YTF Cosmetic Surgery Patient Network

• What Is a Chemical Peel?
• Your Options In Chemical Peels
• Are You a Candidate for a Chemical Peel?
• What to Expect at Your Consultation
• Your Preoperative Appointment
• Preparing for Your Chemical Peel
• How This Procedure Is Performed
• The Road to Recovery 
• Important Contraindication of Chemical Peels
• Risks & Complications of Chemical Peel
• The Least You Need to Know About Chemical Peels

What Is a Chemical Peel?
This procedure can restore sun-damaged, wrinkled, blemished, acne scarred or blotchy skin to its original youthful appearance.  The results are normally a smoother more even toned textured skin.  The skin will look younger, tighter and fresher than before although it cannot remove all facial flaws.  Deeper lines, wrinkles and other flaws may require additional treatments or techniques.  The chemicals normally used are Trichloracetic acid (TCA, for more superficial lines and blemishes) or Phenol (a much deeper and more serious peel) for deeper wrinkles, flaws or discolorations.  Regardless, the down time is considerable so be prepared to take time off for recovery. 

Your Options in Chemical Peels
There are very minor peels and there are deeper, more serious, peels requiring sedation and extensive recovery time.  We will discuss the available options today so that you may make a well-rounded, informed decision.  These peels can be used not only on the face, but on the neck. chest, back, arms, hands, etc.  Anywhere you wish to rejuvenate or improve your skin.

• Alphahydroxy Acid: These peels help with fine, superficial wrinkles, sun damage, unevenness, white and black heads, pimples and splotchiness.  These peels can also improve dryness and dehydrated skins.  They aren't very invasive and provide mild resurfacing results.  They produce a mild rejuvenation without the extended downtime of a more invasive peel.
  • Fruit Acids: There are five main fruit acids: citric acids (citrus-derived), glycolic (derived from sugar cane), lactic acid (although derived from milk, this is still considered a "fruit acid"), malic (derived from apples) and tartaric (derived from grapes).
    • Citric Acid peels: Usually derived from lemons, oranges, limes and pineapples. These peels are simple and effective, although not incredibly invasive or capable of significant improvement with one treatment.
    • Glycolic Acid Peels: formulated from sugar cane, this peel creates a mild exfoliating action.  Glycolic acid peels work by loosening up the horny layer and exfoliating the superficial top layer.  This peel also stimulates collagen growth.

• Lactic Acid Peel: An in-office 70%or less alphahydroxy facial peel to remove dead skin cells, and promote healthier, softer and more radiant skin.  This peel is derived from either sour milk or bilberries.  Cleopatra was said to bathe in asses' milk.
• Malic Acid Peel: This peel is the same type of mildly invasive peel derived from the extracts of apples.  It can open up the pores, allow the pores to expel their sebum and reduce acne.
• Tartaric Acid Peels: This peel is derived from grape extract and is capable of delivering the same benefits as the above peels. Have your skin technician determine which is best for your individual needs.

For the above peels, do NOT pick or pull at the flaking or peeling skin.  Also moisturizing can lessen the benefits of the peel.  Although extensive cracking an bleeding will not help either, moisturize these areas or apply a calming serum such as Neova Calming Green Tea Serum with Copper Peptide.  This will heal these areas and lessen cracking and bleeding which can scar your newly uncovered skin.  Peeling or exfoliating your sensitive skin at this time can significantly scar your skin.  These peels may be reapplied at 2 week intervals.

• Jessner's Peel: This is a medium depth peel designed for more extensive damage than AHA's can improve. It is made from salicylic acid (a beta hydroxy acid), lactic acid (an alpha hydroxy acid) and resorcinol.  Your surgeon or skin technician will apply a glycolic cleanser over your face to fully remove the oils and horny layer so that your Jessner's solution will penetrate properly.  Then he or she will apply the Jessner's solution to your face, it will then burn slightly (although this uncomfortable sensation can be relieved by a fan blowing cool air on your treatment area). you may have several layers applied depending.  You may develop a whitened look, known as "frosting" that will dissipate within a few hours.  Then your skin technician will neutralize the acid and remove your solution with cool water.  Your technician may apply a calming mask and you will be sent home.  You will peel and flake for about 7 days and turn pink or brown afterwards.  After you heal nice, smooth skin will be revealed. 
  
