Chemical peels involve the application of a chemical solution to the surface of the skin to activate the removal of its superficial layers revealing the new, smoother, less wrinkled skin beneath. The strength of the chemical peel needed will depend on the severity of the skins damaged/ condition.
The chemical peel uses varies of strength from superficial, medium depth to deep and how long it is left on the skin will also effect how much skin will peel following the procedure. Chemical Peels are most commonly used on the face for improvement of uneven skin texture, fine lines and wrinkles, age spots, blemishes, scars or acne. However can be used on various parts of the body including acneic backs, sun damaged and ageing décolletage and backs of the hands. Most common forms of acid used to prompt skin benefits, include trichloroacetic acid (TCA), salicylic acid and phenol. The new skin revealed following treatment is more sensitive to the sun, so it is important to keep applying sunscreen to the treated area until it has fully healed.
Chemical Skin Peeling is the procedure that applies chemical solutions to the surface of the skin to remove or 'peel' different layers of the skin. The amount of skin removed will depend on the type of chemical used, the strength of this product and how long it is left on the skin. The chemical peels used at our clinic usually remove only the most outer layers of the skin. This can lead to freshening of the skin, removal of sunspots and rough scaly patches, as well as reduce freckles and irregular pigmentation. It can also reduce fine wrinkles. There is also some evidence that by removing the top superficial sun damaged skin area, it may also reduce the risk of skin cancer.
Cleopatra and the ancient Romans used various food acids to peel their skin. In fact many Egyptian women bathed in sour milk, or rubbed fermented grape skins from the bottom of wine barrels over their skin to enhance beauty. Little did they know that they were benefiting from the superficial skin peeling effects of a family of chemicals called hydroxy acids which remove the outer layers of the skin. These acids have now been identified as lactic acid in milk and tartaric acid in grape skins and can be found in a huge number of modern beauty products. In the early 1900's, European and America women underwent 'non-medical' peels in salons with secret formulas, which were probably mild acids. In the early 1950's, the phenol peel was developed. This was a fierce deep peel that could remove years of wrinkles, but also gave peeling a reputation for complications - pigmentation, depigmentation, scarring and even abnormal heart rhythms due to absorption of the chemicals. However, when done under controlled conditions by an experienced physician phenol peeling can be safe and effective. Trichloroacetic acid or TCA, being a more gentle acid, has made a comeback in popularity as it rejuvenates the skin whilst reducing the risk of serious side effects. Other agents used include combination of other chemicals acids.
At your first consultation with a practitioner, you should explain what you expect from the treatment and how you would like to look afterwards. They will then explain exactly what the treatment will involve and how long it will take for you to recover from it. A medical history should be taken by the practitioner, to ensure that there are no reasons why you shouldn't have the treatment. Once this is established, you would normally be asked to read some detailed information and sign a consent form indicating that you have understood the potential benefits and risks associated with the peel procedure recommended.
This will be determined at the time of your consultation. In general though, texture changes of the skin, rough or scaly patches (keratoses), fine wrinkles, brown marks or spots, freckles, pigmentation, can be removed or lessened through chemical peel treatments. Age and liver spots (lentigines) can also be reduced. It is important to note however that although deeper lines may improve with this treatment, they will not be removed entirely. However these may be improved by the use of other methods. You will be advised accordingly. You must remember that chemical peeling is not a substitute for a facelift. It does not tighten obviously sagging skin, or remove broken capillaries.
In general it is best to avoid having this treatment if you have a history of keloid scarring, have any ongoing active skin infection, have used the Isotretinoin or Roaccutane in the last 12 months, and have darkly pigmented skin, or red hair with freckled skin. Darker coloured patients are generally unsuitable for the deeper peels owing to the potential for skin bleaching or lightening. Furthermore Afro-Caribbean or Asian skin is often not suited to facial peels because of the risk of lightening of the skin. This is particularly the case with the deeper peels where the top layers of skin are removed In these situations, it is very likely that your skin would not be suited to anything deeper than a mild exfoliation treatment such as a Hydrafacial. Chemical peeling is also not appropriate for people who continue to have excessive sun exposure.
Chemical peels can be used on most areas of the body, but the commonest use is to improve the appearance of sun damaged skin on the face, or the backs of the hands. It is safest and most effective on the face. Hands and other areas of the body can of course be peeled but the risk of scarring can be higher and the results less predictable. You will be advised accordingly when you come into the clinic.
