Dermatology

That Peelin’ Feeling: Chemical Peels 101

chemical peels 101

North of 40, my face is well acquainted with fine lines, sun splotches with a touch of melasma and under eye crepiness.  I’ve tried a little of this, a lot of that, but thru the years the treatment that has made a huge difference in my skin has been medical grade chemical peels.

My sweet spot is a carefully curated rotation of superficial and a medium depth peels, orchestrated by my cosmetic dermatologist every 6 to 8 weeks.   After 3 to 10 days of manageable peeling, I emerge triumphant with brighter, tighter, daisy fresh skin and my irksome sun spots put in their place. I feel like I’m getting close to the anti-aging big guns for a fraction of the cost.

A lot of women like me love chemical peels because they’re the gateway drug to the more aggressive procedures, but they’re still serious business.  Not all peels are created equal and knowing what you’re getting can be confusing, so I want to spare you the lessons I learned the hard way:

1. Start by seeing a board certified cosmetic dermatologist.

Here’s why; only your derm can tell the difference between a sun spot, a freckle, melasma or something more sinister, like skin cancer.  They’ll evaluate your Fitzpatrick skin type, ethnic background and lifestyle to see if a chemical peel is truly what you need.  For example, if you’re a surfer girl and not willing to sit out the waves for a while, a chemical peel may backfire on you, making even more vulnerable to sun damage.  Likewise, if you’re Latin American or Hispanic, some peels can actually cause hypopigmentation (lightening of certain spots on the skin).

Another reason for being under a doctor’s supervision is that most states only allow aestheticians to use low doses of acid between 20 to 40 percent, and TCA peels up to 35 percent.

Once your doctor finds the ideal combination of peel strength and frequency, the application may be done by a nurse practitioner, physician’s assistant or licensed aesthetician.  Regardless of who applies the peel, make sure they have at least 5 years of experience with chemical peels because there is an art in knowing how long to leave the peel on and in which spots they need to go deeper.

And please, please, please never attempt to order professional grade peels off the internet and DIY.  You will wind up looking like the Toxic Avenger.

2. Understand what strength of chemical peel your doctor is recommending.    

There’s a lot of curiosity about the acids used in peels, but the reality is chemical peels are a combination of art and science.  Your doctor will customize a chemical cocktail that is highly variable depending on your skin type, condition and problem.

It’s fine to ask about the acids use, but more important to understand the strength of the peel because this impacts your lifestyle afterwards.  For instance, if you’re getting a peel on Wednesday and you have a big event on Saturday, you’ll want to avoid a stronger peel unless you count face dandruff as an accessory.  Conversely, you don’t want to have a beach vacation scheduled a month after a medium depth peel.

Lets break down the differences:

Superficial peels

Otherwise known as “lunchtime” peels, these  work by speeding up the renewal process on the top layer of the skin (epidermis).

The ingredients most commonly used include alpha hydroxyl acids (glycolic, lactic, citric, malic and tartaric acid) and beta hydroxyl acids such as salicylic acid which goes a little deeper into the skin for better acne control and stronger exfoliation. Occasionally, a low strength of TCA (trichloroacetic acid) may be mixed in as well as retinioic acid.

On the upside, superficial peels provide instant gratification in the form of a luminous complexion with little, if any downtime aside from a few days of tight, dry skin. They treat dry skin, soften fine lines, fade mild hyperpigmentation and acne spots and tend to be the safer choice for most skin types. That said, you usually need a series and they don’t have the same long-term anti-aging impact of a stronger peel. My favorites are the Vitalize Peel and Bx-Lift.[/box]

Medium depth peels

Medium depth peels work a little differently in that they penetrate more deeply, getting to the border or the dermis to remove the top few layers of the skin where many blemishes, sun spots and imperfections live.

Medium peels create a deliberate “wound” (think sunburn) that allows the new skin to come thru, but all this hard work your skin’s doing requires at some downtime from you.But the benefits are worth it. Medium depth peels do everything a superficial peel does, but is more effective at treating sun damage and because it goes deeper into the dermis, is more effective at stimulating collagen to tighten the skin.

The most common acid used is TCA (trichloroacetic acid), usually in concentrations of 25-35%, and sometimes in combination with glycolic acid. Concentrations can go as high as 50%, but that comes with a higher risk of scarring, and anything over 35% must be applied by a doctor.

