| Dr. Aaron Stone, MD is a plastic surgeon certified by the American Board of Plastic Surgery. Here the Doctor has answered some of the common questions Bizymoms visitors have about Chemical Peels
Q. How does Chemical peels help reduce the appearance of facial folds, wrinkles and crow’s feet?
A. Chemical peels involve the application of a chemical, usually some type of liquid acid, to the skin surface to perform a controlled removal/destruction of specific layers of the skin. When this controlled wound of the skin surface heals surface irregularities or wrinkles are smoothed out and irregular skin pigmentation is evened out so it is no longer blotchy. The facial appearance is then more youthful and less lined. The peel can be deep or more superficial depending on the depth of the layers of skin affected. Different chemicals applied for different lengths of time will yield different depths of peeling. Deeper peels have also been used to treat acne scarring. In the mid-1990s with the introduction of ablative lasers that allowed physicians much more control over the depth of skin injury, the number of peels performed decreased.
Q. What determines the best type of chemical peel suitable for individual clients?
A. Prior to applying a chemical peel the physician has to first assess what specific problems need to be addressed such as dynamic aging lines of the cheek or sun damage, then decide what skin type the patient has and then assess the skin oil content. All of these affect the results from chemical peeling and the risk of complications after peeling. The Fitzpatrick classification system (skin type) is widely accepted to describe skin pigmentation and the potential for sunburn or tanning. A patient's Fitzpatrick classification suggests his or her sensitivity to some skin care products and peeling agents and the subsequent risk for increased pigmentation. Fair skinned Fitzpatrick I to III tan or burn with sun exposure and are better candidates for chemical peeling. Olive or dark skinned Fitzpatrick V and VI, never tan or burn and are at high risk of problems after chemical peeling. Additionally the skin is usually prepared for chemical peeling by the application of Retin-A and temporary bleaches prior to peeling in order to speed recovery and decrease the risk of complications.
There are a number of acids available including citric, Azelaic, Kojic, lactic, glycolic, tricarboxylic (TCA), salicylic. Cleopatra bathed in soured goat's milk and therefore exposed her skin to lactic acid. Over the counter preparations are generally less than 5% solutions. In doctors' offices the peels are stronger, more than 8% and as high as 50% TCA. Some are called alpha hydroxy acids because of their common chemical structure. Some may be combined such as kojic with glycolic in treating pigment issues.
TCA is widely viewed as the gold standard of chemical peeling. The acid concentration, skin type, skin preparation, pretreatment, and method of application all contribute to the peel depth obtained by TCA.
The Obagi blue peel is a TCA additive with the intention of increasing control during a superficial peel. An extract from the plant saponin and glycerin are added to ensure even application and penetration of the TCA. FDC blue no.1 is also added, which allows another indicator of an peel depth. A progressive number of layers of the solution (either 15% or 20%) are used to increase the depth of the peel. Frost characteristics are used to monitor the peel depth.
In applying the peels a weaker solution is frequently applied around the edges of the peeled area to make the line between peeled and non-peeled skin less obvious.
Q. Who are the best candidates for Chemical peels treatment?
A. As mentioned above fair skinned individuals are the best candidates. Asians and Afro-Americans are more difficult and I personally will not apply chemical peels to these groups. Some doctors do so with good results and others with not so good results. Red haired freckle faced individuals are not good candidates because the peel removes freckles and can leave the patient with an unsightly white demarcated area surrounded by freckled areas.
Q. How effective are the results of Chemical peels? Are the results permanent?
A. Chemical peels are effective when the right chemical is chosen for the right patient and applied by the right doctor. As you can surmise not every doctor is experienced with every peel. My own clinical experience is mostly with TCA, salicylic and glycolic.
All chemical peels make the skin more sensitive to sun exposure with respect to sun burn and sun induced skin cancers. Therefore the use of sunscreen is imperative after chemical peels.
Q. What is the Glycolic peel?
A. Glycolic acid is the most popular alpha hydroxy acid. Unlike other acids the depth is time dependent so by applying a neutralizing agent a specific amount of time after application the doctor has more control over the depth of the peel. Glycolic acid peels produce the least profound results but also are associated with the lowest frequency of complications. it is therefore the most common ingredient in peels available over the counter.
Q. Are multiple sessions required for Glycolic peel treatment?
A. The number of sessions required depends on what is being treated, the severity of the skin condition, the percent strength of the glycolic acid solution and the length of time it is applied before being neutralized. |
