Peels

Aesthetic and / or medical conditions of the epidermis and superficial dermis can be treated with chemical peels. Chemical peels are traditionally discussed in terms of the depth of injury (superficial, medium, or deep).

What are superficial peels?

Alpha hydroxy acids (AHA) are the more commonly used agents in superficial chemical peels. AHA are naturally occurring acids that include the following: glycolic acid, lactic acid, malic acid, and citric acid.

Glycolic acid is the AHA most frequently used. It can be applied to all skin types with minimal risks (Murad, 1995). It is a mild exfoliating agent that smoothes fine lines and wrinkles and improves skin texture and tone if repeated regularly. The extent of the exfoliation is dependent upon the acid's concentration and pH as well as upon the duration of the application.

Experimental studies have shown that glycolic acid has an anti-aging effect on numerous skin components. This acid diminishes skin aging by modulating collagen synthesis: human cultured fibroblast proliferation and collagen synthesis are significantly increased after a treatment with glycolic acid (Kim, 1998). In photoaged hairless mice, glycolic acid treatments contribute to a significant decrease in wrinkles, an increased thickness of the dermal repair zone, and an increased amount of collagen synthesis (Moon, 1999).

Peels using low concentrations of trichloro-acetic acid (TCA 15%) are also considered superficial.
Superficial peels require no downtime; side effects are limited to mild redness.

What are medium peels?

Most of the medium-depth chemical peels are achieved with trichloro-acetic acid (TCA 20% to 35%). This treatment is relatively simple and has a favorable risk/benefit ratio. Indications for medium TCA peels include both medical conditions, such as diffuse photodamage with contiguous actinic keratoses, and cosmetic conditions, such as an overall aging of the face, solar lentiginoses, or fine lines.

Numerous clinical and histological observations underline the effectiveness of TCA peels (Cooley, 1997; Nelson, 1995).

TCA application (degree and depth of penetration) can be controlled easily and accurately. Side effects are uncommon and will depend on the concentration of the acid used (20%, 25%, 30%, or 35%) and on the duration of its application.
Another active used for medium peels is a combination of resorcinol and lactic and salicylic acids. Known as a Jessner’s, this solution is layered on the skin to treat pigmentation, acne, acne scarring and other skin irregularities.
Most medium depth peels are a one-time treatment. Post-operative care includes peeling, redness, and possible crusting. Typically, one to two weeks of downtime is needed until the wounds heal to reveal smoother, younger, clearer skin. Sun protection is an unquestionable must following this treatment.

What are deep peels?

Deep chemical peels can significantly improve the following lesions: excess of sun exposure, hyperpigmentation, actinic keratoses, and the stigmata of aging (deep wrinkles, laxity of the skin, citrin coloration). Phenol is the strongest chemical agent used for peels, and induces a deep peel.

Often called a "chemical face lift", the effects of such peels are similar to those of a CO2 laser resurfacing, restoring a youthful appearance to the face with no loss of its harmony.

What are post-treatment considerations?

Superficial peels do not require any significant postoperative care. However, a sun block should be applied to the treated area.

The postoperative care of medium peels depends on the concentration of TCA used (20%, 25%, 30% or 35%) which is to be determined for every individual case. This will be discussed during your introductory visit at the spa.

Deep peels require a general anesthesia, and a recovery period of about 7 days. Such peels must be followed by postoperative care. Again, this will be discussed in detail during your introductory visit at the spa. Deep peels may pose a particular risk for patients with a history of heart and kidney diseases (Shuster, 1998).

Overall, it should be noted that the effect of all peels can be modulated according to each patient's specific needs and desires.