Cosmetic Procedures
Chemical Peeling: What to Expect Before, During, and After

If you want to diminish fine lines and wrinkles, skin discoloration, a dull complexion, or rough skin, your dermatologist may recommend a cosmetic procedure called a chemical peel. The following explains what happens before, during, and after this procedure.

What to Expect Before a Chemical Peel
A consultation is essential. Your dermatologist will take a complete medical history. Be sure to tell your dermatologist if you are prone to cold sores, have had a cosmetic procedure in the past, scar easily or have ever had a type of raised scar known as a keloid, or took isotretinoin (a prescription medication used to treat severe acne). These can have a tremendous effect on what you see after a chemical peel.

After the consultation and a physical exam that includes a close look at your skin, your dermatologist will tell you if a chemical peel will help diminish the signs of aging that concern you and if a chemical peel is right for you.

If a chemical peel is appropriate, one of the following types of peels will be recommended:

Type of Peel

What it Does

May Contain

Signs of Aging Treated

Superficial — also known as the lunchtime peel

Penetrates only the outer layer of skin to gently exfoliate

  • Glycolic acid (often contains alpha-hydroxy acid)

  • Jessner’s solution

  • Salicylic acid

  • Trichloroacetic acid (TCA)

  • Mild skin discoloration

  • Give the face, neck, chest, or hands a refreshed look

  • Smooth rough skin

Medium

Penetrates the outer layer of skin and reaches into the middle layer of skin to remove damaged skin cells

  • Glycolic acid

  • Trichloroacetic acid (TCA)

  • Age spots

  • Fine lines and wrinkles

  • Freckles

  • Moderate skin discoloration

  • Modest tightening for lax sun-damaged skin

  • Smooth rough skin

  • May remove some actinic keratoses

Deep

Reaches deep into the middle layer of skin to remove damaged skin cells

  • Trichloroacetic acid (TCA)

  • Phenol

Can make a person look years younger — removes fine to moderate lines, age spots, freckles, shallow scars. Will see brighter, smoother, slightly tighter, more youthful skin. Can only be used on the face and only performed once.

Most medium and deep chemical peels require pre-peel skin care. Usually prescribed for 2 to 4 weeks before the peel, this skin-care plan helps the peel deliver the best results and reduce potential side effects. The plan should be carefully followed.

What to Expect During a Chemical Peel
Superficial and medium-depth peels are performed in a dermatologist’s office. A deep peel may be performed in a dermatologist’s office or outpatient surgical center. General (puts the patient to sleep) anesthesia and monitoring equipment for the heart and lungs may be necessary for a deep peel.

Before applying the peel, the skin is prepped. Once the skin is ready, the dermatologist quickly and evenly applies the peel. If a deep peel is being performed, the skin will be treated one small section at a time to limit effects on the heart and lungs. Typically, a 20-minute interval between each application of the peel solution is necessary with a deep peel.

As the peel works, the dermatologist watches the skin carefully so that the peel can be stopped and removed at the appropriate time. After the peel is removed, cool compresses may be applied to help soothe the skin. These are usually not necessary for a superficial peel.

A mild lotion or cream may be applied after a superficial or medium-depth peel to help soothe the skin. After a deep peel, surgical dressing will be used to protect the treated skin.
 

4 Tips for Better Results After a Chemical Peel

  1. Do not scratch or rub the treated skin. While the skin may burn, itch, or swell, it is important to resist the urge to scratch or rub. Scratching and rubbing tend to diminish results. To alleviate the discomfort, apply a cold compress.

  2. Keep your skin moist and supple. This will give you better results. If the skin dries out and cracks, scarring may occur.

  3. Do not pick at scabs. After a deep peel, the face tends to scab, but picking at scabs can increase the risk of an infection, skin discoloration, and scarring.

  4. Wear sunscreen daily once your skin heals. Applying sunscreen before your makeup will help maintain the results.

What to Expect After a Chemical Peel
The chemical used in this cosmetic procedure causes the skin to peel off. Over the next 1 to 14 days, new skin will appear.

All peels require some follow-up care. You will be given specific instructions to follow, which will include everything from how to wash your skin to sun protection. It is important to keep in mind that sun exposure and smoking after a chemical peel can cause unwanted side effects, including infection and scarring.

The following table shows what to expect after each type of peel.

Type of Peel

Healing Time

At-home Care

When Wear Makeup

Follow-up Visit

Superficial

 1 - 7 days

Skin will be red. After the redness disappears, scaling may develop, which lasts 3 – 7 days.

Lotion or cream applied until the skin heals, followed by daily use of sunscreen

Usually immediately after the peel, but sometimes the next day

No. However, 3 to 5 light peels may be necessary, so you may need to return once every 2 weeks for awhile to see desired results.
 

Medium

7 - 14 days

Skin will be red and swollen. Swelling worsens for 48 hours. Eyelids may swell. Blisters can form and break open. Skin crusts and peels off in 7 – 14 days.
 

Daily soaks for a specified period

Apply ointment after each soak

Take an antiviral medication for 10 – 14 days

Apply mild lotion or cream

Total avoidance of the sun until skin heals

5 – 7 days can wear camouflaging makeup

Yes. Follow-up visit required after the procedure.

Deep

14 – 21 days

Area will be bandaged.
 

4 – 6 daily soaks while healing

Apply ointment after each soak for 14 days

After 14 days, apply thick moisturizer as directed

Take an antiviral medication for 10 – 14 days

Total sun avoidance for 3 – 6 months

At least 14 days before can apply makeup

Yes. The next day, the dermatologist will want to see you. Several follow-up visits are required during the first week.

References:
Bernstein EF. “Chemical Peels.” In: Kaminer MS, Dover JS, Arndt KA, editors. Atlas of Cosmetic Surgery. United States of America, W. B. Saunders Company; 2002. p. 311-27.

Hirsch RJ. “Chemical Peels.” In: Sadick N, Lawrence N, Moy R et al. Concise Manual of Dermatologic Surgery. China, McGraw-Hill Companies; 2008. p. 31-6.

Monheit GD and Chastain MA. “Chemical and Mechanical Skin Resurfacing.” In: Bolognia JL, Jorizzo JL, Rapini RP et al, editors. Dermatology. 2nd edition. Spain, Mosby Elsevier; 2008. p. 2313-27.

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Cosmetic Procedures: Chemical Peeling


 

 

 

 

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Page last updated 10/8/08

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