Personally, I do 2 to 3 medium depth peels a year between October and March when the sun is much weaker. I always leave the decision up to my doctor and his aesthetician about which ones to use, but my favorites are TCA 35% with glycolic, Revitalize and I just tried the Vi Peel (still recovering)[/box]

Deep peels

Lastly, there are the deep peels (otherwise known as phenol) made from carbolic acid, which treat deep wrinkles and severe sun damage.

While effective, deep peels require sedation and come with the risks of dramatically lighter skin (hypopigmentation) and that dreaded demarcation between the face and neck. Plus, at least two weeks of downtime is required (meaning you might scare the pizza delivery guy if you answer the door).

Deep peels have largely been replaced by the newer lasers, that provide the same benefits of treating deep wrinkles and severe sun damage without the risks. [/box]

3. Adjust your skin care routine before, during and after your peel. 

Your doctor’s office should be doling out instructions the moment you make your peel appointment.  As a rule of thumb, I avoid retinol and waxing one week prior to my peel.   Also, if you’re prone to fever blisters talk to your doctor about a prescription for an anti-viral medication to prevent an outbreak.

Equally important is making sure your skin care routine is set up to help the “wound” heal immediately after, especially with the stronger peels.  This means stocking up on very gentle cleansers, like Cetaphil, putting your Clarsonic on the shelf for at least we week and moisturizing with only highly emollient moisturizers like Aquaphor or CerAve.  Avoid all your serums, acids and anything exfoliating for at least a week.  If you go outside, sun screen, sunscreen, sunscreen!

After your skin has peeled and healed, slowly introduce the stronger stuff back, but continue to avoid retinol and waxing for two weeks.

4. You must become a sun screen nazi.   I always bring a wide brimmed hat and dark sunglasses to my appointment even though they apply an ample dose of sunscreen before I leave.  More importantly though is avoiding the sun during the week or two you’re peeling, and if you must go outside, grab your wide brimmed hat and apply more sunscreen, not just the moisturizer with the sunscreen baked it.  This is because your skin is so vulnerable while it’s peeling that it can actually make sun damage worse.

Better yet, I like Dr. Irwin’s recommendation to double sunscreen for several weeks following.  This means applying your regular sunscreen, but then topping it off with a mineral power sunscreen on top of your make up.   And this goes for running errands or taking a walk outside, not just laying on a beach.  Which brings me to…

5. …never schedule a medium depth peel less than 6 weeks before a sunny beach vacation – or a sunny, snowy one.   Did you know that even extreme temperatures – hot and cold – can cause hyperpigmentation with healing skin?  So even if you have your wide brimmed hat and double sun screen, it it’s very hot you might be fighting an uphill battle.  This also goes for saunas and steam rooms.  Avoid for at least a month.  But here’s the good news is …

6. …you have an excuse not to exercise, at least for 48 hours.  Most doctors’ recommend laying off the sweaty cardio sessions for 48 hours, especially you have the type of peel you need to rinse off later at home.  In addition, avoid swimming pools while you’re healing as the chlorine can be too drying.

7. Do not pick at your peeling skin!  It’s exciting when your skin starts to peel, which will usually begin around the mouth/nose/chin area around day 3, and spread outward over several days.  But, whatever you do, don’t be tempted to grab a piece of flake and drag it off.  Trust me even if you think there’s no damage, may see a mark later.   The best way to help your skin heal is to gently pat with a towel after you’ve washed your face, and apply a think coating of ointment.

8. With a stronger peel, you may look mangy, so plan a long weekend where you don’t have to be outside or see people who don’t love you.  All of this depends on the strength of the peel of course, but even with light peels, where the peeling is more microscopic, there can be a few days of tight, dry feeling skin although you’re usually presentable to the human race.  With stronger peels though, you will look red, you might be swollen and when the peeling starts, you’ve got a face dandruff blizzard for a few days.

9. But if you don’t peel, that doesn’t mean the peel wasn’t effective.

This happens more with the lighter peels, but even when I don’t experience visible peeling, there is microscopic peeling happening.  For instance, you might rub your forehead and notice some pilling of the skin roll off the surface, especially if you’re well moisturized.  Don’t worry, it’s still working!

10. Peels work best in a series of alternating types, but be careful not to over-peel!

Your doctor will recommend the right type of schedule, and may recommend medium depth only a few times a year (I get mine during the winter to avoid sun), but mix it up with a variety of different superficial peels in between.  It’s also important that the peel types get alternated once you’ve been a veteran peel so your skin doesn’t build up a tolerance.

Most importantly, don’t over peel or you can thin out the skin, making you look waxy and removing the protective barrier.   Chemical peels can be complemented with microdermabrasion, retinol and lasers, but let your doctor, nurse or aesthetician coordinate your skin care and be honest about what you use at home.

