When you think of chemical peels, do images of Samantha’s flaming, glazed face from Sex in the Citycome to mind? Not very enticing if you’re thinking if a chemical peel is right for you. However, our understanding of peels has evolved over time, and the need to feel some pain to see the gain isn’t exactly the mantra of peels anymore.
Chemical peels work by doing just that—peeling away layers of your skin to treat a variety of skin concerns including wrinkles, brown spots, dullness, scarring and pore size. Chemical peels are used to help with melasma, acne and actinic keratoses (precancerous lesions on the skin). The concept behind why peels works is simple—you are creating controlled injury or trauma to the skin to remove unwanted pigmentation and dead skin cells and to restart body’s own ability to regenerate new skin and stimulate collagen production to help with sun damage and wrinkling.
Before we dive into peels, it’s helpful to revisit the two primary layers of the skin, the epidermis and dermis. The epidermis is your outermost layer and consists of four layers: stratum corneum, stratum granulosum, stratum spinosum and stratum basale. The palms and soles also have a fifth layer called the stratum lucidum. Melanocytes or your pigment producing cells live in the epidermis and new skin cells are generated in the stratum basale. The dermis is the second layer and is home to collagen, elastin, nerves, hair follicles and blood vessels.
Peels are often classified based on strength and depth. In general, the stronger the peel, the deeper it penetrates the layers of the skin. Chemical peels use different ingredients including resorcinol, mandelic acid, glycolic acid, lactic acid, phytic acid, salicylic acid, and trichloroacetic acid (TCA). The depth and effect of the peel vary depending on the intensity and make-up of the chemical peel. Peels are typically divided into four types: very superficial, superficial, medium and deep. Very superficial peels target the stratum corneum (dead surface cells) and can be done at home with over-the-counter products. The main goal of very superficial peels is to improve skin texture and to exfoliate and they usually contain alpha-hydroxy acids or mandelic acid. At home peels can also be used to maintain results from in-office peels.
Superficial peels, often referred to as “lunchtime peels” are done in-office and focus on the epidermis and help with texture and improve discoloration. They can also stimulate collagen production indirectly by promoting communication between epidermal and dermal cells. One plus for superficial peels is they have little down time. Medium-depth peels target both the epidermis and the upper dermis and are better for skin with visible sun damage and help promote new collagen while fading sunspots and improving texture. Typically, medium depth peels are TCA based. Deep peels, you guessed it, go deep into the dermis, usually are phenol based and may require general anesthesia. Due to the risk associated with deep peels, many favor laser resurfacing in its place.
Now if you’re thinking a peel might be for you, first it’s important to assess what you’re trying to improve and then a peel will be tailored to your own unique needs and goals. When considering what depth of peel might be your jam, skin tone is also important to avoid hyperpigmentation and scarring. Darker skin types are at higher risk of unwanted pigmentation changes with a peel. Have sensitive skin or think you need skin of steel to handle a peel? Not so! Peels can also be used in more sensitive skin types and patients with conditions like rosacea or eczema. Just remember, there isn’t a one size fits all for chemical peels.
Trotter’s Take: Chemical peels are an undervalued treatment to help with both cosmetic and medical skin concerns and should be performed by a trained professional who can personalize the peel based your skin type and unique needs. Considering doing a peel and want to learn more? Then check out my podcast with Dr. Jennifer Linder as we discuss the latest in chemical peels.