Peels are classified according to how deep they penetrate into the skin layer. Therefore they are divided into 3 different depths: Superficial, Medium and Deep depth Peels.
Superficial peels are by far the commonest types of peel used most often contain and are the mildest types available. Most of these peels use some form of alpha hydroxy acid. Alpha hydroxy acids are a group of natural acids found in foods. Alpha hydroxy acids include citric acid (found in citrus fruits), glycolic acid (found in sugar cane), lactic acid (found in sour milk), malic acid (found in apples), tartaric acid (found in grapes), and others. All Alpha Hydroxy acids come in different concentrations. Salicylic acid, is a beta hydroxy acid and is increasingly popular and unique amongst the hydroxy acids in that it can penetrate deeper into the pores and oil glands causing exfoliation even in the oily areas of the face and scalp. Sometimes combinations of different hydroxy acids are used, such as Jessner's Solution which contains a combination of lactic acid and salicylic acid. Product brands which have Hydroxy Acid based superficial peels include - MD Forte, Agera RX, Dermaceutic, Jan Marini, LA Peel, ICP, Mene & Moy, Skinceuticals Gel Peels, Mandel, Cosmedix (Chirally Correct) and NeoStrata.
In general Superficial peels are used to improve rough skin texture, dry or flaking skin. They are also useful to reduce sun damaged skin, 'age spots' (brownish patches which can be caused by sun damage) and help in re-balancing irregular skin tones (i.e. skin which may be uneven in colour).
These involve the use of stronger peeling solutions. The commonest of these is higher strength TCA., (Trichloroacetic acid) which can be used on it's own at up to 50% strength, but it is more commonly used in concentrations of around 15% - 30% to help reduce possible side effects. TCA peels are obviously much deeper peels than the superficial lactic acid and glycolic acid peels. Occasionally lower strength TCA may also be used to obtain a superficial peel if required. TCA. can also be used in combination with glycolic acid or other solutions to help achieve a more controlled and even peel to the correct depth. Product brands which have TCA based medium depth peels include - Skintech Peels, Mene & Moy, Compositum, Cosmedix (Chirally Correct) and Obagi Blue Peel.
Medium depth Peels are used to improve and reduce the appearance of fine to medium depth wrinkle lines, some acne scars, and certain pigmentation problems (again, making different coloured skin more even).
These are generally performed using phenol, or 40% or greater TCA and they penetrate to the deeper portions of the skin. Although deeper peels can be very effective for the right patient, there are a number of potential complications associated with this procedure. Consequently, you will find fewer trained practitioners offering deep peels in the U.K. than those who can give you a medium or superficial treatment. We at Karidis do not currently administer deep depth peels at our clinic.
Deep depth peels are used for more severe sun damaged skins in order to reduce the appearance of deeper lines, wrinkles and scars. We at Karidis do not currently administer deep depth peels at our clinic.
Superficial peels such as lactic and glycolic acid can generally be used by all kinds of medically trained staff, including doctors and nurses, and in some cases manufacturers train beauticians to perform very superficial peels. Medium peels such as TCA tend to be used by experienced nurses, doctors and surgeons.
Depending on your circumstances the skin may have had preparation with Vitamin A, Alpha Hydroxy Acid or other preparations prior to the treatment, although this is not always the case. On the day of your treatment, the skin is firstly thoroughly cleansed with acetone or other cleanser. Depending on the depth of peel and combination of peels used, different treatment techniques are used. Generally speaking the acid is applied onto the face with a small brush and monitored to see the skin response. It is left for between 2 - 10 minutes, depending upon the strength, type of peel and skin response, before it is washed off and neutralised. If burning or stinging is a problem, a cold pack or cold air will be used to reduce this. Usually the treatment is carried out in sections. Patients who find it particularly uncomfortable may choose intravenous anaesthetic, however this is not usually required with the lighter peels.
As mentioned previously, the depth of any peel correlates directly to any after effects you will experience, such as any pain. With superficial type peels like Glycolic acid peels, during the procedure most patients will experience only a mild stinging sensation whilst the glycolic acid is on the face. However this is readily tolerated by most patients. With medium depth peels, some burning and stinging of the skin may last for 30 minutes to an hour. This will be controlled with the appropriate pain relief.