Sources

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26 Comments

  • Reply
    fairytalesandcoffee
    February 15, 2013 at 11:46 AM

    this was helpful. I love peels but have only done the superficial ones at derms, which was highway robbery for what I could do at home. I am very afraid of the medium/deep ones. Although, I have accidently given myself light-medium depth peels with my over aggressive use of prescription retinoids and strong glycolic acid lotions. Woke up one morning with deeply browned/black quarter-zise spot on my lower chin and had to walk around avoiding people and using my hand as cover. Fortunately, this was in grad school. However, when it fell off my skin was flawless. Tazorac is pretty effective on my skin for the snake shed effect. But deep frying my skin with lasers or phenol – not going to happen.

    • Reply
      narcissista1
      February 15, 2013 at 9:18 PM

      Careful doing this stuff home. There are some real horror stories about DIY peels gone wrong. I know it’s tempting to try to get it this stuff on line, but I consider the price I’m paying at their doctor as an insurance premium. I also didn’t know until I researched this piece that they will often tailor the peel spot per spot and keep different acids on for varying amounts of time.

      • Reply
        fairytalesandcoffee
        February 17, 2013 at 11:33 PM

        Oh, no totally hear you on that. I was just mentioning that I am so hardcore with my Rx retinoids, glycolic acid facial washes and glycolic acid otc peeling lotions that I got the effect of a peel unintentionally. That’s when I realized I had to be careful.

        • Reply
          narcissista1
          February 19, 2013 at 8:43 AM

          Phew! I was worried because you mentioned you had some hyperpigmentation like I do, and that’s where the acids can get especially squirrly in the wrong hands.

  • Reply
    Review: The Vi Peel Revealed - NARCISSISTA.ME | NARCISSISTA.ME
    February 25, 2013 at 9:33 AM

    […] this month, I shared my love of chemical peels and how they’ve made a real difference in my skin from an anti-aging perspective.  Thru the […]

  • Reply
    Edyta
    June 28, 2013 at 11:42 AM

    Thank you so this. Everyone needs to know these 10 things before having any type of chemical peel done, in my opinion. I have had a vitalize peel done 1 time and was very happy with the results, but the medical Aesthetician did not inform me of not using retinol based creams prior or post, nor did she mention the need for taking anti viral medication if you are prone to fever blisters. If I hadn’t researched by myself prior to my visit, I probably wouldn’t have been very happy with the results. It has been a huge problem for me to find someone I can trust with my skin in Jax, FL. Anyway, thank you.

    • Reply
      narcissista1
      June 29, 2013 at 7:56 AM

      Ugh…it drives me NUTS when patients aren’t told about stuff like that, and it’s so easy to just say do this not that. Glad you liked your Vi peel though:)

      Becca

  • Reply
    janine
    September 9, 2013 at 4:02 PM

    I am wondering how you feel about lasers compared to peels? I have stayed away from peels because, like fairytalesandcoffee, I indulge in a fairly heavy, regular regimen of Tazorac and pull out the ol’ .01 percent (I own 3 different strengths of the stuff) when I want a good peeling effect. So, my personal in-office treatment every 6-8 weeks is a BBL photorejeuvanation treatment which I love. Yet, I am still intrigued by the peels, especially the VI peel which my esthetician just started offering. But I think my personal feeling is that a peel does not give the deep down kick-start-the-collagen-boosters effect I crave.
    Also, I am wondering if you include any AHA’s in your daily skincare regimen or do you forgo those for your in-office peels?

    • Reply
      narcissista1
      September 10, 2013 at 9:53 AM

      Great question – lasers vs. peels. In fact, I’m researching the trade-offs now for a post in October. I think it all depends on your skin type as both lasers and peels can be wrong for some skin types. It also dependson your goals. Personally, I’ve had more consistent results with superficial peels in terms of controlling my melasma, brown spots and general brightening/tightening of the skin. My favorite is the Bx Lift. So far lasers have been expensive and tricky. I had the Aurora in ’09. Brown spots left, but came back after a few years. In 2011 I had the Fraxel 1927 and was one of those lucky melasma patients who got more melasma after my treatment. However, I may be trying a new laser treatment in September to see if this works. By the way, what does BBL stand for (I’m assuming it’s not Brazilian Butt Lift).

