This procedure is performed at our Gheringhap St., Geelong Clinic
ABOUT CHEMICAL PEELS
A chemical peel is a solution applied to your skin to remove dead skin cells and stimulate new cell growth to create a more vibrant, rejuvenated skin. The removal of the top layers of skin helps to induce protein remodelling and therefore improve sun-damaged skin, pigmentation problems, wrinkles, skin texture and the overall appearance; leaving skin tighter and lighter. Chemical peels are suitable for women and men of almost any age with different peels formulated for different skin conditions. Chemical peels are a method of regenerating and resurfacing the skin by inducing a controlled wound. The strength of the chemical peel will determine its depth. Deeper peels will result in a greater improvement in the skin will but take longer to recover from. A deep peel may not always be necessary or appropriate.
FREQUENTLY ASKED QUESTIONS
At Body Recon we have several types of chemical peels, each suited to different skin problems and types. Chemical peels also vary in strength and are classified as superficial, medium and deep according to the level of skin they reach. Our peels fall into two categories:
Clinic Peels– Performed at Body Recon Cosmetic Clinic. These peels are medical strength, nontraumatic peels ranging from light rejuvenating treatments to medium depth corrective peels. We have over 20 different in-clinic peels and the peeling solution varies depending on what we are treating. These can be performed as a one-off treatment but best results are achieved when delivered in a series. AHA’s and BHA’s (superficial) and Vitamin A (medium) are the main agents we use for our clinic peels. These peels are often quite relaxing to have done and include a light massage. Allow us to create a treatment plan for you with our clinic peels.
Surgical Peels– Performed by Dr. Richard Rahdon either in conjunction with surgery or at Body Recon Cosmetic Clinic. TCA (Trichloroacetic acid) 35% is the preferred peeling agent and usually this type of peel is reserved for a deep penetration. At these concentrations, TCA peels can help with skin texture, wrinkles and pigmentation. TCA may be a cost effective alternative to laser resurfacing and is usually a one-off treatment. Pigmentation is visibly improved as soon as flaking ceases, however patience is required to see the full results of a TCA peel. It takes six months for the skin to produce new protein, resulting in improved texture and tone of the skin. TCA is not performed during the warmer months.
Alpha-hydroxy acid (AHA) peels – Lactic acid is a naturally occurring acid in the body. These peels can be performed at various concentrations to vary the strength of the peel. Their main role is to remove the top layers of the skin and induce new protein formation. Lactic can also be great for helping to hydrate and plump the skin and is ideal for prepping for fractionated laser treatments and deeper peels. There is no downtime associated with these peels.
Beta-hydroxy acid (BHA) peels – Salicylic acid is the main ingredient found in these peels. These peels are generally used on thicker or acne prone skins as they are oil soluble and have a cutting action on the skin in terms of resurfacing. We have a variety of different salicylic peels, each with modifications to treat different conditions. Beta-hydroxy acids generally contain larger molecules than alpha-hydroxy acids and therefore work by superficially creating cell turnover.
Modified Jessner’s peel (a combination peel of salicylic acid, resorcinol, and lactic acid). This peel brings together a combination of AHA’s and BHA’s as well as resorcinol. Resorcinol is a derivative of phenol (a very deep peeling agent) and is good for resurfacing the skin. The depth of the peel, which in most cases is superficial, is determined by the number of layers placed on the skin. The skin turns a frosty white colour for a short time after treatment.
Retinol peels (Vitmain A) Retinol helps to increase the turn-over rate of the skin cells and makes them behave like a ‘younger skin’. They can also help to reduce DNA mutations caused by UV exposure on the skin. Our Retinol peels utilise cutting edge technology with an ingredient called AGP, a retinol molecule encapsulated in a protein molecule. This allows for a better and slower delivery to the skin and creates more of a feeding response of the vitamin A rather than the traumatic effect of retinoic acid. At Body Recon we have a range of retinol based peels in varying strengths.
35% TCA (Trichloroacetic Acid ) is a reticular dermal skin peel and is a very popular and powerful skin resurfacing treatment. At Body Recon we can provide TCA peels in varying strengths although Dr Rahdon most commonly uses 35%. A deeper peel can be achieved by using a higher concentration of TCA with multiple applications if required. TCA is unique because of it’s penetration – it continues to penetrate until it reaches water within the layers of the skin. Having a TCA peel will result in considerable downtime (usually 7-10 days.)
Chemical peels induce a controlled wound to the skin and can replace part or all of the top layers of skin. The key factors in determining which chemical peel is right for you are: the degree of the skin problem/ageing/sun-damage, the skin type/colour, the amount of improvement you would like to achieve and the length of recovery or downtime that is acceptable to you.
As a rule, the deeper the peel, the greater the potential for side effects and complications and the longer the recovery. Another rule of thumb is that the darker the skin type, the more problems may be encountered post-peel, especially with pigmentation such as post inflammatory hyperpigmentation/ hypopigmentation where the treated skin may become darker/lighter than the untreated skin. Deeper peels in darker skin types should be considered with caution, it may be preferable to perform a series of superficial peels rather than one deep peel.
The degree of skin ageing will also determine which peel to use. Younger patients with less sun-damage, pigmentation and wrinkles may only require superficial peels. The opposite is also true.
Different skin problems also respond to particular peels. Acne, for example, responds well to Jessner’s peels and salicylic peels which are both very oil soluble and able to penetrate deeper into pores to remove oil and sebum. They also have an anti-inflammatory effect. Both AHA and BHA peels help to exfoliate the skin. TCA peels, AHA peels, and Jessner’s peels are suited to pigmentation problems and sun-damage.
