Updated: Apr 30, 2019
The recent explosive interest in skin rejuvenation has led everyone to have heard about chemical peels but are we really aware of the principles behind using it? It is utilized for cosmetic purposes as well as therapeutic basis nevertheless the action is biological in both cases.
Peeling agents are usually extracted from fruits or plants thus known as 'Fruit acids'. Synthetic preparations include Tretinoin, Pyruvic acid, Polyhydroxy acids and Phenol. Peels can be single or a combination and employed directly or using an apparatus (a recent one being Hydrafacial). However, there is a specific technique of application, precautions to be taken and side effects to be tolerated.
Principles behind Chemical Peeling
The thought of using an acid may sound alarming but on knowing the details we reason its application. The basis of chemical peeling is in the use of a controlled concentration of acid that penetrates to a certain depth and this depth can be assessed through signs elicited while performing the procedure. The therapeutic result of chemical peeling is from the direct destructive effect when it comes to rough uneven skin, darkening and raised lesions; or the regeneration and remodeling of skin especially when we talk about wrinkles, skin texture and scars.
Cleopatra, A Don of Beauty or Frantic for Beauty is not known for sure however it is a well known fact that she bathed herself in Sour milk for Soft Flawless skin. Whether she achieved it is a mystery.
In history, the most well known use of chemical peeling dates back to Cleopatra with the use of Sour Milk bath (now known to be lactic acid) as a means of Beautification. In earlier times, French women have used old wine that contains tartaric acid for the same purpose. However, as with other natural remedies the effects are temporary, contradictory and ultimately baseless. This is because the percentage of lactic acid in sour milk is fairly low, furthermore, sour milk contains other constituents that react with it forming salts and other harmful products thereby having very little benefit while posing harmful effects.
The peeling agents used by physicians can be single or a combination, however the concentration of each reagent is specifically mentioned such as Glycolic acid 35% or Trichloroacetic acid 15%. In addition to this, a mention of the pH and the formulation as Free Acid, Buffered, Partially neutralized, Esterified etc with each reagent denotes the acidity and efficacy of the peel.
The scientific facts of use of acids is the lower the pH, the more irritation and the more effective it is. With the addition of buffering reagents, pH is increased thereby reducing irritation. pKa indicates an accurate determination of the reagent's strength by measuring the quantity of free acid available.
Peels can be classified as Very Superficial, Superficial, Medium depth and Deep peels. There is no universal rule regarding the choice of peeling agent, it rather depends on the clinical or cosmetic use. However, physicians tend to choose medium to high concentrations of superficial peels, medium to low concentrations of medium depth peels and bare minimum concentrations of deep peels thereby ensuring safety while exerting considerable efficacy in the intended use.
Apart from the peeling agent, a number of other factors influence the depth and thereby the efficacy of a peel. These include the time a peeling agent is in contact with the skin, the number of coats, the type of skin, the skin care regime followed and any preexisting skin conditions.
Throughout a session of chemical peeling, which is usually 1 - 10 mins long, the physician must inspect for specific changes that correlates directly with the depth of peeling. These include burning/stinging sensation, redness, frosting/whitish discoloration and blistering. These changes differ with respect to each reagent and a physician will be well versed with the reagent he or she is using.
During application, certain peels require a Single coat while a few require Multiple coats. In addition, the number of coats may be influenced by the skin type and area.
Whether the skin is oily or dry, sensitive, or sunburned, this can affect the depth of penetration. Prior to chemical peeling, every client must undergo a session of priming. Priming is the application of a specific topical formulation for a period of 2 - 6 weeks that prepares the skin for the procedure. Depending on the indication of chemical peeling, the application of a Retinoid, Whitening agent, Sunscreen or a combination is chosen. In case of oily skin, skin preparation includes a cleansing and degreasing regime.
The Types of Peels
TCA Cross technique in case of Post Acne Scars
Let's talk about the safest peel to begin with, Salicylic acid. It is a really superficial peel, for it penetrates only the top most layers of skin. Even though its penetration is such, it has profound efficacy in case of pimples, dark marks and toning of the skin. It displays a whitish tinge after application that is called pseudo frost. This particular peel is so safe that it doesn't need to be neutralized. The pseudo frost appearance in contrary to other peels is not an alarming sign as it is due to crystallization on the surface of the skin. Furthermore, any burning sensation disappears with the anesthetic effect it imparts.
The next peel is Glycolic acid and this is considered the gold standard as it has been the most widely studied and used peel. It is described to have a degreasing effect, lightening effect, exfoliating effect and interestingly a moisturizing effect too. Coming to the dark side of it... being a superficial yet deeper peel than Salicylic acid, it requires neutralization and poses risk of darkening, scar formation, soft tissue swelling and scarring if the peel penetrates deeper than required. Even though these effects can be successfully managed by use of sunscreens, lightening agents, and moisturizers, such effects can be preventable by proper priming, correct peel application and post peel care.
A look into all the peels would be exhausting for this blog, so one more will do for now and the last one is Trichloroacetic acid (TCA). This happens to be a favorite due to its multipurpose and ease of use. Be it mollusca, wart, dark spots or scars, a TCA peel is agreeable to clients. In scars, a technique known as TCA Cross is efficacious in lifting up the scars (especially Ice Pick Scars). After peeling, ice or cold water can be applied that serves as a neutralizer and comfort from the short term burning sensation.
Post Procedure Care
This phase aims to prevent complications and ensure early recovery.
Commonly, superficial peels bring about minimal redness, puffiness and peeling of the skin that is evident 1- 3 days after the procedure.
For deeper peels, the redness, puffiness and peeling is to a higher degree and usually last for 5 - 10 days.
Ways to manage this include:
Cleanse skin using a mild soap or soap free cleanser
Avoid traumatizing the 'new' skin by rubbing, massaging, peeling or scratching the treated sites
If there is any evidence of honey colored crusting, a topical antibacterial is indicated
Soothing the skin using ice packs or calamine lotions would be comforting
Sunscreens classed as Broad Spectrum sunscreens must be used at all times
Bland Moisturizers (unscented and nonallergic) can be applied over active peeling to ensure its not severe or accidentally ripped off
Precautions with Chemical Peeling
Dermatologists are better approached for Chemical Peeling as through Clinical Evaluation and comprehensive knowledge of the reagents and their effects, they secure a Safe and Effective session.
Priming is a crucial step in determining efficacy and safety of chemical peeling and must be followed strictly. Another similar step is the Post Peel Care with broad spectrum sunscreens and moisturizers. The importance of using a sunscreen after a peel is profound as this prevents the sudden darkening of skin that can be encountered when the newly regenerating baby skin is exposed to harmful UV rays.
Waxing, bleaching, certain medications, face washes, and beauty treatments such as masks, hair dyeing and resurfacing treatments must be withheld 2 days prior to chemical peels in order to avoid complications.
When it comes to Deeper Resurfacing procedures, these are withheld 6 months prior to a peeling session.
In case of Viral infections and Scarring tendency, these must be declared prior to sessions for ensuring preventive measures are undertaken.
This information is brought to you by Specialized doctors in Al Arif Heart and Children Medical Center, Al Mujarrah, Sharjah, UAE. Keep yourselves fit as a fiddle.