  Do NOT ever pick or pull at the flaking or peeling skin, it can cause scarring or an infection which can spread all over your skin and cause scarring.  Also moisturizing will lessen the benefits of the peel.  Although extensive cracking an bleeding will not help. Moisturize these areas or apply a calming serum such as Neova Calming Green Tea Serum with Copper Peptide.  This will heal these areas and lessen cracking and bleeding which can scar your newly uncovered skin, but may burn a little if you place it on raw skin -- I use a fan to blow on it at first.  Peeling or exfoliating your sensitive skin at this time can significantly scar your skin.  This peel may be reapplied at 2-3 week intervals.

• The Obagi Blue Peel: In order to have the Blue Peel you usually have to go through one cycle of Obagi Nu-Derm to prep the skin.  This will help prevent hyperpigmentations from forming from the peel.  This type of peel is relatively new.  Also developed by Dr. Zein E. Obagi, this peel is an in-office trichloracetic acid (TCA) peel to correct fine lines, superficial scars, minimal laxity and pigmentation problems.  It is performed in 1 to 4 steps and is very beneficial to persons of all skin types.  Usually more invasive peels are unfortunately suitable to only those of European Caucasian descent.  With the Blue peel, persons of ethnic skin tones such Asian, African-America, Italian and other darker skins tones can safely undergo beneficial resurfacing. 
  
  The solution is applied in 1 to 4 layers and left on the skin for 25 to 30 minutes.  You may feel a slight burning or stinging sensation as each layer is applied which may last from 2 to 5 minutes.  A fan will help you tolerate the stinging sensation -- so request if this is used.  The blue tint will darken and advise the skin technician when the peel is complete.  The blue tinge that you get from this peel may last for up to 3 or 10 days, depending.  So prepare to take off a few days for this one as well.  This peel may be reapplied at 4 week intervals. 
  
• Phenol: Chemical peeling with phenol is used to improve significant actinic damage as well as moderate wrinkling of the skin. It provides a relatively deep and predictable injury to the dermis. “Pure” phenol is 88%.  The solution most commonly used was developed by Baker and Gordon and contains 3 ml USP liquid, phenol 88%, 2-ml water; 8 drops liquid soap (Septisol); and 3 drops croton oil.  It has been shown through histologic studies that the Baker/Gordon formula penetrates deeper than pure phenol.  This is a serious peel, requires sedation and monitoring of your vital statistics.  Unfortunately, there is usually blanching of the skin and a distinct resulting demarcation line.  It is very possible that your skin will never regain its ability to tan after a phenol peel so consider this before committing to such a procedure.  Also this peel is usually reserved for the face - and not the neck, arms, etc.  It is reported that scarring can result when used on these non-facial areas.
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• Refinity Medical Skin Solutions®: This peel and the accompanying skin care is a medical strength AHA without the high known to occur with this type of peel.  Refinity goes by the belief that in order to produce maximum results, a high level of acid must be made available to the skin.  The higher the level of Exfoliation or skin renewal.  However, increasing acid strength also increases the potential for skin irritation.  They report that in order to obtain the best result, one begins using a mild solution then works up to a higher concentration -- but without the intense irritation seen with high concentrations of acid or Retin A use.  Refinity allows this to happen with the addition of COSMODERM-7™. 

The peel itself takes about 5 to 15 minutes and the entire treatment lasts about 30 minutes.  You will be a little pink or even slightly red afterwards but smoother skin is a definite benefit.  The Refinity Peel helps improve crow's feet wrinkles about 35%, whereas age spots, superficial facial lines and uneven skin town can be improved from a little over 50% to 70%.  The smoothness of the skin and moisturization properties can be improved by as much as 98%. 

• BioMedic MicroPeel®: This procedure is a three step process which is a combination of a manual exfoliation, a chemical peel and a Cryogenic Therapy session -- together.  It outcome is extraordinary.  The first step is a five minute manual or enzymatic exfoliation treatment.  This step allows the removal of the skin's horny layer, known as the stratum corneum.  This allows the acids to penetrate more deeply and also to improve the look of hyperpigmentations. 

The optional second step is a 15 to 30% Alpha Hydroxy Peel. Your skin specialist will leave this on your skin anywhere from 15 seconds to 2 minutes, and no longer.  You will feel a slight burning or stinging which can be lessened by a cool breeze from a small fan although this step is very short and may not be needed.  If you choose to add this step BioMedic recommends that you have no more than 4 to 6 treatments WITH the AHA peel.

