Chemical peels act to remove dead surface layers of the skin through the means of chemical agents (generally acids), simultaneously stimulating the regeneration of younger cells. Depth of the effect or how many layers of skin cells are removed can be precisely controlled through the chemical composition of the peel as well as the technique of application. Today a chemical peel is a routine cosmetic procedure that has existed for many years and always remained in high demand, which contributed to the continual improvement of the technique. Primary causes of such popularity are the relatively low costs of chemical peels and their effectiveness. Unlike physical or mechanical peels, they are easy to perform and do not require costly equipment, yielding results that can be truly impressive!
Surface and Medium Chemical Peels
Depending on the depth of the peel’s effect, they are categorized as “surface”, “medium” and “deep”. Surface peels affect only the cornified layer of the skin (dead cells), medium peels affect all of epidermis without damaging the basal membrane, and deep peels are specifically designed to affect cells of the basal membrane, destroying the epidermis completely. Naturally, surface peel is by far the most common variant of the procedure, with medium peels also frequently used, but a distant second, and deep peels are used extremely rarely and are classified as a surgical procedure.
Essentially any peel is a controlled chemical burn process and not an entirely harmless procedure, as it may appear to an uninformed observer (or patient!). However, with proper preparation and a responsible attitude, it is quite safe. In order to minimize the risk of complications, steps must be taken to prepare the skin for the treatment, and to take care of the skin afterwards. Proper use of pre- and post-peel products will ensure a harmless chemical peel session, as well as facilitate a quick recovery.
- Aging of the skin (wrinkles, loss of turgor, [disruption of microrelief])
- Hyperpigmentation of various origin
- Acne and similar skin problems
- Post-acne scarring and minor scars of other origins
Pre-peel and Post-peel
A complete course of treatment associated with a chemical peel procedure consists of three distinct stages:
- Chemical Peel
- Rehabilitation Period
We will discuss the types and other details of the chemical peel procedure itself a bit later, but first we need to mention the purpose and importance of the pre-peel preparation and post-peel rehabilitation periods. These steps are often wrongfully deemed unimportant, when in reality they mean the difference between mediocre and excellent results.
The goal of the pre-peel course is to prepare the skin for the treatment. Use of proper skin care products during the preparation determines the degree of control over the procedure, its depth and effectiveness. This step is performed at home and it is aimed at stabilization or inhibition of melanogenesis, stimulation of skin’s natural regenerative processes (especially important for aging skin), and normalization of thickness of the cornified layer. It is the cosmetologist’s duty to fully explain this phase of the treatment and to determine the best pre-peel products based on the patient’s individual skin profile. During the rehabilitation period, when the newly-exposed skin layer is extremely vulnerable, the patient must take care to protect her skin from external irritants (UV radiation, dryness, rapid changes in temperature, etc), as well as undergo a course of antioxidative and anti-inflammatory therapy. A variety of specialized post-peel skin care products is available and strongly recommended for this period. Negligent attitude during the time of rehabilitation can lead to side effects and overall worse condition than prior to the peel.
It is common knowledge that performing a chemical peel during summer is impossible due to high UV radiation and therefore, risk of severe skin damage. However, that is largely a thing of the past. Thanks to the advances made in the science of cosmetology in recent years, most problems associated with UV levels can be solved today. Peels over a certain depths are still not recommended in summer, but surface chemical peels can be safely performed if accompanied by proper skin care. Our Educational Centre at Martinex offers a seminar specifically on the subject of Summer Peels, where you can receive extensive information on latest advances in this area.
Selecting a Chemical Peel
Effectiveness of chemical peels is directly correlated with the depth they affect. The deeper the effect of the peel, the higher is the probability of side effects, and chances of complications during the rehabilitation period. The choice of the appropriate peel is made on a per-patient basis and depends on:
- Desired effect and maximum allowable damage to the skin
- Epidermis conditions (dry, oily, pigmented, etc)
- Regenerative abilities of the skin
- Signs of photo-aging
- Area to be affected
- Successful completion of the pre-peel preparation
Based on the above indications, the cosmetologist determines the best type of chemical peel, concentration and pH of the peeling agent, form of delivery (gel, lotion, cream, etc), technique of application (such as brush or cotton swab) and whether the patient will require multiple sessions.
Most common type of surface chemical peel, based on alpha-hydroxy acids. Glycolic acid is the most active of all organic acids, and so glycolic-based peels have distinct exfoliating, stimulating, and anti-oxidant effects. All Glycolic peels are highly effective, simple to apply, and have a short rehabilitation period. They can be used in response to a wide array of indications: skin aging, hyper-pigmentation, irregular skin contours, acne, and post-acne scarring. Concentration of Glycolic acid can vary from 30 to 70 percent, however pH plays an even more important role. The most effective glycolic peels have a pH of < 2.0 (which makes a neutralizing agent mandatory). Glycolic peels can also contain other effective ingredients, mixed with Glycolic acid. Common supplements include Phytic, Lactic, Kojic, and Salicylic acids. This variety allows specialists to better tailor the procedure for each individual patient, accounting for peculiarities of her skin.
Lactic acid-based solutions are another common class of peels. They have exceptionally high penetrative properties, making them idea for patients with hyperkeratosis (thick, rough skin, usually caused by aging or prolonged exposure to environmental irritants). Since lactic acid is a natural component of the skin, playing a critical role in moisturizing processes, lactic peels have a very delicate effect on the epidermis and moisturizes the skin. Lactic peels are recommended for correction of skin defects in patients with dry and aging skin.
Commonly known as “yellow” peels, Retinoic peels are currently on the rise in popularity. The word “peel” in this case is somewhat of a misnomer, since Retinoic peels do not peel away the skin as the other types do. They are cardinally different from traditional peeling agents. Retinoids do not damage the skin, do not destroy cells, and do not coagulate proteins. However, they lead to the same end result as other types of chemical peels, so naturally they are included in this category. Retinoic peels act on particular receptors of the cells’ nuclei, which were discovered in basal keratocytes, melanocytes, and fibroblasts. Thus, retinoids act to increase the mitotic activity of basal keratocytes, normalizing the processes of differentiation among them, to control melanogenesis, and stimulate the synthesis of epidermal lipids. All of the above normalizes the appearance of skin cells and uniformity at the celluar level leads to an overall healthy-looking skin. Retinoic peels improve the texture of the skin, slow aging processes, have an anti-oxidant effect (through stimulating skin’s own defense mechanisms), and most importantly – the effects were scientifically proven to persist for 4 months after the procedure. Naturally, the biggest advantage of Retinoic peels is they are completely non-traumatic and practically do not require a recovery period.
A “golden standard” in aesthetic medicine among peeling solutions. Phenol-based peels typically fall into the category of “medium” peels. They have been used for a very long time and were always regarded as the most highly effective method. Contemporary advances in medicine, biochemistry, and pharmacology have significantly reduced their toxicity without compromising their effectiveness. Phenol exfoliates through denaturation of proteins and at the same time stimulates synthesis of new celluar material. Compared to other similar treatments, such as those based on trichloroacetic acid, phenol solutions are easier to use and more comfortable for the patients. Side effects of phenol peels are practically nonexistent.