      • Reply
        janine
        September 10, 2013 at 11:26 AM

        Ha, I WISH it stood for Brazilian Butt Lift…….actually, it stands for Broad Band Light and differs from the Intense Pulsed Light (IPL) treatments in that the beam has a broader ranger rather than a singular direction. It feels more uncomfortable than the IPL and tends to really take care of a lot of discoloration, not just capillaries. Plus it makes my pores look super small and delicious! I also had the Fraxel (series of 6) about a year and half ago and find this particular BBL laser to be great maintenance. Also should mention that I have persistent red marks from acne and it seems that peels never have that much of an impact on those. But again, I am not participating in a regular regimen of those so who knows…..
        BTW – just discovered your blog a few days ago and really enjoy it a lot. Thanks for all of it.

        • Reply
          narcissista1
          September 10, 2013 at 9:38 PM

          Thanks for the compliment and the enlightenment on BBL vs IPL. I had no idea, but yet another reason why there needs to be more clarity around lasers. Very confusing to say the least.

  • Reply
    Lena
    October 12, 2013 at 3:19 AM

    Good article, but There are some things you need to know when it comes to chemical peels. They are a cheap way to get rid of sun spots, give your skin a fresh look and fight melasma. However, be wary that if your skin is naturally dark light spots, or hyper-pigmentation, may occure. A licensed dermatologist should always perform chemical peels. They can determine the strength that is needed for a customized look and give you the best results.

    • Reply
      narcissista1
      October 12, 2013 at 11:41 AM

      Thanks for the builds Lena. Frankly, chemical peels are one of my favorite treatments for my skin, because I have melasma and brown spots. Thanks for pointing out they’re not for all skin types though, that is where one can get into trouble, especially if you’re not in the right hands.

  • Reply
    Sdg
    October 31, 2013 at 10:46 AM

    I just got back from a sunny vacation and have been thinking about getting a chemical peel.How long should I wait before getting one done?

  • Reply
    Mabel Rodriguez
    December 1, 2013 at 1:15 PM

    I am 40 year old Latina with Melasma and sun spots over my eyebrows and upper lip. I tried all the creams that promise to help with dark spots. They all failed. I finally went to a dermatologist and she recommended a chemical peel. This is my third peel. She used Perfect Peel 10. This procedure was harsh on my skin. My face was RED and swollen. My face Looked burned. I had to use Hydrocortisol cream. The peeling starts 3-4 days after treatment. I have seen dramatic improvement. Some sun spots are gone. Others are almost unnoticable. I wear sunscreen every day. I highly recommend this procedure to be performed by a doctor.

    • Reply
      narcissista1
      December 30, 2013 at 8:03 AM

      Thanks for sharing your story Mabel and reinforcing seeing a doctor for treatment. Good to know about the Perfect Peel 10, I’ll ask my doctor about it. When did you have it done? Have you done thru a summer season with it yet? I’ve heard it’s tough to keep melasma at bay during the summer.

      It is TOUGH treating ethnic skin with melasma (I have a story about this coming out in January) and have suffered from it myself ever since I had my son 10 years ago.

  • Reply
    eva
    December 9, 2013 at 1:36 AM

    ive done light peels at home and built on to medium deep peels and ive been fine. Nothing wrong with it if your an adult and know what you are doing. so when u say don’t don’t order off the internet, theres nothing wrong with it. ive had a good experience sorry.

    • Reply
      Nikki
      December 29, 2013 at 10:28 AM

      I agree with this. Nothing wrong with getting peels online IF you do your research. Some people want instant gratification and are upset if one 30% glycolic peel doesn’t give immediate results or others just jump right into a 30% TCA peel and wonder why their face is burned.

      If you have the patience you can save hundreds of dollars. A 6-series glycolic acid peel would cost me over $200. I can buy peel kits online for $60 (enough for 15 peels) and do them myself at home. It only takes 30 minutes.

      I was very cautious, started out low and did a spot test before trying a different peel. I began with several light peels to build tolerance for a step up to medium peels. My skin never looked better.

      • Reply
        narcissista1
        December 30, 2013 at 7:17 AM

        Peels are one of those things that seem easy but can go wrong quickly. The biggest issue begins with not have a clear sense of your skin and what you’re treating, especially since with ethnic skin (black, Asian, Indian, Mediterranean, Latin) where the risk of discoloration is huge. I understand the temptation – believe me I’ve thought about it myself – but I’ve made enough mistakes to know better by now:) If you can’t resist the temptation of getting peels online, then at least go to your derm once, get a diagnosis of what your Fitzpatrick skin type is, the best way to treat it and be honest that you want to get peels online. They will claim “no responsibility” of course, but will likely tell you what type and what strength to be safe.

