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:
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]
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.
- Evidence and Considerations in the Application of Chemical Peels in Skin Disorders and Aesthetic Resurfacing (The Journal of Clinical and Aesthetic Dermatology)
- Chemical Peels for Face: Choosing the Right One (Real Self)
- Is a Chemical Peel Right for Me (ASPS)
- Chemical Peel Reviews (Real Self)
- The Peel Sessions (T Magazine NY Times Blog)
- Skin Resurfacing (MedScape)
- Chemical Peels and Your Skin (Web MD)
- After Glow (Allure)
- Peel Appeal (New You)