What are chemical peels and are they safe?

                      Question: What are chemical peels and are they safe?

Answer: Say "chemical peel" and many of us imagine Samantha's horribly botched one on Sex and the City, but things have changed at the derm's office since the '90s. Now, you can get a peel on your lunch break and go right back to work looking better and brighter, bypassing the red, flaky, irritated stage altogether. So what gives? According to Dr. Carlos A. Charles, founder and medical director of Derma di Colore in New York City, it's not that the chemical peels themselves have changed so much as doctors' approach. "Most dermatologists tend to avoid performing the deeper peels to minimize the associated high risk of complications," he says. The alternative is superficial peels—the kind you get on your lunch break that leave no tell-tale evidence behind. They are in fact true chemical peels, says Charles, but they take longer to show results—about five monthly treatments along with the use of a strong topical retinoid in between sessions. Here's what you need to know:

                  What defines a chemical peel?

Chemical peels are substances used for the treatment of a variety of skin conditions including but not limited to sun damage or photo-aging, fine lines and wrinkles, superficial scarring, acne, and some pre-cancerous lesions. Additionally, they can help to minimize discoloration resulting from any skin insult commonly known as post-inflammatory hyperpigmentation or from melasma and they work by producing limited and controlled injury to the skin, thereby promoting the growth of new skin with an improved appearance.

  What's the difference between the superficial peel and the                      deeper ones we associate with extreme redness & shedding?

Superficial peels, which primarily target the very top layers of the epidermis of the skin, are most commonly composed of glycoloic or salicylic acids in various concentrations.

Medium depth peels are most commonly made up of Trichloracetic acid or TCA at varying concentrations, usually 20 to 35%. Medium depth peels also can consist of combination agents such as the Jessner's solution, which consists of 70% glycolic acid, and solid carbon dioxide with 35% TCA. The advantages of this combination medium depth peel is that one can achieve greater penetration with modest concentrations of the TCA, thereby avoiding potentially adverse reactions. Medium depth peels target the deeper layer of the epidermis and the superficial dermis of the skin. With this increased penetration, these peels can result in an impressive improvement in skin texture with a reduction in pigmentation, freckling and some pre-skin cancers known as actinic keratosis. Although fine wrinkles and some acne scars may become less obvious with medium strength peels, they do not improve upon deep wrinkles and furrows.

Deep peels are typically made up of an ingredient known as phenol. Phenols produce injury within the deeper layers of the skin or the dermis. These stronger peels can treat moderate to severe photo-aging and wrinkles. While deep peels can potentially offer the greatest level of improvement, they also require long recovery times and carry the greatest risk of complication such as scarring and hyperpigmentation. 

                  Are they safe?

Yes. However, as with all things in medicine, they must be performed by a trained and experienced professional. There are many factors that have to be taken into consideration when performing chemical peels, including but not limited to: baseline skin pigmentation, the concomitant use of topical agents, potential for skin irritation, active skin conditions, and the propensity for scarring. Those with more darkly pigmented skin generally should only receive superficial peels or very mild medium strength peels with proper supervision and preparation.

                  What's the difference between in-office peels                                                 and at-home versions?

The main difference lies in the concentrations of each. Since in-office peels are performed in a controlled setting under the guidance of a medical professional, they can be performed at stronger concentrations for better results. Additionally, in-office peels can be performed in tandem with prescription strength topical agents for added efficacy of the peel.

                  Who should get peels and how often?

Anyone that is looking for modest correction of hyperpigmentation, sun damage, fine lines and for diminution of the appearance of pores. Additionally, peels containing salicylic acid can offer improvement to those with acne prone skin, particularly when used along with topical agents. Generally, peels are performed every 3-4 weeks with an average of about 5 treatments.

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