To Peel or Not To Peel? That Is The Question...

Chem­i­cal peels are one of the most pop­u­lar treat­ments that are sought after today. But they can sound scary, espe­cial­ly when you real­ize that acids are being used to exfo­li­ate the skin. So why do peo­ple use them? Are they ben­e­fi­cial for every­one? To help with those who may have some doubts and ques­tions about peels, I will explain why chem­i­cal peel­ing is not only safe, but there is a chem­i­cal peel that is right for every­one no mat­ter what skin type or condition. 

Using acids to exfo­li­ate the skin pos­si­bly began with the Egyp­tians, who have been known to use fruit and milk acids more than 5,000 years ago. Around 1903, we had the first record­ing of a phe­nol peel being used by a physi­cian to remove acne scars. A lighter and more tol­er­a­ble phe­nol peel was devel­oped in Europe dur­ing the 1930’s and lat­er came to the Unit­ed States when a Euro­pean trained estheti­cian moved to Los Ange­les. She spread the prac­tice of chem­i­cal peel­ing among der­ma­tol­o­gists and plas­tic sur­geons, and we believe that this is when the use of alpha hydroxy acids, com­mon­ly known as gly­col­ic acid, were intro­duced. As the prac­tice devel­oped, using dif­fer­ent strengths of gly­col­ic acid and the intro­duc­tion of sal­i­cylic acid made the prac­tice of peel­ing safer and more wide­ly used for esthet­ic purposes. 

Today, chem­i­cal peels have gone from basic acids that can some­times be unsta­ble to advanced pro­pri­etary blends of acid, min­er­als, antiox­i­dants and neu­tral­iz­ing agents. They are the new ​“smart” peels because they can tar­get spe­cif­ic skin con­di­tions with great pre­dictabil­i­ty. Chem­i­cal peels are now rec­om­mend­ed for a vari­ety of skin types and conditions. 

The whole point of apply­ing a chem­i­cal peel is exfo­li­a­tion. The strength of each peel cor­re­sponds to how deep the acids pen­e­trate, or basi­cal­ly, how much exfo­li­a­tion is desired. And because exfo­li­a­tion can improve almost every skin con­di­tion; sun dam­age, acne, hyper­pig­men­ta­tion, most will ben­e­fit from a chem­i­cal peel. 

There are basi­cal­ly three lev­els of peels: super­fi­cial, medi­um depth and deep. Super­fi­cial peels pen­e­trate into the upper lay­ers of the skin called the epi­der­mis, remov­ing old skin cells from the sur­face, and they are typ­i­cal­ly either a gly­col­ic or a sal­i­cylic acid. Super­fi­cial peels are rec­om­mend­ed for ​“sur­face” prob­lems, such as rough tex­ture, skin dull­ness from aging, excess oili­ness, come­dones (com­mon­ly known as black­heads) and fine lines. Super­fi­cial peel­ing can reveal more skin radi­ance, increase smooth­ness and cre­ate a more even skin tone appearance. 

Medi­um depth and deep peels pen­e­trate below the epi­der­mis. These deep­er peels induce a con­trolled wound to the der­mis that will begin a heal­ing response that results in more aes­thet­i­cal­ly pleas­ing skin. They are typ­i­cal­ly a blend of acids such as lac­tic, gly­col­ic, sal­i­cylic, phe­nols, resor­ci­nol, phyt­ic, pyru­vic, retinoic acids, and TCA (trichlo­racetic acid), etc. These peels are rec­om­mend­ed for ​“deep­er” skin prob­lems, such as pho­to-aging, fine lines and wrin­kles, pig­men­ta­tion from sun or melas­ma, acne, and mild acne scar­ring. As the skin repairs itself, there may be 3 – 7 days that the skin will be red and go through a peel­ing process of shed­ding the old cells and the new cells replac­ing them. This process is called ​“re-epithe­lial­iza­tion” and usu­al­ly starts 24 hours after wound­ing. One of the ben­e­fits of this heal­ing process is that it trig­gers an increase in fibrob­last pro­duc­tion, a major der­mal com­po­nent of col­la­gen. Improve­ment in hyper­pig­men­ta­tion, age spots and a more youth­ful appear­ance can require repeat­ed peels, but the results can be dramatic. 

Sen­si­tive skin, dark skin col­or and cer­tain inflam­ma­to­ry con­di­tions can receive chem­i­cal peels, but there may be some lim­i­ta­tions. Dark­er skin types must be care­ful when using deep chem­i­cal peels. The skin may respond in the wound heal­ing process by dark­en­ing, which is why, gen­er­al­ly, only super­fi­cial peels are rec­om­mend­ed. Inflam­ma­to­ry skin con­di­tions like acne, acne rosacea and seb­or­rhe­ic der­mati­tis can use super­fi­cial peels with care but, sal­i­cylic, lac­tic and man­del­ic acids are pre­ferred over alpha hydroxy acids that can some­times be too stim­u­lat­ing for these con­di­tions. These par­tic­u­lar acids are anti-inflam­ma­to­ry, reduce red­ness, and help con­trol flare-ups that are due to cel­lu­lar buildup of dead skin. Chem­i­cal peels can help man­age prob­lem­at­ic skin by giv­ing the skin a smoother and clear­er complexion.

There are many vari­eties of chem­i­cal peels and know­ing which one is right for you may be dif­fi­cult. Many fac­tors have to be con­sid­ered, but a trained estheti­cian will take your med­ical his­to­ry, skin con­di­tion and lifestyle habits when deter­min­ing which peel is most ben­e­fi­cial for you. Whether you need a super­fi­cial or deep peel, bet­ter look­ing skin is the result, and who does­n’t want that? 

So yes — ​“To Peel” is the answer.