A "chemical peel" is a
procedure during which chemicals are put
on the skin, causing it to
"peel" in many cases. The
application of chemicals actually
produces a burn of the skin.
Chemical "peels" are not new.
The ancient peoples of Egypt described a
method of treating the skin with ground
rocks and chemicals; therefore, we know
that chemical treatments have been around
for at least four thousand years.
Chemical peels were used by cosmeticians
in the early 1900's. The Gypsies of
Europe used peeling agents, and German
dermatologists brought the formulas to
the States. During the 1960's, Drs. Baker
and Gordon in Miami and Dr. Linton in
Washington did studies to establish the
effects and safety of the
Over the past few decades, other methods
of "chemical peels" have been
developed. In today's day and age,
peeling agents are available that have
fewer potential side effects than the
"phenol" peel. Today there is
an increasing number of peeling agents
that are safer and give a result which is
in many cases as good as or better than
the potentially toxic chemicals used in
the past. Many chemical peels are done
using chemicals normally found in the
Since people who are getting older are
the ones seeking improvement by a
chemical peel, the use of less toxic
chemicals is certainly a welcome
Improvement after a chemical peel takes
the form of a tightening and smoothing of
the skin. Studies of treated skin have
shown that the peel affects the fibers
within the skin. Treatment by peeling
tightens the elastic fibers of the skin
which were like a bunch of dropped pickup
sticks. These elastic fibers become
aligned into a pattern, causing a general
tightening of the skin.
This tightening changes the way the skin
looks. It looks better when it is
examined under the microscope. The
realignment of the skin fibers gives the
skin the appearance of that found in
After a peel there is a thickening of the
"dermal" layer of the skin.
This is the layer that usually thins with
age and/or severe sun damage. This is the
layer that is mainly responsible for
Generally, the degree of change in the
skin depends on the chemicals used, the
concentration, additives, the type of
skin, the process of healing, the depth
of the peel, etc.
Depending upon the type of peel and the
patient and doctor's preference along
with the extent, the peel may be
performed under sedation in the hospital
outpatient department, in the office
using no anesthesia, or rarely under
You can get an idea of what a 'peel' is
like if you compare it to a severe
sunburn or a steam burn. As you know, the
skin at first is swollen and red. Crusts
may form. Blisters may be present. The
scab makes the skin look dark. The outer
dark layer 'peels' off revealing the
underlying skin. The skin is usually red
and this redness may last for weeks and
even months to some degree. Some patients
have reported the area to darken, but
this is temporary. You should be aware
that in the few days after the procedure
this may be noted.
Rarely the skin will remain red. Such
cases have been associated with the drug
ACCUTANE. This drug is used for acne
therapy. If you have taken Accutane and
are interested in a chemical peel, YOU
MUST MAKE US AWARE OF THIS FACT.
As in severe sunburns or steam burns,
blisters can result. Fluid may drain and
crusting can occur. It is not unusual to
have a minor infection in the crusts.
Deep or extensive infections are rare.
The use of antibiotics, the application
of compresses, and personal care of the
skin minimize the chances of severe
On the evening of the day of the peel,
and depending on the areas and the type
of the peel, you will be asked to begin
showering or using compresses 6 to 8
times a day, and to apply certain creams
and ointments. The face should be kept
moist at all times. Once the crusts
separate and healed skin is present,
moisturizing creams or ointments such as
Vaseline or A&D cream or ointment
should be applied to healed areas.
Compresses may be needed if infection
begins. A compress is a wet piece of
gauze that is put on the areas of
crusting and/or infection. Water is
boiled, cooled, and stored in a clean
container in the refrigerator. This can
be warmed as needed. (A microwave is
quite convenient for this.) The gauze is
moistened and put on the crusts. The
gauze may be remoistened if it dries out.
Antibiotics may be prescribed in some
HEALING AND CHANGES
A change in skin color is seen. The outer
layer of skin is shed similar to the
"peeling" from a sunburn. There
may be a lightening of the skin. With
deep chemical peels, very light skin can
result. If for example, the lip alone is
treated, the area can be lighter in color
than the surrounding skin. On the other
hand, light skin may turn darker. Blotchy
skin usually smooths out to some degree.
Over time, the color of the skin usually
evens out. Remember that skin color on
different portions of the face and are
not even to begin with.
After healing, you should be prepared to
use cosmetics and makeup if the color
difference is very noticeable.
Medications, including steroids (Kenalog
or Hydrocortisone), bleaching agents
(such as Hydroquinones), or tape
containing medications also may have to
be applied for several weeks in some
cases. Over a few months the difference
in color can blend back in, resulting in
a more normal appearance. However, with
deep peels, such as the phenol peel,
permanent lightening can occur and is
common. With the TCA peel used in our
practice, the chances of permanent
significant lightening is quite low.
As you know after a bad sunburn you don't
go into the sun again until the skin is
healed and is not tender or red. After a
chemical peel, direct sun should be
avoided until the skin is well healed.
The use of sun blocks with at least a 45
factor is recommended thereafter. We
recommend sun screen for everyone,
regardless of whether or not you undergo
a chemical peel.
Wind burns, such as those incurred while
skiing, should be avoided.
If you have taken the drug Accutane for
acne treatment in the past, you should be
aware that your skin may be prone to
thickened scars following a chemical
peel. You must inform the Doctor if you
have ever been treated with Accutane.
Even without having taken Accutane, thick
scars could occur.
There is no sure way of predicting who
will develop thick scars. Individuals
with American Indian, African, or Asian
blood seem to have an increased chance of
developing such scars. They have,
however, occurred in all peoples. Please
notify the doctor if you or members of
your family have developed thick scars.
Please show the doctor scars that may
Other factors influence healing. Smoking
is a significant deterrent to good
healing. Those who smoke would have to
accept the increased possibility of
infection, thickened scars, etc.
<<** If you have a history of "COLD SORES" (herpes labialis), you should inform the doctor before the peel.**> > Treatment with Zovirax (a medicine
that controls herpes) may be needed.
Other conditions such as diabetes, light
sensitivities, and diseases such as
scleroderma can cause unexpected
consequences. If you have any skin
problems or diseases, let us know.
Because of the many factors that
influence the final result, there is no
sure way of determining the exact outcome
of a chemical peel. Results do differ.
Other factors affecting results include
the type of peeling agent, the
pre-treatment condition of the skin, the
thickness of the skin, the depth of
wrinkling, the health of the skin, the
presence of oils in the skin, and the
"turn over" rate of the skin.
Diabetes, medications, smoking, ethnic
background, environment, etc., also can
affect the results.
Severe problems, while rare, can occur.
Thick scars which cannot be improved and
deep infections have been reported, but
have not been seen by Dr. Capuano. Great
caution is used in treating the eyelids.
If there is a major question as to how
your skin might react to a peel, a test
area could be done in an area hidden by
hair. Color changes that result from the
treatment can be watched. The way your
skin heals can be observed. Anesthetic risks are a
possibility but no severe problems have
Improvement in the texture of the skin
can be anticipated after a chemical peel.
Unfortunately no guarantee, promises or
assurances can be given you as to the
Chemical peels are at one time simple but
complex. We expect that you might have
questions, and we strongly encourage you
to ask them.