The response after this treatment is directly related to the depth of peel. Most times with Superficial peels apart from some light redness, there is not much else to see and therefore patients can return to work immediately. Some patients do not experience any visible peeling off of the skin after treatment, but the treatment still has a beneficial effect, like a very good exfoliation. The deeper the peel however the more red and swollen the skin will go in the hours after the treatment. You will of course be advised accordingly beforehand. Once the initial stinging has worn off it is not painful, but does feel tight. Over the next few days the skin dries, tightens and looks somewhat brownish in color. A light application of vaseline may be applied several times a day to prevent any possible cracking. Water will do no harm but soap should be avoided as this dries the skin out further. The skin will begin to peel between 5 and 7 days later, and must be left to come off at its own pace. As soon as the skin has healed, make up may be applied over the new, pink skin. Sometimes a secondary peel occurs during the second week in the form of dry scaly skin. Sunscreen is mandatory for at least three months, whilst moisturisers are usually helpful. You will be advised accordingly.
With superficial peels, in general, most patients can return immediately back to work the next day after this procedure. You are also able to apply makeup the next day. With a medium depth peel however this will require longer and therefore may take a week or two depending on how well you heal, your age (older skin tends to heal less quickly) and any post-treatment complications. You will be advised accordingly.
Superficial peels can be repeated more regularly such as every 4-6 weeks if necessary. Medium depth peels can be repeated after 4-6 months, however most patients find that this is not required. It can however be repeated at any time later in the future and should not harm the skin. The regular use of sunscreen will prevent further sun damage and maintain your improved skin quality. Additionally, the use of vitamin creams, AHA creams or enzyme creams can continue to improve the skin texture and reverse some of the effects caused by years of sun exposure. You will be advised accordingly.
Anytime there is a break in the skin through any means, scarring and other effects may occur. Any such effects are more likely to occur with stronger acids and thus deeper peels rather than with weaker superficial and medium depth peels. Very rarely however, some patients may develop side effects such as scarring following only a medium depth peel. This can occasionally be permanent, but you should be aware that such a result is extremely unlikely. The most common causes of scarring are usually in relation with very high concentrations of acids, infection, and pulling off the skin before it is ready to peel. Cold sores can also sometime be activated with a chemical peel, in those prone to this kind of condition. Anti-viral medication can usually prevent this. Changes in skin pigmentation may also occur with this treatment. Hyperpigmentation or brown spots may also occur. Bleaching creams may be used to help reduce the appearance of these brown areas where appropriate. This usually occurs with darker skin types and thus you will be advised beforehand accordingly. Although this usually improves with time, it may not disappear entirely. It can of course be minimised by regular use of sunscreen for at least three months after the peel. Your practitioner will be able to recommend one which is suitable for you. Prolonged redness of the face may also last for longer than 2 - 3 months in some patients; appropriate creams to reduce this will be prescribed, and ultimately this should disappear over time. In situations where there is a suspicion that you are at high risk of developing any pigmentary changes it will be advised that a small patch of skin is peeled first before undergoing a full face chemical peel.
You will be given appropriate instructions in how to care for your skin depending on the precise type of peel and concentration you had applied. In general however with Superficial peels, after treatment advice may include cleansing of the face gently with a soap-free cleanser, patting the skin dry with a towel, and moisturising twice a day; You will be advised to not pick off any dead or peeling skin as this may cause bleeding and discoloration, or even mild scarring. You should avoid the sun without a sunscreen for at least 6 weeks after treatment to reduce the risk of any colour changes. A high factor sunblock will aid with this. For medium depth peels, applying a thin layer of antibiotic ointment several times daily to reduce the risk of infection may also be advised; if itching occurs antihistamines may be recommended to help stop this.
In general although some slight tightening of the skin may be felt after any chemical peel, these do not and cannot change your pore size, improve loose skin, or deal with deep scarring. In these situations other treatments, including surgery may be indicated.
Yes it is possible to combine a chemical peel with a facelift. You will be advised accordingly at a consultation.
Yes. The other way to resurface your skin to improve the complexion is through the use of Laser technology. Laser resurfacing can also improve your skin in a similar way to a chemical peel.
Price dependant on area and specific peel
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