The third step is very beneficial and the main component of the entire treatment.  This step is performed with what is called cryotherapy.  Cryogenic Therapy is the act of using a very cold substance to freeze a layer of skin.  You may have heard of sun damage and precancerous cells being removed with Cryogenic Therapy.  The substance used is Carbon Dioxide and it is applied to the face in circular motions, freezes the surface cells, helps deliver an anti-inflammatory response and smoothes the skin.  The result is a smoother, clearer, healthier complexion.

Are You a Candidate for a Chemical Peel?
Depending upon the peel, you may be a candidate for a chemical peel if you have slight wrinkles, hyperpigmentations, splotchiness, unevenness, acne, acne scars, black heads or sun damaged skin.  You may not be a candidate if you have horal erpes, as this can spread to your healing skin and cause great, weeping sores which will damage and scar your skin.  Ask your primary physician for a release and perhaps a prescription for a oral medications such as Zovirax.  This will decrease your risk of an outbreak. If your primary care physician does not release you or opposes to your having a peel -- DON'T take that chance!

For deeper peels which require sedation or extensive recovery, first and foremost, you must be in good health, not have any active diseases or pre-existing medical conditions and must have realistic expectations of the outcome of your procedure.  Communication is crucial in reaching one's goals.  You must be able to voice your desires to your surgeon if he/she is to understand what your desired results are.  Discuss you goals with your surgeon so that you may reach an understanding with what can realistically be achieved.

You must be mentally and emotionally stable to undergo an cosmetic procedure such as this.  This is an operation which requires patience and stability in dealing with the healing period.  There is sometimes a lull or depression after a deeper peel and if there is already a pre-existing emotional condition, this low period can develop into a more serious issue.  Please consider this before committing to this procedure.

What to Expect at Your Consultation
After checking a few dermatologists', surgeons' or skin technicians' backgrounds and credentials, you will make an appointment for a consultation.  You will meet with these possibles and discuss your goals and you will disclose all information regarding your health; if you smoke, what medications or vitamins you presently take, etc. -- this is very important.  Visit the Medication & Supplements List for more information. 

You will discuss your complaints and concerns and discuss the various results one can achieve, the amount that can improved, etc.  Your doctor will explain the technique and options that may be most appropriate for you and should discuss the risks associated with chemical peel with you, as well. 

You will also discuss the available anesthesia, if applicable,  that will be used for your procedure.  Most deeper chemical procedures are performed under either Oral Sedation or Light Sleep Sedation.  However, lighter peels pay need no more than an electric fan blowing cool air on you.  Either way, discuss this beforehand as many people are not aware of the risks of anesthesia.

If you would like more information on consultations or a list of questions to ask your doctor please visit the Consultation Help Page.  If you should choose to book or reserve a procedure date you will usually give a deposit to hold your date.  Most times if you cancel a few days beforehand, this amount is non-refundable.  After paying your deposit and scheduling a surgery date, you will also schedule a pre-operative appointment...

Your Preoperative Appointment
Although usually not necessary for lighter peels, this appointment addresses more questions you may not have thought to ask at the initial consultation, such as more procedure details, concerns and even ascertaining that your doctor is aware of what you desire from your procedure.  Just as your doctor will make certain that you know what it realistically possible from this procedure.

You will also discuss your pre-operative instructions and speak about the recovery period instructions and what to expect in the weeks or months ahead.  If for deep peels, you may be given prescriptions for antibiotics, pain relievers, perhaps blood pressure medicines, prescription anti-inflammatory drugs, and perhaps a box or directions for gaining Arnica montana.  Would like to know more on the benefits of Arnica montana?  Perhaps you will be instructed to obtain Bromelain or other types of remedies, although many surgeons would rather have you not take ANYTHING other than your prescription medications, please do not go against your surgeon's wishes.  Remember, always ask your doctor before taking any of these products. 

Please do not hesitate to address any concerns that you may have during this time and even after your pre-operative appointment.  If you remember something when you get home or the next day or even the day of surgery -- don't be afraid to ask. 

Preparing for Your Chemical Peel
You will more than likely be asked to closely follow a skin care regimen which includes the use of AHAs, Retin A and Hydroquinone to prepare your skin and even out the skin tone itself.  This makes the peel more effective as well as lessens the pigment and fades a tan by bleaching and skin cell turn over. This way you are less likely to hyperpigment after the procedure.

