According the NHS a chemical skin peel is ‘solution applied to the face to remove dead skin cells and stimulate the growth of new cells’
The main aim of the procedure is to improve the appearance of the skin. This may be through:
- Age spots reduction
- Evening out skin tone
- Sun damage repair
- Acne treatment
- Reduce fine lines under the eyes and around the mouth
- Improve the appearance of mild scars
- Treating freckles and melasma in the skin
- Better the overall look and feel of the skin
…and many more!
There are 3 main types of peels, that refer predominantly to the intensity of the procedure:
Superficial peels are a low risk, semi-permanent treatments that should be repeated each month or so to achieve lasting effects. Skin cells are removed from the top layer of skin known as the ‘epidermis’ for a refreshed and revitalised complexion. Skin may feel tight for a few hours afterwards but there are no significant lasting effects.
Medium peels are also low risk, semi permanent treatments but need only be repeated every 6-12 months. In this procedure skin cells are removed from both the epidermis and middle layers of the skin creating more of a burning/stinging sensation. The side effects differ between individuals with the possibility of skin redness lasting up to 6 weeks before the skin returns to normal.
Deeper peels carry more risk due to their thorough nature, meaning they need not be repeated as often and have much longer lasting effects. In this way, it is important, that these peels especially, are carried out by experienced practitioners. Some people may feel it necessary to use a local anaesthetic to numb any pain & discomfort that the treatment can cause. The solution is applied for a longer duration of approximately 30 minutes while heart rate and blood pressure are monitored. Peeling, redness and discomfort is likely to occur with effects taking as long as 3 months to fully heal.
The chemical solutions are likely to include any of the following acids and are used to create a controlled wound so new skin may take its place:
- Glycolic Acid
- Glycolic acid peels are the most common alpha-hydroxy acid peel and are also known as the fruit peel. It is simple and requires no downtime. Many studies refer to its positive affects on acne, acne scars, melasma, postinflammatory hyperpigmentation, photoaging, and seborrhea. Depth of the glycolic acid peel depends on the concentration of the acid used, the number of coats applied, and the length of time it is applied. In this way, it can be used as both a superficial peel, or medium depth peel. Research has proven this type of acid to be safe with Fitzpatrick skin types I–IV and to have anti-inflammatory, keratolytic, and antioxidant effects. The glycolic acid must to properly neutralised to stop acidification of the skin. Applying acid to the skin saturates the cells ability to resist acidification and thus any excess acid must be neutralised to avoid burning. Typically, alpha-hydroxy acid peels can be neutralised with water or basic solutions, such as ammonium salts, sodium bicarbonate, or sodium hydroxide. Glycolic acid peels have frequently been combined with other peels and treatments, to achieve better results – for example, microneedling, TCA peels and microdermabrasion.
- Trichloroacetic Acid
- Also known as TCA peels, or tricholorinated carbonic acid, the peel precipitates epidermal proteins and causes destruction of the upper dermis. In order to create the desired concentration it is dissolved in distilled water to create a clear solution that can be stored for up to 6 months. This solution may be used alone or in combination with other peels and treatments. Its most notable difference to other peels is the ‘frosting’. This refers to the whitening of the skin due to protein coagulation. It can be used for superficial peeling with concentrations of 10–30% or for medium‐depth peeling, concentrations of 35–50%. Higher TCA concentrations (>50%) carry higher risk of post‐inflammatory hyperpigmentation and scarring.
- Salicylic Acid
- Salicylic acid (also known as ortho‐hydroxybenzoic acid) is a naturally occurring beta hydroxy acid that is derived from the sweet birch, wintergreen leaves and willow tree bark. It is not very soluble in water meaning it is used for superficial peels at concentrations of 10-30% in a hydroethanolic or polyethylene glycol base as there is no need for neutralisation. It is applied to skin for 3–5 min, causing a quick burning sensation before its analgesic properties start to begin. On evaporation a white precipitate remains but is not the same as the ‘frosting’ occurring from in TCA peels. Salicylic acid peels are favoured for use in comedonal and inflammatory acne, as well as for oily skin.
- Lactic Acid
- Lactic acid is specifically used to treat hyperpigmentation, age spots, and other factors that contribute to a dull and uneven complexion. Unlike alpha-hydroxy acid peels such as glycolic acid, lactic acid is milder. Though structurally identical to glycolic acid, recently lactic acids have become more popular for superficial peeling, largely due to their equivalent efficacy which only causes relatively mild discomfort with minimal associated downtime and risk. It has a much lower pH that glycolic acid at a similar concentration, with studies showing very similar results. Neutralisation of the solution is still required as well as exfoliation in following days after treatmen
- Carbolic Acid (Phenol)
- Deep peels are typically performed with phenol (in combination with croton oil) and may be used for severe photoaging, deep or coarse wrinkles, scars, and sometimes precancerous skin lesions. These deep peels cause rapid denaturisation of surface keratin and other proteins in the dermis and outer dermis. Penetrating the reticular dermis, the deep peel maximises the regeneration of new collagen. Phenol is rapidly absorbed into the body’s circulation, and so patient vitals are always monitored closely. Other complications include hypopigmentation, hyperpigmentation, scarring, and keloid formation. Phenol peels are primarily performed in operating room settings and frequently used in conjunction with surgical procedures. Currently, new laser techniques are a popular alternative for major deep skin resurfacing because they avoid the adverse effects of deep chemical peels, even if phenol is used in lower concentrations.
Following a peels clients can expect the refreshed skin to be smoother and less wrinkled than the older skin that has been ‘peeled’ away. While treatment areas are mainly targeted around the face, peels can also be offered for the neck and hands.
In general, peels are better suited to fair-skinned and light-haired individuals, purely because the peel can have ‘lightening’ effect on the skin. Darker skin types are more prone to attaining an uneven skin tone following treatment. The intensity of peel is determined by the acid concentration, the vehicle used to carry it, the amount of acid applied, and the technique used.