Chemical Peels

Chemical and laser peels are essentially divided into three categories, superficial, medium and deep, depending upon the depth of the wound created by the chemical or CO2 laser.The skin is divided into two main layers, the epidermis and dermis.The epidermis is itself a five-layer structure and the dermis is composed of two layers.Superficial depth peels penetrate into the epidermis only, while medium-depth peels damage the entire epidermis plus the papillary dermis to the level of the reticular dermis.Deep chemical peels create a wound to the level of the mid-reticular dermis.Each category of peel addresses a different aspect of patient dissatisfaction of sun damage and pigmentary abnormality.

Superficial chemical peels and CO2 laser resurfacing can be performed comfortably in an office-based setting.Although one peel will provide noticeable results, a series of superficial peels may be necessary in order to achieve additional benefit.Superficial peels offer improvement in skin texture, thickening of layers of the epidermis, as well as improvement of some melasma (dark irregular patches) and solar lentigenes (brown lesions).Medium depth and deep chemical or laser peels further improve the sign’s of aging that are located deeper in the dermis.Medium depth and especially deep peels typically require some level of local anesthetic or sedation.General anesthesia is also a good option for some skin resurfacing procedures.

CO2 laser skin resurfacing is a time honored and predictable method for resurfacing the facial skin.Laser resurfacing of the neck is less predictable but can be performed with success.The CO2 laser beam wavelength is 10.64 microns and targets the water in the skin and causes a vaporization of the layers of the skin. Fractional CO2 resurfacing means that only the laser beam treats a fraction or portion of the skin.By leaving small "bridges" of untouched skin, the healing process is faster and patients can return to normal activities sooner.CO2 resurfacing not only results in an improved aesthetic component to the skin, but also results in clinically and microscopically healthier facial skin.

DeepFx is a revolutionary fractional laser technology for aged, sun-damaged or scarred skin.This low-downtime procedure uses CO2 laser microbeams to precisely target the deep dermal layers of the skin in a single pass.This stimulates a cascade of healing responses that leads to tissue regeneration and new collagen formation throughout the entire treatment area.Each laser pulse removes a narrow column of tissue while simultaneously treating surrounding skin.This technology penetrates the epidermis and the dermis while leaving adjacent tissue (bridges) intact and viable.This deep heating causes immediate collagen contraction and long-term collagen remodeling.The result is softening and smoothing of deeper wrinkles and scars, and improved skin texture.Benefits of DeepFX include; significant results in a single treatment, low downtime, scar improvement, wrinkle reduction and texture refinement.

Chemical peels are available to all patients and skin types.The type, aggressiveness and purpose of the peel are always taken into consideration and depend on many variables. Individuals treated with Accutane must wait 6-12 months after its discontinuation prior to engaging in skin peels. In general, performing resurfacing on whiter skin results in fewer potential side effects and complications versus darker skin types.Depending on skin type, peel depth and skin conditions, 6 to 8 weeks of skin pre-conditioning may be prescribed in order to properly prepare the skin for the chemical peel and to reduce the incidence of side-effects and potential complications.Not all people are "ideal" candidates for CO2 skin resurfacing. Patients with darker skin (Fitzpatrick 4-6) are best suited for chemical peels.The Fitzpatrick skin classification correlates skin color to sun exposure response and indicates to a good degree how someone will respond or react to facial resurfacing treatments.

The Fitzpatrick Classification Scale was developed in 1975 by Harvard Medical School dermatologist, Thomas Fitzpatrick, MD.This scale classifies a person’s complexion and their tolerance of sunlight.Many physicians utilize this categorization to help determine how someone will respond or react to facial treatments. In general whiter skin has fewer side effects and potential complications following more aggressive peels versus darker skin types.

Fitzpatrick Classification Scale

The skin is the human bodies largest organ.Human skin makes up 15% of our total body weight.Skin acts as a protective barrier to harmful substances such as bacteria, foreign bodies, chemicals and ultraviolet light.Skin also helps to retain water and regulate body temperature.The skin is made up of three distinct layers; the epidermis (top layer), the dermis (the middle layer) and the subcutis (the bottom layer).The epidermis is responsible for manufacturing skin cells and pigment.The dermis is deep to the epidermis and is the foundation for the epidermis.The dermis contains collagen, elastin, pilosebacous glands and blood vessels.The dermis supports the epidermis both structurally and physiologically with all the nutrients and vitamins it needs to produce an effective barrier.All skin resurfacing, whether done by traditional dermabrasion, chemical peeling, or laser resurfacing targets the layers of the epidermis or both the epidermis and the dermis.In general, Fitzpatrick skin types I-III are the best candidates for these treatments.Skin types I, II and III typically are at minimal risk of significant or prolonged complications.Skin types IV, V and VI are treated with caution and great care when applying any ablative laser technology.Fractional resurfacing is now allowing for more effective treatment of darker skin types using adjusted laser settings.When skin types IV-VI are treated with this modality, intensive pretreatment skin care is coupled with lighter CO2 treatments and followed by post-treatment skin care.Instead of using the CO2 laser, darker skin types are best treated with chemical peeling agents.

