Deciding if chemical
peel is right for you
Chemical peel is most
commonly performed for
cosmetic reasons -- to
enhance your appearance
and your self
confidence. Chemical
peel may also remove
pre-cancerous skin
growths, soften acne
facial scars and even
control acne. In certain
cases, health insurance
may cover the peel
procedure. Be sure to
check your policy and
contact your insurance
company before the
procedure is performed.
Alphahydroxy acids (AHAs),
such as glycolic,
lactic, or fruit acids
are the mildest of the
peel formulas and
produce light peels.
These types of peels can
provide smoother,
brighter-looking skin
for people who can't
spare the time to
recover from a phenol or
TCA peel. AHA peels may
be used to treat fine
wrinkling, areas of
dryness, uneven
pigmentation and acne.
Various concentrations
of an AHA may be applied
weekly or at longer
intervals to obtain the
best result. Your doctor
will make this decision
during your consultation
and as the treatment
proceeds. An
alphahydroxy acid, such
as glycolic acid, can
also be mixed with a
facial wash or cream in
lesser concentrations as
part of a daily
skin-care regimen to
improve the skin's
texture.
Trichloroacetic acid (TCA)can
be used in many
concentrations, but it
is most commonly used
for medium-depth
peeling. Fine surface
wrinkles, superficial
blemishes and pigment
problems are commonly
treated with TCA. The
results of TCA peel are
usually less dramatic
than and not as
long-lasting as those of
a phenol peel. In fact,
more than one TCA peel
may be needed to achieve
the desired result. The
recovery from a TCA peel
is usually shorter than
with a phenol peel.
Phenol is the strongest
of the chemical
solutions and produces a
deep peel. It is used
mainly to treat patients
with coarse facial
wrinkles, areas of
blotchy or damaged skin
caused by sun exposure,
or pre-cancerous
growths. Since phenol
sometimes lightens the
treated areas, your skin
pigmentation may be a
determining factor as to
whether or not this is
an appropriate treatment
for you. Phenol is
primarily used on the
face; scarring may
result if it's applied
to the neck or other
body areas.
All chemical peels carry
some uncertainty and
risk Chemical peel is
normally a safe
procedure when it is
performed by a
qualified, experienced
plastic surgeon.
However, some
unpredictability and
risks such as infection
and scarring, while
infrequent, are
possible.
AHA peels may cause
stinging, redness,
irritation and crusting.
However, as the skin
adjusts to the treatment
regimen, these problems
will subside.
With a TCA peel, your
healed skin will be able
to produce pigment as
always; the peel will
not bleach the skin.
However, TCA-peel
patients are advised to
avoid sun exposure for
several months after
treatment to protect the
newly formed layers of
skin. Even though TCA is
milder than phenol, it
may also produce some
unintended color changes
in the skin.
With a phenol peel, the
new skin frequently
loses its ability to
make pigment (that is,
tan). This means that
not only will the skin
be lighter in color, but
you'll always have to
protect it from the sun.
Phenol may pose a
special risk for
patients with a history
of heart disease. It's
important that you make
your surgeon aware of
any heart problems when
your medical history is
taken.
It is also possible that
phenol will cause some
undesired cosmetic
results, such as uneven
pigment changes. Certain
modified phenol peels
are gentler and may be
preferred in some
circumstances.
Planning for a chemical
peel
In some states, no
medical degree is
required to perform a
chemical peel - even the
strongest phenol peels.
Many states have laws
that permit
non-physicians to
administer certain peel
solutions, but regulate
the strengths which they
are permitted to apply.
You should be warned
that phenol and TCA
peels have been offered
by inadequately trained
practitioners claiming
"miracle techniques" to
rejuvenate the skin.
It is very important
that you find a
physician who has
adequate training and
experience in skin
resurfacing. Your
plastic surgeon may
offer you a choice of
peel techniques or
suggest a combination of
peels to obtain the best
result for you.
During your initial
consultation, it is
important that you
discuss your
expectations with your
plastic surgeon. Don't
hesitate to ask any
questions or express any
concerns that you may
have. Expect your
plastic surgeon to
explain the planned
procedure in detail,
including its risks and
benefits, the recovery
period and the costs. If
you have a history of
herpes, you should
inform your physician
prior to the procedure.
Remember, chemical peel
treatments are usually
not covered by medical
insurance unless they
are performed for
medically related
problems.
Preparing for your
chemical peel
Your plastic surgeon
will instruct you on how
to prepare for your peel
treatment.
Sometimes Retin A - a
prescription medication
derived from Vitamin A -
is used to pre-treat the
skin. This thins out the
skin's surface layer,
allowing the TCA
solution to penetrate
more deeply and evenly.