Parts of the body other than the face can also be peeled. For example, chemical peels can be done on the chest and back for acne or on the neck and décolletage to help treat sun damage.
Skin preparation is mandatory and must be commenced at least two weeks prior to peeling (preferably more) to help with uniform penetration of the peel, accelerated healing and to reduce post-peel complications such as post-inflammatory hyperpigmentation. Think of prep as training for your skin – you wouldn’t just run a marathon, and it’s the same with your skin. Your specialist will be able to prescribe the correct homecare for your peels. Often this is the use of AHA cleansers and vitamin A (APG or retinoic acid) in the weeks prior to chemical peeling as these are the ingredients that can assist in achieving an even penetration. In clients at higher risk of post-inflammatory hyperpigmentation, topical lightening agents are introduced to help prevent any adverse effects post peel.
Experience is key with chemical peels. Our specialists are highly trained and have many years of hands on experience with medical grade peels. The skin is thoroughly cleansed and degreased with an appropriate cleanser first. Vaseline is sometimes used to prevent the peel from entering the eye. A fan may be used to help cool the skin for comfort during the peel. Your eyes should be closed during the procedure.
The chemical peel solution is then applied to the face. The procedure is timed, and you will be asked about your comfort level. The length of application depends on the chemical used – some peels self-neutralise, others we neutralise (to prevent too deep a penetration) and others we leave overnight. Neutralisation of the peel can be performed if there is an untoward skin reaction or if the pain is excessive.
When the peel is complete either sunscreen or a soothing balm will usually be applied.
Patients with a history of, or a current infection of herpes simplex virus (cold sores) should ensure that their specialist is aware of this before chemical peeling. If there is an active infection present, you may be asked to wait until it has passed prior to having a chemical peel. Also, if you have a history of cold sores, your doctor may place you on anti-viral medication to prevent an outbreak during your treatment.
If you have a history of keloid (thick, pigmented scars) you may also be excluded from all but the most superficial of peels.
Patients with HIV/AIDS or immunosuppression should avoid chemical peels because of the potential for impaired wound healing and increased likelihood of infection and scarring.
People who have recently had a course of oral isotretinoin or Roaccutane should wait for at least six months before undergoing medium or deep chemical peels. Similarly, patients who have had recent facial surgery should wait at least six months.
As a rule, the deeper the peel, the higher the rate of complications and the longer the recovery. Most superficial peels carry a very low risk of complications, whereas medium and deep peels require more experience from the operator and more thorough pre-peel preparation and post-peel care.
Downtime can vary from a few hours (in the case of a light lactic peel) to a week for a 35% TCA peel.
Swelling – usually only associated with the deeper peels and lasting up to three days.
Pain – usually only seen with the deeper peels and may last for a few hours.
Redness – most superficial peels produce a mild amount of redness that may last for a few days. Medium to deep peels can cause redness that may persist for up to a month.
Itchiness – this is only common after medium and deep chemical peels.
Ocular injury – care must be taken during the procedure to avoid the peel from entering the eye.
Allergic reactions – uncommon, although the Jessner’s peel has a higher rate of allergy. Anti-histamines may be taken before (if an allergy is known) or after the procedure.
Folliculitis /acne – this occurs commonly as a result of the emollient creams used during healing. Antibiotics may be required to heal these eruptions.
Bacterial/fungal infection – is uncommon and usually only associated with medium to deep peels, however, left untreated, it can lead to scarring.
Herpes simplex recurrence – is common and needs to be treated with anti-viral medication to prevent spread and scarring.
Hyperpigmentation – dark patches over the peeled areas. This may occur over the deeper parts of the peel and is a result of inflammation causing release of melanin/pigmentation from the skin (post-inflammatory hyperpigmentation). This is usually temporary but can last for up to 2 years. Treatment usually involves a lightening agent such as hydroquinone.
Hypopigmentation – is a loss of pigmentation and usually occurs in darker skin types after peeling. This can sometimes be permanent.
Telangiectasia – are small red vessels under the skin which can become more prominent with peeling. The vessels are easily treated with lasers such as our NdYAG.
Milia – these are small white cysts that form about 2 to 3 weeks after the skin has re-epithelialised (grown over). They can result from blockage of the skin by the emollient creams used after chemical peeling. They can be removed with a needle or lancet.
Demarcation lines – these can occur after medium to deeper peels and mark the border between peeled and untouched skin. This may be noticeable even after the skin has healed.
Scarring – a very uncommon complication of chemical peels, this is usually associated with a history of poor healing or keloid scarring. A deeper peel carries a higher risk of scarring. An early sign of scarring is persistent redness and itchiness and this needs to be treated with a topical steroid.
Patient selection is a very important part of reducing the rate of complications. By choosing the right peel for each particular skin type, complications can be minimised. Darker skinned patients in particular, especially those of European, Asian, Indian, Sri Lankan, or African backgrounds are more prone to pigmentation problems (either a gain or loss of pigmentation) after a medium to deep chemical peel. It is possible to prepare the skin beforehand with hydroquinone or other lightening agents and retinol which help to reduce the rate of post-inflammatory hyperpigmentation (dark areas) post peel. This regime can be continued for two weeks after the peel to further reduce pigmentation problems. You will be provided with detailed pre and post peel information and it is imperative that you follow these instructions to limit any complications.
Pre and post care with an emphasis on sun protection is required for all chemical peels. Sun exposure, pre and post peel, should be avoided or at least minimised as this can also lead to an increase in pigmentation problems.
Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.