or washed with a wash cloth or treated with strong
astringents or exfoliatives for at least one month after healing. A sunscreen
with a protective factor of 20 with a total UVA screen should always be
applied (women should apply it before make-up) whenever you go out the
house during daylight hours. Minimize sun exposure and avoid direct sunlight
for four to six months as excessive sun exposure can cause possible permanent
discoloration. With the passage of time, the peeled skin will become less
sensitive to sun exposure, extremes of temperature and strong wind.
Make-up does wonders as a camouflage during the postoperative period.
It can easily mask the temporary redness resulting from peels allows most
people with deeper phenol peels to return to normal activities within
ten days after surgery.
Possible Complications
The incidence of complications is infrequent, but the following may occur:
these include infection, scarring, discoloration with the skin healing
lighter, darker or mottled, prolonged redness, etc. Dr. Binstock will
cover these in detail during your consultation.
How Long Will the Benefits Last?
The most common inquiry about chemical peel is, "How long will its benefits
last?" This varies greatly with the age of the patient, the severity of
the aging process, the condition of the skin, and the type of penetration
of the acid mixture. Generally speaking, the trichloroacetic acid peels
result in a temporary freshness and the crispness of the skin fades over
several months to a year. The Baker's formula peel can literally take
ten to twenty years of aging away, and if the new skin is properly cared
for, the benefits will last for years.
Please call our office for detailed information, (415) 956-8686 for San
Francisco and (415) 383-5475 for Mill Valley.
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