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A chemical peel is a treatment to improve the look of the skin. A chemical is applied to the skin and allowed to soak in. Over the next 1 to 14 days, depending on how deep the chemical soaks into the skin, the skin peels off. This process destroys parts of the skin in a controlled way so that new skin can grow in its place. The chemicals used are sometimes called exfoliating or wounding agents.
There are different types of chemical peels, based on how deep the chemical soaks in and what type of chemical is used. Things that may affect the depth of a peel include the strength of the acid in the peeling agent, the number of coats that are applied, and the amount of time allowed before the acid is neutralized. Deeper peels give more dramatic results. But they also have higher risks, cause more pain, and have a longer healing time. There are three basic types of peels:
Your doctor can help you decide what depth of peel and what type of chemical is best for you. This decision is based on your skin type, which areas you want peeled, what kind of results you want, how much risk you are willing to take, and other things. A small "test spot" may be peeled to get a better idea of the results, especially for people who have darker skin.
You will start to prepare your skin 2 to 3 weeks before the peel. You will clean it 2 times a day, apply a special moisturizer or cream 1 or 2 times a day, and use sunscreen every day. This skin care routine will help the skin peel more evenly and heal faster after the peel. It may also reduce the chance of infection and other problems, especially uneven colour changes in the skin.
In some cases, daily use of tretinoin (Retin-A) is also suggested. This is a medicine you apply to your skin. It is most often used to treat acne, but it may speed healing after a peel.
For medium and deep peels of the face, you may get a short course of medicine (such as acyclovir) to prevent viral infection. This is most likely if you have had cold sores before and if the peel will be near the mouth or eyes.
Right before the peel, the skin is cleaned. The chemical (usually a liquid or paste) is then applied to the skin with a small brush, gauze, or cotton-tipped applicators. The chemical is left on the skin for several minutes, depending on the type of chemical used. Water or alcohol may be used to neutralize the acid and end the chemical reaction, then the chemical is wiped off. You may feel a little burning while the chemical is on your skin. A hand-held fan can help cool the skin and relieve any discomfort.
The technique used to do a medium peel is like that used for a superficial peel, but the chemical may be left on longer. Medium peels are more painful because the chemicals are stronger and they soak deeper into the skin. You may get a pain reliever and an oral sedative to reduce pain and anxiety during the procedure. Cool compresses and fans can be used to cool the stinging and burning caused by the chemical. The peel takes about 40 minutes. There is little or no pain after the peel is finished.
Deep peels take the most time and are the most painful type of chemical peel. The process for a deep peel using phenol is also more complex than for other types of peels.
Depending on how large an area is being treated, the entire process may take 60 to 90 minutes.
The time it takes to heal after a chemical peel depends on what kind of peel was done and how deep it was. Proper care of the skin after the peel is very important. This care can speed healing, help results last longer, prevent infection, and avoid colour changes in the treated area caused by sun exposure. Proper skin care after a peel is very similar to the care used to prepare for a peel. It most often involves:
Some doctors may also suggest using tretinoin cream each night, usually starting 2 to 3 weeks after the peel.
Superficial peels are done on an outpatient basis. They don't require anesthesia, and they cause only slight pain afterward. Most people can go back to their normal activities right away. The skin heals quickly after a superficial peel. The skin may turn pink. In most cases, there is only a small amount of peeling. You can use makeup to hide any redness until it fades.
Medium peels are usually done on an outpatient basis. You may need to take a few days off work to recover. A medium peel causes a burn of the skin. The skin takes 5 to 7 days to heal to a point where you can use makeup to hide the redness caused by the peel. There is little or no pain after the peel. But there may be some swelling, mainly if the area around the eyes is treated. The skin will turn reddish brown in 2 to 3 days and become crusty. Then the skin will flake and peel over the next few days.
A deep peel causes a deeper burn of the skin. Skin grows back about 10 to 14 days after a deep peel. The skin stays very red for 3 weeks, and up to 2 months for some people. Most people take about 2 weeks off from work. Complete healing of the skin may take several months.
Chemical peels are sometimes done with dermabrasion or laser resurfacing for a more dramatic overall effect.
A chemical peel (except for a superficial peel) may not be done if you have:
The results of a chemical peel depend in part on the depth of the peel.
Your skin type, your skin care before and after the peel, the doctor's level of experience, and your lifestyle after treatment can also affect the results. Some types of skin problems respond better to a chemical peel than others. People with lighter skin who limit their sun exposure after the treatment tend to have better results than those who have darker skin and those who keep spending lots of time in the sun.
Before you decide to have a chemical peel, talk to your doctor about the kind of results you can expect.
Changes in the colour and texture of the skin caused by aging and sun exposure may still get worse after a chemical peel. Chemical peels are not a permanent solution for these problems.
In general, the deeper the peel, the greater the risk of side effects and problems. Chemical peels can cause:
In rare cases, deep peels using phenol can cause more severe problems during the treatment, including heart, liver, or kidney failure.
Chemical peels are designed to wound and remove the upper layers of the skin. You need to prepare yourself for how your skin will look after the peel and as it heals. You also need to be prepared to use makeup to blend skin tones between treated and untreated areas, such as between the face and jawline.
It is important to let your doctor know what you hope to achieve and that you know what results you can expect. Even with realistic expectations, you may not see results for several weeks or months after a chemical peel.
During the early healing period after a chemical peel (before the skin has finished peeling), you will need to avoid sun exposure. After the skin stops peeling, you will need to wear sunscreen every day. Limit your time in the sun as much as possible. New skin is more likely to be damaged and change colour from sunlight.
Chemical peel, dermabrasion, and laser resurfacing are the most common techniques used to improve the texture and look of the skin. Although these techniques use different methods, they have almost the same effect on the skin. They destroy and remove the upper layers of skin to allow the skin to regrow.
No one technique is better than the others. When done by an experienced surgeon, laser resurfacing may be slightly more precise than chemical peeling or dermabrasion. But the choice of technique is based on the site you want to treat, your skin type and condition, the doctor's experience, your preferences, and other things. Some people may get the best results by using more than one technique.
Other Works ConsultedTanzi EL, Alster TS (2012). Ablative lasers, chemical peels, and dermabrasion. In LA Goldman et al., eds., Fitzpatrick's Dermatology in General Medicine, 8th ed., vol. 2, pp. 3021–3031. New York: McGraw-Hill.
Current as of: April 1, 2019
Author: Healthwise Staff
Medical Review:Anne C. Poinier MD - Internal Medicine & Adam Husney MD - Family Medicine & Martin J. Gabica MD - Family Medicine & Keith A. Denkler MD - Plastic Surgery
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