If your skin won't
tolerate Retin-A
pre-treatment, an AHA
cream may be used
instead. Hydroquinone, a
bleaching agent, is
sometimes used in
conjunction with Retin-A
or AHA pre-treatment,
especially if you have
blotchy skin areas or
pigmentation problems.
You may have to spend a
month or more in the
pre-treatment phase
before the doctor will
schedule your actual
peel.
You will need to arrange
for someone to drive you
home and help you out
for a day or two if you
are having a phenol or
deeper TCA peel. You
probably won't need any
extra assistance if
you're having an AHA
peel or superficial TCA
peel.
Where your peel will be
performed
Most chemical peels may
be safely performed in a
plastic surgeon's
office, office-based
surgical facility or
outpatient surgical
center. Your plastic
surgeon may want you to
stay overnight in a
facility or hospital if
other cosmetic
procedures are performed
simultaneously.
Types of anesthesia
Anesthesia isn't
required for phenol or
TCA peels because the
chemical solution acts
as an anesthetic.
However, sedation may be
used before and during
the procedure to relax
you and keep you
comfortable.
No anesthesia is needed
for AHA peels since they
cause only a slight
stinging sensation
during application.
The peel
AHA peels/treatments:
Your doctor will apply
the AHA solution to your
cleansed facial skin, a
process that usually
takes no more than 10
minutes. No "after-peel"
ointment or covering is
required. Depending on
the strength of the
peel, periodic
treatments may be
necessary until the
desired effects are
achieved.
For some patients, the
application of an
AHA-based face wash or
cream once or twice a
day at home will be
sufficient to accomplish
the desired goal. Your
plastic surgeon may add
Retin-A or a bleaching
agent to your at-home
treatment schedule.
After several weeks of
at-home use, your doctor
will examine your skin
to determine if your
regimen needs
adjustment.
Phenol and TCA peels:
Typically, the skin is
first thoroughly
cleansed. Then, the
surgeon will carefully
apply the phenol or TCA
solution. You may feel a
stinging sensation as
the peel solution is
applied, but this
feeling will quickly
pass.
A full-face TCA peel
usually takes no more
than 15 minutes. Two or
more TCA peels may be
needed to obtain the
desired result, and
those may be spaced out
over several months.
Mild TCA peels may be
repeated as often as
every month.
If phenol solution has
been used, your plastic
surgeon may coat the
treated area with
petroleum jelly or a
waterproof adhesive
tape. With lighter
peels, no covering is
necessary.
A full-face phenol peel
generally takes one or
two hours to perform,
while a phenol peel to a
smaller facial region
(perhaps the skin above
the upper lip) may take
only 10 or 15 minutes. A
single treatment usually
suffices.
After your treatment
After an AHA peel, it is
common to experience
some temporary flaking
or scaling, redness and
dryness of the skin.
However, these
conditions will
disappear as the skin
adjusts to treatment.
After a phenol or TCA
peel, your doctor may
prescribe a mild pain
medication to relieve
any tingling or
throbbing you may feel.
If tape was used to
cover your face, it will
be removed after a day
or two. A crust or scab
will form on the treated
area. To help your face
heal properly, it is
essential that you
follow your doctor's
specific post-operative
instructions.
A TCA peel may also
cause significant
swelling, depending on
the strength of the peel
used.
If you've had a phenol
peel, your face may
become quite swollen.
Your eyes may even be
swollen shut
temporarily. You will
need someone to help
care for you for a day
or two. You may also be
limited to a liquid diet
and advised not to talk
very much during the
first few days of
recovery.
Getting back to
normal
With an AHA peel, the
temporary redness,
flaking and dryness that
you experience will not
prevent you from working
or engaging in your
normal activities. A
fresher and improved
skin texture will result
with continued AHA
treatments. Remember,
protecting your skin
from the sun is also
important following
these mild acid peels.
Ask your doctor to
recommend a sun block
with adequate UVA and
UVB protection and use
it every day.
With a TCA peel, the
moderate discomfort and
mild swelling you may
experience will subside
within the first week.
In about a week to ten
days, your new skin will
be apparent and you
should be healed
sufficiently to return
to your normal
activities. It is best
to avoid sun exposure
unless you are
adequately protected.
With a phenol peel, new
skin will begin to form
in about seven to ten
days. Your face will be
very red at first,
gradually fading to a
pinkish color over the
following weeks to
months. During this
time, it is especially
important that you use a
sun block or blotchy,
irregular skin coloring
may result.
About two weeks after
treatment you may return
to work and resume some
of your normal
activities. Your skin
will be healed enough
for you to wear makeup.
(For makeup tips, ask
your plastic surgeon for
the ASPRS brochure on
camouflage cosmetics.) |
