CHEMICAL PEELS

If you’re considering a chemical peel…

Chemical peels use a chemical solution to improve and smooth the texture of the facial skin by removing its damaged outer layers. It is helpful for those individuals with facial blemishes, wrinkles and areas of uneven skin pigmentation. Phenol or Trichloroacetic Acid (TCA) have been used for this purpose. The precise formula used may be adjusted to meet each patient’s needs. Although area chemical peels may be performed in conjunction with a facelift, it is not a substitute for such surgery, nor will it prevent or slow the aging process. This section provides basic information about certain types of chemical peel treatments and the results you might expect. It won’t however answer all your questions, since a lot depends on your individual circumstances. Once you and your plastic surgeon have decided on a specific peel program, be sure to ask about any details that you do not understand.

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Alphahydroxy Acids (AHAs), such as glycolic, lactic, or fruit acids, are the mildest of the peel formulas and produce light peels. These types of peels can provide smoother, brighter-looking skin for people who can’t spare the time to recover from a Phenol or TCA Peel, but usually have to be repeated over time.

Trichloroacetic Acid (TCA) can be used in many concentrations, but it is most commonly used for medium-depth peeling. Fine surface wrinkles, superficial blemishes and pigment problems are commonly treated with TCA. The results of TCA Peel are usually less dramatic than, and not as long-lasting as, a CO2 Laser Peel. The recovery from a TCA Peel is also shorter than with a CO2 laser.

All chemical peels carry some uncertainty and risk. Chemical peels are normally a safe procedure when performed by a qualified, experienced physician. However, some unpredictability and risks such as infection and scarring, while infrequent, are possible.

With a TCA Peel, your healed skin should be able to produce pigment, as always. In other words, the peel should not bleach the skin. TCA Peel patients are advised to avoid sun exposure for several months after treatment to protect the newly-formed layers of skin. Even though TCA is milder than the Phenol Peels or Lasers, it may also produce some unintended color changes in the skin.

Trichloroacetic Acid (TCA)

Uses:

∙ Smoothes out fine surface wrinkles

Removes superficial blemishes

Can correct some pigment problems

Considerations:

Can be used on neck or other body areas

Requires pre-treatment with Retin-A. Is usually done in the office.

Peel depth can be adjusted

Repeat treatment may be needed to maintain results

Sunblock must be used for several months

Healing is usually quick, about 4-5 days, much quicker than with a Phenol Peel or CO2Lase

PLANNING FOR A CHEMICAL PEEL

In most states, no medical degree or training is required to perform chemical peels – even the strongest Phenol Peels. Many states have laws that permit non-physicians to administer certain peel solutions, but regulate the strengths which they are permitted to apply. You should be warned that Phenol and TCA Peels have been offered by inadequately trained practitioners claiming to be able to rejuvenate the skin.

It is very important that you find a physician who has adequate training and experience in skin resurfacing. Your plastic surgeon may offer you a choice of peel techniques or a laser.

If you have a history of herpes or “cold sores”, it is VERY important that you inform your physician prior to any facial resurfacing procedures.

PREPARING FOR YOUR CHEMICAL PEEL

Retin-A, a prescription medication derived from Vitamin A, should be used to pretreat the skin. This thins out the skin’s surface layer, allowing the TCA solution to penetrate more deeply and evenly. If your skin won’t tolerate Retin-A pre-treatment, an AHA cream may be used instead. Hydroquinone, a bleaching agent, is sometimes used in conjunction with Retin-A or AHA pre-treatment-especially if you have blotchy skin areas or pigmentation problems. You may have to spend a month or more in the Retin-A pre-treatment phase before your actual peel.

You probably won’t need any extra assistance following your procedure if you’re having an AHA Peel or superficial TCA Peel.

WHERE YOUR PEEL WILL BE PERFORMED

Most chemical peels can be performed in your plastic surgeons office.

TYPES OF ANESTHESIA

Anesthesia isn’t required for Phenol or TCA Peels because the chemical solution acts as an anesthetic. However, sedation may be used before and during the procedure to relax you and keep you comfortable.

THE PEEL

Typically, the skin is first thoroughly cleansed. Then the surgeon will carefully apply the Phenol or TCA solution. You may feel a stinging sensation as the peel solution is applied, but this feeling will quickly pass. Ice compresses are applied during the process.

A full face TCA Peel usually takes about an hour. Two or more TCA Peels may be needed to obtain the desired result, and those are usually spaced out over several months. Mild TCA Peels may be repeated as often as every month.

A full face Phenol Peel generally takes one or two hours to perform. A Phenol Peel to a smaller facial region (perhaps the skin above the upper lip) may take only 10 or 15 minutes. A single treatment usually suffices. Phenol Peels can also be used on isolated pigmented spots. Patients who need a peel deeper than a TCA Peel can provide are usually treated with a CO2 Laser.

AFTER YOUR TREATMENT

After a Phenol or TCA Peel, your doctor may prescribe a mild pain medication to relieve any post-treatment tingling or throbbing you may feel. A medicated ointment with daily face washes is usual. A crust or scab may form on the treated area. To help your face heal properly, it is essential that you follow your doctor’s specific post-operative instructions.

A TCA Peel may cause significant swelling, depending on the patient and strength of the peel used.

GETTING BACK TO NORMAL

With a TCA Peel, the moderate discomfort and mild swelling you may experience will subside within the first week. In about a week to ten days, your new skin will be apparent and you should be healed sufficiently to return to your normal activities. It is best to avoid sun exposure.

With a Phenol Peel, the new skin will begin to form in about seven to ten days. Your face will be very red at first, gradually fading to a pinkish color over the following weeks to months. During this time, it is especially important that you use a sunblock or blotchy, irregular skin coloring may result.

About two weeks after treatment, you can return to work and resume some of your non-strenuous, normal activities and your skin should be healed enough for you to wear makeup. During this skin maturation phase, be sure to use hypoallergenic soaps, moisturizers and make-up.

The results of a TCA Peel are usually not as long lasting as those of a Phenol Peel or CO2 Lasers. However, your skin will be noticeably smoother and fresher looking. If you are planning a Phenol Peel you can expect dramatic improvement in the surface of your skin – fewer fine wrinkles and fewer blemishes. Loss of pigmentation can be a problem however, which is why a CO2 Laser is usually used for difficult skin problems. Your results will be long lasting, although not immune to the future effects of aging and sun exposure.

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Chemical peel is especially useful for the fine wrinkles on cheeks, forehead, and around the eyes, and the vertical wrinkles around the mouth.
The chemical solution can be applied to the entire face, or to a specific area -for example, around the mouth – sometimes in conjunction with a facelift.
At the end of a phenol peel, a thick layer of petroleum jelly may be applied to the treated area.
A protective crust may be allowed to form over the new skin. When it’s removed, the skin underneath will be a bright pink.
After healing, the skin is lighter in color, tighter, smoother, and younger looking.