Today, with skin rejuvenation and reversal of sun damage paramount in the minds of many, chemical peeling has emerged as an exciting supplement to a total skin care program.  Peeling of the skin to improve its texture and color has been practiced since the days of ancient Egypt.  Dermatologists have been using peeling agents for the past 50 years.  Peels of varying strengths can be used over the face, chest and hands or on isolated problem areas.  Dermatologist, Steven Werth, MD, discusses some of the benefits and limitations of chemical skin peels. 

Q. What are the different types of peels and what are they used for?

A. "Light" peels can be used to treat acne and blend irregular pigmentation.  "Medium" peels can be used to treat acne, pigment abnormalities, shallow wrinkles and rough precancerous growths.  "Deep" peels are used for deep wrinkles with dramatic results; however, there are more risks involved, such as scarring and loss of pigment.

Q. Are there conditions not improved by skin peels?

A. They cannot improve lax skin, deeper wrinkles or scarring, or treat broken blood vessels on the face.  Other procedures are much more effective and may be followed by a chemical peel.

Q. What should I expect from a chemical peel?

A. The skin is usually "primed" for a chemical peel with a 3-6 week course of Retin-A.  This preparation opens and cleans pores so that the healing process can occur as rapidly as possible.  The peeling agent is applied for a few minutes and is then neutralized.  Afterwards the face may be pink and tight.  There is usually some dryness and peeling over the next few days, revealing soft new skin underneath; rarely, blisters occur.  Healing varies and depends on the type of chemical used and the individual's skin.  Patients may then choose to use a facial cleanser and/or lotion at home containing a more dilute peeling agent to maintain the result.

Q. Can I have several peels?

A. The effects of repeated peels are generally cumulative and successive peels may be performed 1-2 weeks apart for several weeks.  The light and medium peels are the safest and the recovery is quick.  There is a growing tendency among physicians to perform repeated light or medium peels to achieve the desired effect rather than risk the side effects of the deep peels.

Q. What are the risks involved?

A. Like most procedures, there are possible complications that may occur.  In general, the deeper the peel, the greater the risk and the more time that is required for healing.  Pigmentary changes (darker, lighter or blotchy) are possible; these usually blend in over time and depend on the patient's skin type and amount of sun the skin is exposed to after a peel.  Scarring is possible, but uncommon.  Other complications include skin infections, a line of demarcation between the peeled skin and the unpeeled skin, and persistent itching or redness.

Q. Will a peel always work?

A. It is recommended that all expectations be thoroughly discussed with your physician prior to considering a chemical peel.  A peel, designed to improve your skin, cannot be expected to produce perfection.  Certain patients may benefit more from alternative modes of treatment.

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