By inducing a controlled wound to the skin, chemical peels and laser resurfacing replace part or all of the epidermis and none or part of the dermis, induce collagen remodeling which helps to improve photodamage, wrinkles, pigmentation abnormalities and scarring.Light or superficial chemical peels offer a minimal downtime procedure designed to refresh healthy but dull skin.A series of superficial peels will offer more dramatic results.Deeper peels are designed to target more severe photodamage and aged skin characteristics. While CO2 laser resurfacing is typically limited to the face and carefully applied to the neck, chemical peeling is useful and effective on multiple body areas including the arms, hands, neck and chest.

Alpha-hydroxy Acid Peels

Alpha-hydroxy acids (AHAs) are naturally occurring substances found in many foods.Glycolic acid, which is derived from sugar cane, is the most commonly AHA agent for superficial peeling.Synthetic glycolic acid is commonly used today. Lactic acid and citric acid are other alpha-hydroxy acids. Glycolic acid is found in low concentrations (10% to 15%) in many over the counter facial creams.When used medically as a superficial peeling agent, a higher concentration of 35% to 75% is used.A greater depth of wounding can be achieved by using greater concentrations of glycolic acid.AHA’s deliver both cosmetic and therapeutic results to the skin with a quick recovery time.AHA peels are nicknamed the “lunchtime peel” because there is minimal apparent disfigurement post peel.AHA peels are superficial peels that remove layers of the epidermis. Higher concentration AHA’s such as 50% or 70% glycolic acids will induce a deeper skin effect that offers therapeutic dermal collagen remodeling and longer term beneficial skin benefits.AHA peels can be used to treat all skin types. AHA peels are used for sun damage, acne, melasma (dark skin discoloration), lentigines (raised spot on the skin) and seborrheic keratosis (benign non-cancerous skin growth).An AHA peel is used in the patient looking to refresh their skin’s appearance.The improvement of fine lines, uneven skin tone, and rough skin is achieved with this peel. The number of treatments necessary is dependent on the initial skin condition and desired result.Deeper wrinkles and grooves will not be corrected with this peel.Glycolic peel advantages include minimal recovery and minimal potential complications.

Jessner’s Peel

Jessner’s solution is a superficial or medium depth chemical peel. Compared to a glycolic acid peel a Jessner’s peel is used for more extensive skin damage. The Jessner’s peel is excellent for all skin types.It’s one of the most effective light chemical peel’s available. This peel is used to lighten areas of hyperpigmentation and to treat sun damaged skin.It smoothes and rejuvenates skin, producing beautiful results in treating acne, discoloration, wrinkling and photodamage.Like other peeling agents, Jessner’s solution can be used effectively on the neck, hands and chest.Following a Jessner’s peel, you can expect flaking and exfoliation of the treated areas in the following three to seven days. Jessner’s solution combines resorcinol (a light peeling agent), lactic acid (an alpha-hydroxy acid) and salicylic acid (beta-hydroxy acid) to result in deeper penetration and greater exfoliation of the outer layers of skin cells. Resorcinol is used to treat acne and other skin conditions.Resorcinol helps break down hard, rough skin.

This type of peel provides a greater exfoliation and requires a longer healing time versus glycolic peels.A Jessner’s peel may be used by itself or in combination with other peeling agents.For more damaged skin, Jessner’s Peel is combined with TCA.Acne vulgaris, wrinkles, sun damage and skin lesions are corrected with this peeling agent.

Trichloroacetic Acid (TCA) Peel

TCA peels are very popular treatments.TCA may be used for tissue penetration of superficial, medium and deep depths, depending on the concentration and number of coats applied. The choice of TCA concentration and number of coats applied will be determined based on factors including skin type, amount of sun damage and patient desires.If more than a superficial peel is desired and in dark skin types, typically six to eight weeks of skin pre-treatment will be necessary in order to obtain the best results with the fewest possible side effects and complications. TCA peels are used for wrinkle reduction, pigmentation abnormalities and some forms of skin laxity.

Prior to undergoing any cosmetic treatment or surgery, make sure your goals and expectations are reasonable.Except for superficial peels and in certain cases, a six to eight week skin preparation is required prior to undergoing skin resurfacing.The preparation includes the use of Retin-A, skin bleaching agents and regular use of sunscreen.A light chemical peel may be performed in the weeks prior to a deeper peel. Therefore you must allow enough time for this important step prior to having the actual resurfacing treatment. This preparation phase allows for better, more even penetration of the chemical peeling agent and less incidence of post treatment complications.A further consideration includes understanding the time period for post-treatment healing.While superficial peels have virtually no downtime, deeper peels are associated with downtime from 3 to 10 days.Erythema (pinkness or redness) associated from the procedure may last up to 14 days and occasionally longer.Cover up makeup can almost always be applied at 10 days post procedure.