  • Reply
    dani
    June 8, 2015 at 10:02 PM

    Hi!! I am thinking of having a medium depth peel , but I am not sure how many days I will have to avoid work…What do you think?

  • Reply
    Lani
    October 20, 2015 at 7:28 PM

    I got a TCA 20% peel at the dermatologists office 8 days ago. My skin is still peeling. When I put on Cerave cream to moisturize and mineral sunscreen, it won’t blend in so my face is white with cream and sunscreen. Also, I don’t want to disturb the peeling skin by rubbing it in, so I pat it on. After I wash my face with Cetaphil cleanser, the moisturizer does not come off. My face is a constantly white with peeling skin hanging off of it. I can’t find any advise online about this and do not know how others manage it.

  • Reply
    Bridgett
    January 28, 2016 at 8:56 AM

    Great article! After years of going to a medical spa, I do mine at home; with a lot of caution. Before I started I watched many UTube videos, some helpful, others not so much. As I type, I am now peeling from one I did three days ago. I bought Glycolic Acid 50% – yes you read that right online. This is a very STRONG acid, use complete caution and read the instructions! Always dilute with water and try a small spot like on your hand before applying to your face to get used to the sensation. I use 1/2 teaspoon of the acid to 2 half teaspoons of water in a small bowl. Before I apply to my face, I coat my eyes with a thin layer of vaseline (in case it drips) along with my nostrils and lips. Basically, cover all wet membranes on your face with a layer of vaseline before applying. I then mix 1/4 cup of baking soda (the neutralizer) with water to make a paste and set aside. I like to have everything done before the peel, because timing is everything. Now I am ready to apply; I apply with a brush specially for this acid in long stokes. This mixture is very runny, use caution to make sure it does not drip anywhere on your face, even though your membranes are covered! I then allow it to stay on my face for 2 minutes all the while fanning it. I also double check my baking soda water mixture to make sure it is ready to apply. My skin is mildly “burning” during this and I can feel the sensation. When done I use the baking soda mixture on my face; NEVER WATER – it will reactivate the acid! I apply a very thick coating and allow it to dry (about 20 minutes.) When there is no sensation on skin, I rinse off and apply moisturizer, I use Neutrogena. In a few days my skin starts to peel and i then use a thin layer of vaseline, never picking at it or peeling myself. Two weeks after my skin looks great. I only use chemical peels in the winter months because of the lack of sun; I would never use in the seasons when the sun is bright. I do this monthly from Dec-March and it makes a huge difference in my skin. If you plan on doing this at home, use complete CAUTION, this acid is no joke!!

    • Reply
      Becca
      January 29, 2016 at 7:45 AM

      Wow Bridgett, you seem like a master chemist!! I want to underscore the point you made about how this stuff is no joke; most probably shouldn’t do this at home until they’ve had some experience (like you’ve had) with peels done professionally. Glad you pointed out the sensitive areas like the mucous membranes – that’s where the peels can really do serious damage. Are there any YouTube vides you would recommend on the subject?

  • Reply
    AJ
    September 30, 2016 at 5:26 PM

    Hi! I’m SELLING my 2 remaining sessions (package) of Easy Peel at Flawless SM North for only 6k (save 1k)! NEGOTIABLE. 🙂 Can’t use them anymore because I’m on isotretinoin now. I have to say the results of Easy Peel on me was very good. 🙂 If you’re interested, you can send me a PM at https://web.facebook.com/aj.gutierrez.56 or call/txt 09309947157. Thanks! 🙂

  • Reply
    Shiree
    October 25, 2016 at 1:17 PM

    This post was very helpful, thank you. My sister in law is a PA and she did The Perfect Peel on me the day before a big international trip. I had questions and as unable to get hold of her. As you said in your post, the lower half of my face around my chin and mouth peeled deeper and quicker and left me concerned that the upper half would remain crunchy and crinkly looking. Thanks to your article I’m reassured the upper half will continue to peel and look as beautiful, pink and fresh as the lower half. I’m going through an unwanted divorce and the peel and nasolabial Juvederm she did for me have visibly reversed most if not all the aging
    I did this year.

  • Reply
    toby
    November 20, 2016 at 7:14 PM

    While its not a peel, the Tangerine Tingle (from CItrus Clear) works just like a peel, you just have to LEAVE IT ON FOR 5 MINUTES. Its starts to tingle, and that is the glycolic acid working. Once you wash it off, its like having a professional $100 glycolic peel. Highly recommended.

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