You will be instructed or given a high quality moisturizer, skin preparation lotions and sunblock which you will use as you heal afterwards to protect the newly uncovered skin from the harmful UV rays.  The skin will crack and depending upon your instructions, peel and skin type you will either be asked to cover it with a thin layer of lotion or antibacterial ointment or allow it to dry, crack and fall away NATURALLY.  So please adhere to your own physician's or skin care specialist's instructions.  These steps are very important.

How This Procedure Is Performed
Depending upon the peel, peel depth and the skin type -- you will either be anesthetized or not, if so please read the anesthesia section.  If not, you will have your skin cleansed and prepared either by exfoliation, sterilized or whatever is needed.  The layers of acid will be applied and the timer set for your treatment protocol.  The acid will be removed with a neutralizing lotion abs you will then have a moisturizer applied to your face.  You may or may not have a "second skin" type of dressing placed on your face then gauze - unless of course this is a superficial peel.

Please consult with your physician for specific details of your procedure as many treatments are carried out differently and are entirely individual-dependent.

Sometimes a membrane is applied to help with comfort and healing -- some of these may be burn dressing membranes, or commercially available masks such as the HydroGold Full Face Gel Mask® from www.BioDermis.com.  But ALWAYS ask your physician before using any product post-operatively.   Masks such as this are usually reserved for more serious peels (Phenol, Obagi Blue, Laser, etc) as they can be quite pricey.

EXTRA! A relatively new and exciting burn bandage is made from cotton and purified chitin, called chitosan, (a polysaccharide), which is extracted from the exoskeletons of crustaceans (crab, shrimp and lobster shells).  Incidentally, Chitosan is also an ingredient in controversial "fat magnet" pills and supplements.   Below is from Youngdeok Chitosan:

"Chitosan is a natural product derived from Chitin, a polysaccharide found in exoskeleton of crustacean like crabs and shrimps, in the crusts of the insects like beetles, gold bugs, and grasshoppers, and in the cell wall of bacteria and fungi like molds and mushrooms.

Crab's shell consists of Chitin substance, Protein, Calcium carbonate which are all boned together very strongly to become a hard and stable crust.

Therefore, pure Chitin (acetylamino-polysaccharide) is extracted by removing protein and calcium carbonate from crab's shell. Through the process of deacetylization called purification, Chitosan (amino-polysaccharide) is obtained from Chitin by getting rid of acetyl radicals.

Chitosan-Oligosaccharide is obtained by an enzymatic hydrolysis of chitosan using chitosanase. Compared with Chitin and Chitosan that has poor solubility and absorbability into our body, Chitosan Oligosaccharide is absorbed perfectly. "   

Some bandages consists of several layers, the main layers consisting of the purified crab and shrimp shells (chitosan, pronounced KEYE-toe-san) as well as a synthetic barrier that whisks away moisture and fluids from a weeping, healing wound.  An outer layer of cotton gauze absorbs the fluids.  The gauze pads can be changed but the synthetic skin and chitosan covering stays to protect the wound.  The chitosan are actually absorbed harmlessly into the body and excreted.  Miraculously, the crab shells have a superior antibacterial property unheard of in any relative substance. Reportedly, no known fungus or germ can adhere to it's surface.  When the bandage is removed - fresh, new skin appears. 

The Road to Recovery
You will feel as though your skin has a windburn or sunburn and will find that your skin is tight.  Do not make excessive or widely exaggerated facial expressions.  This can tearing of the skin and bleeding, hence -- scarring.  Just let your skin heal naturally and do not peel or tug on ANY skin that may peel from the face.  You can cause excessive damage resulting in sever scarring if you do this.  Below is a typical after care instruction sheet, please ask your physician or skin care specialist for your own specific instruction sheet.

1. You will cleanse your face as usual but be instructed to use a gentle-formulated cleanser.
2. You may be instructed to use a special moisturizing cream or lotion.
3. Do not apply any type if glycolic acid or exfoliation products as this can severely damage or irritate the skin.
   during the entire time of healing or the skin will become irritated.
4. Avoid sun exposure if you can.  Use a high SPF sunblock to help block the harmful UV rays.
5. Do NOT peel, rub or scratch your skin at anytime, whatsoever.  This WILL cause damage and compromise your results as well as possibly severely scar you.
6. Let your surgeon or skin care specialist know immediately if you have a herpes break out.  This can also result in severe and permanent scarring.