While chemical and laser skin resurfacing is generally safe and significant complications are unusual, any procedure has associated risks and potential complications.In general the darker the person’s skin and deeper a peel is delivered, the greater the risks.Most complications are avoided by proper preparation of the skin for peeling and proper choice of agent or device and depth of peel for the patient.Some of the risks include; post-inflammatory hyperpigmentation (darkening of the skin), hypopigmentation, (lightening of the skin), infection, prolonged erythema (redness) and scarring,

Every adult is a great candidate for professional home skin health care. The results derived from physician prescribed and supervised skin care can be impressive and many times avoid more aggressive future treatments.Unlike over-the -counter skin care products, prescription skin care products typically contain more effective ingredients or higher active ingredient concentrations designed to target specific skin related conditions. An effective, well-planned home skin care regimen is analogous to exercise for your body. As exercise is healthy for your heart and muscles, a good skin care program is beneficial to your skin.The result is firm, clear and resilient skin.Utilizing a Physician prescribed and supervised skin health care regimen is like having a personal trainer for your skin.

Besides the regular and committed use of an excellent home skin health care program, superficial chemical peels are very popular due to their relative safety, ease of performance and cost value.There are many options when considering superficial chemical peels.More popular peels include; Alpha-hydroxy acids (glycolic acid), TCA (Trichloroacetic Acid) in low concentrations, and Jessner’s peel.Performed comfortably in an office based setting, superficial facial chemical peeling offers a great skin refresher option.

It is very important to follow the pre skin resurfacing protocol closely.By following the pre-peel regimen as prescribed, the effectiveness of the peel will be maximized and incidence of post-peel complications minimized.You will be asked to use a six to eight week home skin care system.This includes a gentle cleanser and toner; exfoliate, bleaching cream and sunscreen.These products are used for a distinct purpose.Using this program as prescribed is analogous to an athlete training for a big event.If an athlete did not prepare, train or warm up for his or her game, the chance for injury or under achievement is higher.The same goes for your skin.With proper pre-resurfacing skin care, your skin will be much more likely to have a top-notch finish.

Downtime is predictable and should be balanced with patient expectations and skin type.It is important that you be sufficiently prepared for your post-peel recovery period.Complete written post-operative instructions will be provided prior to your chemical peel or laser resurfacing.In addition, our staff is available 24 hours a day to answer your questions. The discomfort experienced from a chemical peel or CO2 laser resurfacing is temporary.Healing at home is painless.The burning feeling from a chemical peel dissipates quickly, typically before you leave the office.Deeper CO2 resurfacing involves a burning sensation lasting a few hours after the procedure. You will be instructed to wash your face twice daily without rubbing off any skin.Applying antiseptic compresses is instructed in some cases.A moisturizer or a thicker emollient will be used.You will be instructed to minimize facial expression and to sleep on your back for the first two or more nights.Deeper peels require more aggressive home care while superficial peels require little initial care.Healing time can be delayed by patient factors such as picking or rubbing the skin or by making too much facial expression that can lead to cracking of the scabs.The first stage of healing is complete when the epidermis has been restored(reepithelialization) and the skin can tolerate topical treatment with hydroquinone and tretinoin (Retin-A).In the next stage of healing, dermal changes, including collagen production and alignment and neovascularization take place for two to six weeks.For that reason, the results of the peel should not be judged until then. You will experience tightness in the face and/ or neck for the first week.For the first day or two you should eat a soft diet until the tightness improves. While looking at your face in the mirror is allowed, please do not obsess about your initial appearance. Everyone experiences a temporary surprise when viewing a reddened or swollen appearance in the mirror. Remember that a more attractive, youthful "you" will show through in several days. Ice bags should NEVER be used against the skin.Applying ice directly to the skin may result in skin death.Showering is allowed but avoid being struck on the face by the shower water while bathing.Remember, the face will be gently washed twice daily using a gentle cleanser and then patted dry. Gentle shampoo may be used. Glasses can be worn as long as the stems do not irritate your skin or ears.

When it comes to chemical peeling, the physician-patient relationship and patient compliance with all instructions is paramount to obtaining the desired result.

Dr. Mitchell is a Board-Certified Facial Plastic and Reconstructive Surgeon.Dr. Mitchell has successfully treated hundreds of patients for both premature and mature aging of the face.Dr. Mitchell’s artistic ability and thorough knowledge of facial anatomy and physiology translates into reliable and consistent success using both medical and surgical forms of facial rejuvenation. From simple mole removal to full face and neck resurfacing, Dr. Mitchell is at the forefront of delivering the CO2 laser wavelength for skin rejuvenation. Dr. Mitchell has objectively documented numerous sequential successful cases and has been chosen by Lumenis to be a Lumenary Physician; selected to train other physicians on proper and safe use of laser and light based technologies.