In a chemical peel, a chemical solution is applied to the skin and
allowed to soak in. Over the next 1 to 14 days, depending on how deeply the
chemical penetrated the skin, the skin peels off. This procedure destroys parts
of the skin in a controlled way so that new skin can grow in its place. The
chemicals used are sometimes called exfoliating or wounding agents.
The types of chemical peels differ based on how deeply the chemical
penetrates and what type of chemical solution is used. Things that may affect
the depth of a peel include the acid concentration in the peeling agent, the
number of coats that are applied, and the amount of time allowed before the
acid is neutralized. Deeper peels result in more dramatic effects as well as
higher risks, increased pain, and longer healing time. There are three basic
types of peels:
Your doctor can help you decide what depth of peel and what type
of chemical solution is most appropriate, based on your skin type, which areas
you want peeled, what kind of results you want, how much risk you are willing
to take, and other issues. A small "test spot" may be peeled to get a better
idea of the results, especially for people who have darker skin.
Two to three weeks before the peel, you will need to begin
preparing your skin by cleansing it twice a day, applying a special moisturizer
or cream once or twice a day, and using sunscreen every day. In some cases,
daily use of
tretinoin (Retin-A), a topical medicine usually used
to treat acne, is also recommended and may speed healing. This skin care
regimen will help the skin peel more evenly, speed healing after the peel, and
may reduce the chance of infection and other complications, especially uneven
color changes in the skin.
For medium and deep peels of the face, you may be given a short course of medicine (such as
acyclovir) to prevent viral infection. This is especially likely if you have had cold sores before and if the peel will be in the areas
near the mouth or eyes.
Right before the peel, the skin is cleaned. The chemical (usually
a liquid or paste) is then applied to the skin with a small brush, gauze, or
cotton-tipped applicators. The chemical is left on the skin for several minutes,
depending on the type of chemical used. Water or alcohol may be used to neutralize the
acid and end the chemical reaction, then it is wiped off. You may feel a little
burning while the chemical is on your skin. A handheld fan can help cool the
skin and relieve any discomfort.
The technique used to do a medium peel is similar to that used
for a superficial peel, but the chemical may be left on for a longer period of
time. Medium peels are more painful than superficial peels, because the
chemicals are stronger and they soak deeper into the skin. You may be given a
pain reliever and an oral
sedative to reduce pain and anxiety during the
procedure. Cool compresses and fans can be used to cool the stinging and
burning caused by the chemical. The procedure takes about 40 minutes. There is
little or no pain after the peel is finished.
Deep peels take the most time and are the most painful type of
chemical peel. The procedure for a deep peel using phenol is also more
complicated than for other types of peels.
Depending on how large an area is being treated, the entire
procedure may take 60 to 90 minutes.
Recovery time after a chemical peel depends on what kind of peel
was done and how deep it was. With all types of peels, proper care of the skin
after the peel is very important to speed healing, help results last longer,
prevent infection, and avoid color changes in the treated area caused by sun
exposure. Proper skin care after a peel is very similar to the care used to
prepare for a peel and typically involves:
Some doctors may also recommend using tretinoin cream nightly,
usually starting 2 to 3 weeks after the peel.
Superficial peels are done on an outpatient basis, do not require
anesthesia, and cause only slight discomfort afterwards. Most people can return
to their normal activities immediately. The skin heals quickly after a
superficial peel. The skin may turn pink, and usually only minimal peeling
occurs. You can use makeup to hide any redness until it fades.
Medium peels are usually done on an outpatient basis, but you may
need to take a few days off work to recover. A medium peel causes a
second-degree burn of the skin. The skin takes 5 to 7 days to heal to a point
where you can use makeup to hide the redness caused by the peel. There is
little or no pain after the peel, but there may be some swelling, especially if
the area around the eyes is treated. The skin will turn reddish brown in 2 to 3
days, become crusty, and then flake and peel over the next few days.
A deep peel causes a deeper second-degree burn of the skin. Skin
regrowth takes between 10 to 14 days after a deep peel. The skin remains
extremely red for 3 weeks, up to 2 months for some people. Most people take about 2 weeks off from
work. Complete healing of the skin may take several months.
Chemical peels are sometimes done with dermabrasion or laser
resurfacing for a more dramatic overall effect.
A chemical peel (except for a superficial peel) may not be done if
The results of a chemical peel depend in part on the depth of the
Your skin type, skin care before and after the peel, the doctor's
level of experience, and your lifestyle after the procedure can also affect the
results. Some types of skin problems respond better to chemical peeling than
others. People with lighter skin who limit their sun exposure after the
procedure tend to have better results than those who have darker skin and those who
continue to spend lots of time in the sun.
Before you decide to have a chemical peel, talk to your doctor
about the kind of results you can expect.
Changes in the color and texture of the skin caused by aging and
sun exposure may continue to develop after a chemical peel. Chemical peels are
not a permanent solution for these problems.
In general, the deeper the peel, the greater the risk of side
effects and complications.1 Chemical peels can result
In rare cases, deep peels using phenol can cause more severe
complications during the procedure, including heart, liver, or kidney
Chemical peels are designed to wound and remove the upper layers
of the skin. You need to prepare yourself for how your skin will look
immediately after the peel and throughout the healing process. You also need to
be prepared to use cosmetics to blend skin tones between treated and untreated
areas, such as between the face and jawline.
It is important that your doctor understands what you hope to
achieve and that you understand what results you can realistically expect. Even
with realistic expectations, you may not see results for several weeks or
months after a chemical peel.
During the early healing period after a chemical peel (before the
skin has finished peeling), you will need to avoid sun exposure. After the early
healing period has passed, you will need to wear sunscreen every day and limit
sun exposure as much as possible. New skin is more susceptible to damage and
discoloration from sunlight.
Chemical peel, dermabrasion, and laser resurfacing are the most
commonly used techniques for improving the texture and appearance of the skin.
Although these techniques use different methods, they have basically the same
effect on the skin—they destroy and remove the upper layers of skin to allow
for skin regrowth.
No one technique is necessarily better than the others. When
done by an experienced surgeon, laser resurfacing may be slightly more
precise than chemical peeling or dermabrasion. But the choice of technique
is based on the site you want to treat, your skin type and condition, the
doctor's experience, your preferences, and other things. Some people may get
the best results using a combination of techniques.
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CitationsTanzi EL, Alster TS (2008). Skin resurfacing: Ablative
lasers, chemical peels, and dermabrasion. In K Wolff et al., eds.,
Fitzpatrick's Dermatology in General Medicine, 7th ed.,
vol. 2, pp. 2364–2371. New York: McGraw-Hill Medical.
July 31, 2012
Anne C. Poinier, MD - Internal Medicine & Keith A. Denkler, MD - Plastic Surgery
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