As we age, our skin undergoes several changes like wrinkles, fine lines, loss of radiance, hyperpigmentation, smoothness, skin tone and sagging of the skin. These manifestations are due to natural aging process and other environmental factors like excessive sun exposure, smoking, stress and various other factors. These skin changes can be treated by several skin resurfacing cosmetic surgery procedures, such as dermabrasion, chemical peeling, and laser skin resurfacing.
While laser skin resurfacing and dermabrasion are comparatively expensive, chemical peeling has become widely popular among the people for facial aging. Chemical peels have been used for many years for skin surface resurfacing, superficial scars and treating irregular pigmentation. Chemical peeling is safe, simple and cost-effective procedure if done with well-trained professionals.
What is Chemical Peeling?
Chemical peeling is a procedure where your skin texture is improved by controlled applications of one or more exfoliating agents to the skin. These agents cause controlled destruction of the layer of skin leading to exfoliation of the skin surface. As skin exfoliates, regeneration of the new skin surface occurs with much improvement in texture and surface abnormalities.
There are several types of chemical peeling agents and the classification of chemical peel is usually based on the level of injury and expected depth of penetration into the skin.
Superficial Peels: Epidermis to upper papillary dermis
Medium-Depth Peels: Papillary dermis to upper reticular dermis
Deep Peels: Mid-reticular dermis
Superficial Peels
Superficial peels are used in the treatment of mild photo-aging, acne, actinic keratoses, solar lentigines, and pigmentary disorders. Superficial peels have minimal effects on wrinkles and deep furrows and requires several treatment session (weekly or monthly) before desired results can be seen. These wrinkles and deep furrows improvement may be possible with medium or deep chemical peels.
Superficial Chemical Peeling Agents
Trichloroacetic acid (TCA)10%-25%
Jessner’s solution (Lactic acid+Salicylic acid+ Resorcinol+Ethanol)
Modified Unna’s resorcinol paste
Solid carbon dioxide
Alfa-Hydroxy acids
Salicylic acid
Tretinoin solution
Chemical Peels
Medium Depth Peels
Unlike superficial peels which usually requires multiple treatments, medium depth chemical peels are done as single treatment procedure. These peeling agents causes epidermal necrosis and significant dermal injury, resulting in increased collagen production during wound healing process over the next several months. These peels are used in the treatment of mild to moderate photo-aging, wrinkles, actinic keratoses, solar lentigines, epidermal growth and other pigmentary disorders.
Medium-Depth chemical peeling agents
- Trichloroacetic acid (TCA) 35%-50%
- Solid CO2 and 35% TCA
- Jessner’s solution and 35% TCA
- 70% Glycolic acid and 35% TCA
Deep Peels
Deep peels are used in the treatment of moderate to severe photo-aging and advanced wrinkles. These chemical peels destroy the epidermis and progressive layers of the dermis and have extended period of healing following treatment.
Deep peeling agents:
Although, one may also use 50% or greater concentration of TCA to achieve this result, Phenol, a keratocoagulant is the only deep peeling agent widely used. The Baker’s formula for the preparation of phenol peel includes;
Phenol USP 88% – 3 mL
Croton oil – 3 drops
Hexachlorophene (Septisol) liquid soap – 8 drops
Distilled water – 2 mL
The medium-depth chemical peels and deeper chemical peels are now being replaced by laser treatment like laser skin rejuvenation.
Though the procedure is generally safe, complications may occur. The risk of side effects and complications increases proportionately with the depth of the chemical peeling agent. Superficial chemical peels are usually associated with the lowest risk of adverse reactions, whereas medium-depth peels can cause pigmentation disorders and sometimes scarring. Phenol peels are further associated with hepatic, renal, and cardiac toxicity.
Side Effects and Complications of Chemical Peels
- Persistent erythema
- Infection
- Milia
- Dyspigmentation
- Textural changes
- Fibrosis and scarring
- Cardiac, renal, and hepatic toxicity (associated with phenol peels)
Fractional CO2 laser severely scared my entire face. How could this happen, you ask ? You have been told that this laser is safe and it is known to improve scaring from acne, bla bla bla. I will start from the beginning. I went to see Precision Cosmetic And Laser serge ray in Brisbane. I am a 47 yo female that had extensive sundamade. I have what is referred to as a Kirkpatrick skin type ( fair and I freckle, with Auburn hair colour) I had no deep wrinkles, fine lines and other issues associated with aging. My skin was showing the damage from years of incidental sun, I didn’t like what I saw in the mirror and decided to have laser resurfacing done. I had read up on the co2 ablative laser ( which is the gold standard in laser) I decided to have that done. I went to see the above Dr in Brisbane, who used this particular laser. I was set to have it done when shortly before my scheduled laser resurfacing procedure, I got a call from this doctor, he informed me that he leased this machine and could no longer get it. He said that the non ablative co2 fractional Laser, he was able to hire. I would need two laser proceedures to equal results of the ablative. He said that this laser also had fewer complications. I had it done. One treatment. I noticed that my skin looked like it was healing well. It wasn’t till the swelling went down that I could see that, it wasn’t. I started looking rather knocked around. I started seeing white lines all over my face and they were risen. Actually the lines formed a grid pattern. Some are risen and some appear to hollow. Giving me a wrinked appearance. The texture of my skin has changed as well. I have bigger pores and scaring all over my lower face. It looks similar to the texture of a person who has at one point had acne, that has been treated before it developed and formed craters or lesions. You know the irregular skin texture with scarring. I looked like I had been roasted in an oven, people told me and this was 8 weeks after. I went along to see a plastic surgeon on the Sunshine Coast He told me that , that particular laser was not suitable for a person with my skin type, that presented with the type of problems that I did. He also said that the laser may have been set too high. I was put on a medical grade skin care program. This did help, with the tenderness of my skin and also with improving the skin, but it was minimal. As the scaring starts at the dermis. This type of laser causes injury to the dermis, this is suppose to tighten elastin and speed up the production of collegen. I should never of had this laser, I was told by the second doctor. The ablative co2 was the right laser for me with the skin problems that I presented with. This laser removes the epidermis, that is damaged and a new one grows back in its place. Skin quality re lines and texture are improved by 50 percent, sometimes more. My problem is I should have gone to a plastic surgeon or a dermatologist. This doctor does have 29 years experience. He used the ablative co2 for a long time and used it well, how ever he obviously doesn’t know a lot about the non ablative co2 laser or I wouldn’t have the scarring that I have all over my face, including eye area. I look so much worse than I did prior to laser. I have been using Retind A 0.5 percent now for 4 m6 months. It has helped but it has it’s limits. I now have an appointment to see Dr M Chin in Brisbane on the 9 th Febuary. Apparently there is a laser that is a cold touch laser, that can help. Don’t know what the laser is called or what to expect , regarding scar improvement. I do know that it’s multi treatment and it’s not cheap. I paid $2.200 for a laser that scarred my face all over and god knows how many thousands it will cost to see some improvement. I’m going to be left with scarring no matter what. It’s the level, that I worried about. Before you consider laser resurfacing get several opinions. Yes that works out to be around $400 to $500 which is over the top, but in the long run, if you don’t you could be out of pocket thousands and scared for life.