As we age, our skin undergoes several changes like wrinkles, fine lines, loss of radiance, hyperpigmentation, smoothness, skin tone and sagging of the skin. These manifestations are due to natural aging process and other environmental factors like excessive sun exposure, smoking, stress and various other factors. These skin changes can be treated by several skin resurfacing cosmetic surgery procedures, such as dermabrasion, chemical peeling, and laser skin resurfacing.
While laser skin resurfacing and dermabrasion are comparatively expensive, chemical peeling has become widely popular among the people for facial aging. Chemical peels have been used for many years for skin surface resurfacing, superficial scars and treating irregular pigmentation. Chemical peeling is safe, simple and cost-effective procedure if done with well-trained professionals.
What is Chemical Peeling?
Chemical peeling is a procedure where your skin texture is improved by controlled applications of one or more exfoliating agents to the skin. These agents cause controlled destruction of the layer of skin leading to exfoliation of the skin surface. As skin exfoliates, regeneration of the new skin surface occurs with much improvement in texture and surface abnormalities.
There are several types of chemical peeling agents and the classification of chemical peel is usually based on the level of injury and expected depth of penetration into the skin.
Superficial Peels: Epidermis to upper papillary dermis
Medium-Depth Peels: Papillary dermis to upper reticular dermis
Deep Peels: Mid-reticular dermis
Superficial Peels
Superficial peels are used in the treatment of mild photo-aging, acne, actinic keratoses, solar lentigines, and pigmentary disorders. Superficial peels have minimal effects on wrinkles and deep furrows and requires several treatment session (weekly or monthly) before desired results can be seen. These wrinkles and deep furrows improvement may be possible with medium or deep chemical peels.
Superficial Chemical Peeling Agents
Trichloroacetic acid (TCA)10%-25%
Jessner’s solution (Lactic acid+Salicylic acid+ Resorcinol+Ethanol)
Modified Unna’s resorcinol paste
Solid carbon dioxide
Alfa-Hydroxy acids
Salicylic acid
Tretinoin solution
Medium Depth Peels
Unlike superficial peels which usually requires multiple treatments, medium depth chemical peels are done as single treatment procedure. These peeling agents causes epidermal necrosis and significant dermal injury, resulting in increased collagen production during wound healing process over the next several months. These peels are used in the treatment of mild to moderate photo-aging, wrinkles, actinic keratoses, solar lentigines, epidermal growth and other pigmentary disorders.
Medium-Depth chemical peeling agents
- Trichloroacetic acid (TCA) 35%-50%
- Solid CO2 and 35% TCA
- Jessner’s solution and 35% TCA
- 70% Glycolic acid and 35% TCA
Deep Peels
Deep peels are used in the treatment of moderate to severe photo-aging and advanced wrinkles. These chemical peels destroy the epidermis and progressive layers of the dermis and have extended period of healing following treatment.
Deep peeling agents:
Although, one may also use 50% or greater concentration of TCA to achieve this result, Phenol, a keratocoagulant is the only deep peeling agent widely used. The Baker’s formula for the preparation of phenol peel includes;
Phenol USP 88% – 3 mL
Croton oil – 3 drops
Hexachlorophene (Septisol) liquid soap – 8 drops
Distilled water – 2 mL
The medium-depth chemical peels and deeper chemical peels are now being replaced by laser treatment like laser skin rejuvenation.
Though the procedure is generally safe, complications may occur. The risk of side effects and complications increases proportionately with the depth of the chemical peeling agent. Superficial chemical peels are usually associated with the lowest risk of adverse reactions, whereas medium-depth peels can cause pigmentation disorders and sometimes scarring. Phenol peels are further associated with hepatic, renal, and cardiac toxicity.
Side Effects and Complications of Chemical Peels
- Persistent erythema
- Infection
- Milia
- Dyspigmentation
- Textural changes
- Fibrosis and scarring
- Cardiac, renal, and hepatic toxicity (associated with phenol peels)