The chemical peeling, also known as chemical exfoliation or derma-peeling, is a technique used for improving the skin appearance. During this treatment, the chemical substance applied on the skin determines the appearance of blisters, followed by the exfoliation of the cutaneal surface. ”The new skin” is much softer and less wrinkled, but it is temporarily sensitive to sun rays.
Whom the chemical peeling is addressed to?
This procedure (chemical peeling) can be performed on the face, neck or hands and is used for removing the fine wrinkles under the eyes and around the mouth, as well as the ones resulting from the sun exposure, ageing or hereditary factors. At the same time, it is addressed to persons suffering from certain types of acne or post-acne scars, it reduces the freckles and the sun spots, as well as the post-pregnancy hyperpigmentations (melasma) or the hyperpigmantation that appeared after the treatment with oral contraceptives.
Usually the persons having fair skin and hair are the ideal candidates for chemical peeling (I-III Fitzpatrick prototype), but also the persons with darker skin may obtain good results, depending on the type of problem for which this procedure was indicated.
Preparation and planning for this procedure
The chemical peeling can be performed only by a doctor, in a medical office, no anaesthesia being required for the peelings based on AHA and TCA. Before a chemical peeling, the conversation with your doctor should clarify your expectations, the benefits and risks, the recovery time and the costs. Don’t forget to inform your doctor if you are currently taking antibiotic or antiviral drugs, since certain drugs are photosensitizing. As a rule, after the superficial peeling, no assisted care is required.
There is a wide range of chemical peelings, as there is a great variety of chemical products, each having its own properties. The peeling with phenol is the solution with the highest concentration and it cleans the skin deeply, while TCA (trichloroacetic acid), in various concentrations, is considered to be a peeling of medium deepness. The glycolic acid and alpha hydroxy acid peelings are considered to be mild, being frequently recommended in the home care treatments.
Alpha hydroxy acid and glycolic acid peeling
The alpha hydroxy acids, such as the glycolic acid, the lactic acid or the fruit acids have become popular due to their property of removing the dead cells from the skin surface. Since the very times of Queen Cleopatra, well known for her frequent bathing into goat milk, rich in lactic acid, these mild peelings have been included in the beauty care products in time, becoming freely distributed in pharmacies, but with too low concentrations to obtain notable effects (<10%). The alpha hydroxy acid peelings, with concentrations varying from 30 to70%, performed by the doctor only, removes the horny layer of the skin (the dead cells), leaving a smooth and radiant skin, being indicated for the removal of the fine lines, of the pigmentation spots and of the acne. It is well known the role of glycolic acid in the stimulation of collagen production, the collagen being the protein that gives structure to the skin.
Advantages: recuperarea este rapida, in mai putin de 12 ore, nu se formeaza cruste, exfolierea nu este notabila si de obicei sint necesare peelinguri repetate. Se recomanda protectie solara cu SPF>15 pe o perioada de 8 saptamani.
Preparation: at least one week before peeling, you must stop using creams or lotions based on retinoic acid or Retin-A, and also you must stop applying gommage or exfoliation creams. No hair removing wax will be used, and men are not allowed to shave on the peeling day.
Procedure: zonele mai sensibile (pleoape, buze) si este lasat sa actioneze timp de 2-5 minute, cu cat timpul mai lung cu atat mai mult produsul patrunde mai bine. O data timpul scurs, indepartarea acidului se face mecanic (tifon imbibat cu apa) si chimic (solutii ce neutralizeaza acidul glycolic).
Dupa tratament, pielea capata o culoare rosie care dispare in maxim 12 ore. Tratamentul poate fi repetat la interval de saptamani sau luni pentru imbunatatirea si mentinerea aspectului proaspat al pielii, precum ca pretratament pentru peeling TCA.
TCA (Trichloroacetic acid) peeling
The trichloroacetic acid (TCA), used in various concentrations, for a peeling of medium deepness, reduces the surface fine lines and treats the problems related to the skin pigmentation. Several peeling sessions are required, at 2-3 months distance from one another, and sometimes, in order to increase their efficiency, the doctor might recommend the combination of such peelings with other rejuvenation procedures, including mesotherapy or Laser rejuvenation.
Considerations: this is a deeper peeling, addressing more significant cutaneous defects that cannot be solved by superficial peelings, sometimes several treatments being necessary. The maximum crust formation takes place within 48 hours, while after 2-3 days the crusts start falling spontaneously with progressive attenuation within 7-10 days. In order to ease the desquamation process, it is recommended to apply antibiotic ointments, and sometimes the antibiotic administration is required post-peeling.
Procedure: after cleaning the face, the trichloroacetic acid is applied by means of cotton swabs, passing once or several times over the skin, until the “frosting” effect is obtained, meaning that the skin colour becomes pearled – white, freezing like. The discomfort is bearable and can be eliminated by ventilating the face. A TCA peeling doesn’t take more than 15 minutes and once the time is up, the chemical solution is removed by washing thoroughly with water or by using neutralizing solutions.
Two or more TCA peelings might be necessary for obtaining the desired results, and you can have these peelings at intervals of several months. After a few minutes, the skin becomes red, edematiated, and in a few hours the skin will be covered by brown crusts (maximum 48 hours), and these crusts will start falling after 2-3 days. It is forbidden to force these crusts out as there is a risk of wounds and scars appearance.
The social reintegration usually takes place after 1-2 weeks, when the redness and the oedema have diminished and when it is allowed for the patient to apply make-up products. After the treatment, sun exposure is completely forbidden for 2-6 months after the peeling, and the use of SPF cream is required.
The possible complications after the chemical peeling are directly related to its aggressiveness.
There is little probability that the scars appear after the superficial peelings, while the medium and deep peelings may present this risk.
By removing the horny layer of the skin (dead cells), the skin pores may seem open, dilated, but this is just a temporary condition until the curing of the erythema and of the oedema.
Though infections are rare, they may be connected to the pre-existence of local conditions (papulous acne, herpetic infections), being preferable to postpone the intervention in such cases.
It is absolutely necessary that the patients should be informed that the non-uniform pigmentations (hypopigmentation, hyperpigmentation), may be avoided by limiting the use of photo-sensitizing medicine, oral contraceptives, direct exposure to sun, without chemical protection (screen factor) or mechanical protection (hats with large brim) or even without pregnancy for at least 6 months after the peeling.
The chemical peeling is a relatively safe procedure, accompanied by a high satisfaction rate, and the above-mentioned complications are rare.