Important Contraindication of Chemical Peels 
You should not have a chemical peel if you will continue to have excessive sun exposure.  Active herpes simplex, warts, history of keloidal scarring (excessive ropey scarring where the collagen forms outside of the incision or cut area, Any type of recent facial surgical procedures.  You should not have a chemical peel if you've used Accutane in the last year (which increases your chances of excessive scarring).  If you are pregnant or lactating (although simple, superficial fruit acids may be acceptable, ask your physician).  If you have any auto immune diseases, have had any recent radioactive or chemotherapy treatments -- have sunburn, windburn or broken skin or have recently waxed or have recently used a depilatory such as "Nair®" or used "Vaniqua®."

Risks & Complications of Chemical Peels
If you have oral herpes.  You MUST gain the approval of your primary physician and seek a prescription for oral acyclovir -- one brand name is Zovirax®.  This is very important! Zovirax® can significantly decrease your chances of a break out.  If you have a break out during your healing period, it can spread to your entire face and result in severe and permanent scarring.

Be careful of crusting or excessive weeping.  In AHA peels you may think this is normal but there is a borderline appearance that you must watch out for.  Ask your skin care specialist for specifics regarding what to look for.  If for a typical AHA peel, you should feel and look normal within 3 to 4 days.  For deeper peels your downtime may take weeks and then months for complete recovery.

If you experience painful areas of the face, contact your surgeon or skin care specialist immediately -- ESPECIALLY if you are prone to cold sores.  Blisters that form will need to be treated as soon as posible!

Hyperpigmentations (excessive coloration) and hypopigmentation (lack of pigmentation) can be problematic of misdiagnosed skin types, failure to reveal any skin problems or ethnicity and improper post-peel care.  Infection is uncommon but possible so keep an eye out for redness and pain.

Scarring is a problem if the above is experienced so please adhere to your post-peel instructions to decrease your chances of long term or permanent, visible signs of damage.

The Least You Need to Know About Chemical Peels

• What: the use of chemicals or a combinations of chemicals and manual or cryogenic exfoliation to remove damage or dull layers of the skin to reveal healthier, smoother and even toned skin.

• Why: the skin becomes dull, scarred or wrinkled after damage and/or natural aging.  Acne can also be a problem and can improve after chemical peels, especially with the use of accompanying,, customized skin care.

• When: Anytime there is sun damage, age-related problems, or hyperpigmentations associated with aging hormones and sun damage.  Whenever acne affects the skin.

• Who: A skilled skin specialist, physician or dermatologist with a good background and experience in performing peels bad understanding the skin.

• Where: Depends upon the type and depth of peel -- from a sterile environment for deeper, invasive peels to home care superficial peels.

• Risks: Please see above

• Contraindications: Please see above

• incisions/scars: n/a unless infections or cold sore breakouts occur which can result in scarring.

• Anesthesia: Read All About Anesthesia (if applicable)

• Duration:  15 seconds - 1.5 hours, depending upon extent of work to be done.

• Pain Factor: nonexistent to moderate, pain meds should alleviate any discomfort. If not, call your physician or skin care specialist immediately.

• Swelling:  nonexistent to moderate -- depending upon individual's bodily reactions and the depth of the peel.

• Bruising: usually n/a

• Post-treatment instructions: This depends upon the peel type and depth of peel, and if anesthesia was utilized, please see Recovery and ask your physician or skin care specialist for specific instructions.

• 1st Post-treatment visit:  This also depends upon the peel type and depth of peel. Although next day and 3 day visits are not unheard of with deeper peels, they usually occur at 5 to10 days post-treatment. 

• 2nd Post-op visit: check up usually at 3 weeks for exercise/activity release

• Return to work:  From immediately to usually within 7 to10 days -- but depends upon type of peel. 

• Activity: Check with your physician or skin care specialist.

• Sun exposure: Avoid sun exposure and where sunblock! This is extremely important and the duration in which to adhere to this is dependent upon the depth of the peel and if there is a subsequent skin care regimen.

• End result: usually can be seen anywhere from immediately to 9 months.

• Loss of Sensitivity: It is possible to lose sensation with deeper peels, especially with Phenol. 

• Other complications: Possible eyebrow and eyelash loss from medications and anesthesia (if applicable). 

• Longevity:  Usually permanent unless you expose your skin to the sun or have hormonal changes again. Although a good skincare regimen can lengthen the results by as much as 75%.

• Special Notes:   Disclose all your medical background.  Be realistic in your expectations.

• The average prices: