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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