Superficial Chemical Peeling—The "Lunchtime Peel"

Dermatologists have a great variety of treatments to improve your skin and make you look better, as well as feel better about your appearance. One of these treatments is superficial chemical peeling, also known as a "lunchtime peel" because it is a treatment you can undergo on your lunch hour.

Superficial chemical peeling is a treatment with many benefits and few risks or side effects. It is a treatment available to people of all ages and it can begin as early as age 25 to 30 when the first effects of photoaging (damaging effects of sunlight on skin) begin to be visible on facial skin. Superficial chemical peeling offers a way to peel off the appearance of age by removing the fine wrinkles and skin roughness caused by photoaging. Also removed by superficial chemical peeling are the early patches of scaly skin that become actinic keratoses, lesions that can be an early beginning of skin cancer (Link to ActinicKeratosesNet for more information on actinic keratoses and early benefit most from this treatment that. skin cancer).

Chemical peeling of superficial layers of skin is not appropriate for deep photo damage or skin defects such as acne scars. Moderate to deep chemical peeling, alone or in combination with other skin rejuvenation procedures such as soft-tissue augmentation, may be necessary when defects lie deeper than the surface layer of skin.

What is Chemical Peeling?

Chemical peeling is a procedure used for cosmetic improvement of skin or for the treatment of some diseases of the skin. Chemical exfoliating agents are applied to the skin to remove skin cells at superficial, moderate, or deep layers so that new skin can grow and resurface the damaged or diseased areas. (Link to American Society for Dermatologic Surgery  for more information on chemical peeling).

Who is Qualified to Do Chemical Peeling?

Dermatologists and dermatologic surgeons are most qualified by training and experience to perform a chemical peel (Click on Choosing a Dermatologist for information on questions to ask about a physician’s qualifications). The dermatologist should be a board-certified specialist with knowledge of skin diseases and their treatment and both training and experience in chemical peeling.

What Qualifies a Patient for Superficial Chemical Peeling?

A prospective patient’s first qualification is that he or she wants to improve photo damaged and prematurely aging skin. Consultation with a dermatologist or dermatologic surgeon is the first step.

The patient should be in good general health as determined by the physician from the patient’s medical history and physical examination. Medical criteria are less rigorous for superficial chemical peeling than for moderate or deep peeling. Nevertheless, there are some conditions that might delay superficial peeling by the need for further diagnosis or treatment—for example, autoimmune disease, or immunosuppressive drugs or disease that can compromise healing or increase susceptibility to infection; skin rejuvenation surgery within the past two to six months in the areas to be peeled; recent isotretinoin treatment for acne; a tendency for the patient’s skin to form hypertrophic or keloid scars in response to injury; and, a tendency for the patient’s skin to undergo pigmentation changes in response to injury.

A patient also should be psychologically prepared for superficial chemical peeling. While the procedure is called superficial because of its depth of skin exfoliation, it is still a medical procedure that requires a patient’s willingness to follow post-procedure instructions applying medications and avoiding sun exposure during healing. A patient who is anxious about the procedure may ask if a "test spot" can be peeled first.

Can Superficial Chemical Peeling Be Done on All Colors of Skin?

While all colors of skin are acceptable for superficial chemical peeling, it is pale white to white skin that is most likely to have the early photo damage best treated by superficial peeling. Some darker skin may have a temporary loss of pigmentation after superficial peeling. A temporary loss of pigmentation can usually be disguised with cosmetics until pigmentation returns to normal.

What Determines the Depth of Peel Needed?

The dermatologist or dermatologic surgeon determines the degree of photoaging by examining the patient’s skin. The physician also determines which area(s) of the face have photo damage and should be peeled. If the photoaging is determined to be in the outermost (epidermal) layer of skin, superficial peeling is an appropriate procedure and the physician selects a chemical peeling agent. Alpha-hydroxy acids such as glycolic acid and lactic acid derived from natural sources are typical superficial peeling agents. Sometimes the skin is pretreated with a vitamin A derivative to prepare it for peeling and to extend results of the peeling.

How Long Does it Take to Do a Superficial Chemical Peeling Procedure?

The reason superficial peeling is called a "lunchtime peel" is because the procedure can be done in an hour or less, usually in the dermatologist’s office. The patient is able to leave immediately after treatment and resume normal daily activities with some restrictions such as avoiding exposure to strong sunlight.

A series of peels at weekly, biweekly or monthly intervals is usually required to attain the best skin rejuvenation result.

What Are the Side Effects of Superficial Chemical Peeling?

Skin redness and slight swelling for a day or two are the most common post-procedure effects. Post-procedure medications and ointments are prescribed as necessary for discomfort and moisturization of the new skin. A very important post-procedure precaution is avoidance of sun exposure during healing and the use of broad-spectrum sunscreen of SPF 30 or higher on healed skin to prevent new photo damage.

What Are the Long-Term Benefits of Superficial Chemical Peeling?

Superficial chemical peeling is very effective in rejuvenating skin that has early indications of photoaging—fine wrinkles, roughness, and patches of early actinic keratoses. Superficial chemical peeling can be repeated as often as necessary to keep skin looking young.

Under the care of a dermatologist or dermatologic surgeon, the effects of gravitational aging can be monitored. Gravitational aging is the constant and insidious pull of gravity on muscles under the skin, eventually causing skin defects such as crow’s feet, frown lines in the forehead, and corrugated lines in the neck. Chemical peeling can be combined with other procedures to reverse the effects of both photoaging and gravitational aging. (Look under Cosmetic Procedures for treatment that reverse gravitation aging—botulinum toxin, soft-tissue augmentation, and surgical excisions). (Link to American Society for Dermatologic Surgery for detailed discussion of treatments for gravitational aging).

References

AAD Guidelines of Care for Chemical Peeling