What is a chemical peel?
Chemical peel, also known a chemexfoliation or derma-peeling, is a technique that uses a chemical solution to improve and smooth the texture of the facial skin by removing its damaged outer layers.
By using phenol, trichloroacetic acid (TCA) and alphahydroxy acids (AHAs), dermatologists and surgeons at Cleveland Clinic Cosmetic & Plastic Surgery Center apply precise formulas adjusted to your facial needs to cause the skin to “blister” and eventually peel off. Chemical peels are a way to promote the growth of a new layer of skin that is smoother and younger-looking
Am I candidate for a chemical peel?
Chemical peel is most commonly performed for cosmetic reasons – to enhance your appearance and self-confidence – but it may also be recommended to remove pre-cancerous skin growths or soften acne facial scars. The best way to determine if you are a candidate for a chemical peel is through a consultation with an expert at Cleveland Clinic Cosmetic & Plastic Surgery Center.
Chemical peel is a good option if you:
- Are physically healthy
- Have mild, moderate or severe degree of facial aging
- Have skin growths and/or acne facial scars
- Have specific, but realistic goals in mind for the improvement of your appearance.
How do I prepare for chemical peel?
Preparation for your chemical peel at Cleveland Clinic Cosmetic & Plastic Surgery Center will depend on the type of peel treatment you are having.
Your doctor may recommend Retin-A - a prescription medication derived from Vitamin A - to pre-treat the skin. This regularizes the skin's surface layer, allowing a TCA or phenol solution to penetrate more deeply and evenly. If your skin won't tolerate pre-treatment with Retin-A, an AHA cream may be used instead.
Hydroquinone, a bleaching agent, is sometimes used in combination with Retin-A or an AHA pre-treatment, especially if you have blotchy skin areas or pigmentation problems. This type of pre-treatment may take a month or more before your doctor will schedule your actual peel.
If you are having a phenol or deeper TCA peel, you will need to arrange for someone to drive you home and help you out for a day or two following the procedure. Chemical peels are often done under local anesthesia with sedation.
Preparation for your chemical peel may also include:
- Lab testing or a medical evaluation
- Taking certain medications or adjusting your current medications
- Stopping smoking well in advance of the peel treatment
How is chemical peel performed?
Chemical peels at Cleveland Clinic Cosmetic & Plastic Surgery Center are generally performed as outpatient procedures. Full-face AHA and TCA peels usually take 30 minutes to complete. Phenol peels of the full face may take between one to two hours, while phenol peels of small portions of the face, such as the upper lip, may take only 10 to 15 minutes.
The skin is thoroughly cleansed with an agent that removes excess oils, and the eyes and hair are protected. One or more chemical solutions, such as glycolic acid, trichloroacetic acid, salicylic acid, lactic acid or carbolic acid (phenol) are used for the peel treatment based on your skin’s needs.
During a chemical peel, the doctor applies the solution to small areas on the skin. These applications produce a controlled wound, enabling new, regenerated skin to appear.
During the procedure, most patients experience a warm to somewhat hot sensation, which lasts about five to 10 minutes, followed by a stinging sensation. Cool compresses may be applied to help alleviate this stinging. A deeper peel may require pain medication during or after the procedure.
What are the different types of chemical peel?
There are three different types of chemical peel used at Cleveland Clinic Cosmetic & Plastic Surgery Center:
- Alphahydroxy acids (AHAs) or superficial peels,
- such as glycolic, lactic, or fruit acids are the mildest of the peel formulas and produce light peels. These types of peels are performed by aesthetic skin care specialists and can provide smoother, brighter-looking skin. They are best if you 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. 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) peel, blue peel, or medium peel
- can be used in many concentrations, but it is most commonly used for medium-depth peeling to treat fine surface wrinkles, superficial blemishes and pigment problems. The results of TCA peel are usually less dramatic than and not as long-lasting as those of a phenol peel, and it may require more than one TCA peel to achieve the desired result. The recovery from a TCA peel is usually shorter than with a phenol peel.
- Phenol or deep peel
- is the strongest of the chemical solutions and produces an intermediate or deep peel. It is used mainly to treat 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.
What results can I expect?
The results from your chemical peel depend on the peel treatment used:
- AHA (superficial) peels produce improvements to the skin that may be very subtle at first. You may first notice a healthier glow to your skin, and with continued treatments, you will notice a general improvement in the texture of your skin.
- TCA (medium) peels result in skin that will be noticeably smoother and fresher looking. However, results from a TCA peel are usually not as long-lasting as those of phenol peel.
- Phenol (intermediate to deep) peels lead to dramatic improvement in the surface of your skin – fewer fine wrinkles, fewer blemishes and more even-toned skin. Your results will be long-lasting, although not resistant to the effects of aging and sun exposure. Life-long sun protection is key to maintaining your results.
Follow-up with an expert at Cleveland Clinic Cosmetic & Plastic Surgery Center is the best way to ensure long-lasting results from your chemical peel.
What is involved in recovery?
Just as your results may vary, recovery from chemical peel depends on the type of peel treatment used:
- AHA (superficial) peel causes some temporary flaking or scaling, redness and dryness of the skin. However, these conditions will disappear as your skin adjusts to treatment.
- Phenol (intermediate to deep) or TCA (medium) peel may cause tingling or throbbing. You may be prescribed a mild pain medication to relieve this. If tape was used to cover your face, it will be removed a day or two after treatment. It’s normal for a crust or scab to form on the treated area. To help your face heal properly, it’s important that you follow your doctor's specific post-operative instructions.
- TCA (medium) peel may also cause significant swelling, depending on the strength of the peel used. A TCA peel may cause your face to become quite swollen and your eyes may even be swollen shut temporarily. You will need someone to help care for you for a day or two following your treatment. Your may also be limited to a liquid diet and advised to limit your talking during the first few days of recovery.
Is chemical peel safe?
All surgical procedures carry some risk. In general, the deeper the peel, the greater the risk of side effects and complications. Possible side effects and complications from chemical peel include:
- Redness (erythema)
- Prolonged color changes in the skin (lightening or darkening)
- Crusting and scaling.
- Swelling (edema) especially around the eyes.
- Allergic reaction to the chemical used
- Infection (People who have a history of herpes outbreaks should be pre-treated with Zovirax® or Valtrex® for one to two days because these individuals are especially prone to infection after a chemical peel)
- Increased skin sensitivity to sunlight.
Special concerns to consider with deep peels, which use phenol, is that they can rarely cause more severe complications, including heart, liver or kidney failure.
Why Choose Us
If you’re considering chemical peel, look for a dermatologist or plastic surgeon with specialized training and significant experience performing these procedures. Consider going to a specialist who is affiliated with a major medical center, such as at a Cleveland Clinic. Ask your doctor about credentials, training and how many chemical peel procedures he or she has performed.
Is this procedure covered by health insurance?
Like all cosmetic procedures, chemical peel is not covered by health insurance. Although, in certain cases, health insurance may cover the peel procedure. Ask to talk with a financial representative from Cleveland Clinic Cosmetic & Plastic Surgery Center who can explain costs of the procedure and if insurance coverage is an option for you.
This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.