One of the more common procedures performed to improve the appearance of aging and sun-damaged skin is the procedure known as chemical peels. The concept is that the pH of the skin is 5.5 and anything that changes that injures the skin.
One simple example of this is the use of soap on the face rather than a cleanser (soaps by definition are alkaline) and drying out the skin. Chemicals that change the pH can be either alkaline or acid. Alkaline (like lye) can increase the pH significantly and cannot be controlled. Therefore, the procedures are performed using acid rather than alkaline materials.
How does a Chemical Peel Work?
The purpose of a chemical peel is to injure the skin, i.e. wound it and it heals back smoother and prettier. The depth of the peel determines a number of things. Most important is the fact that the stronger the acid, the more benefit will be obtained and the better the results. On the other hand, the stronger the acid, the more likely to be side-effects. The most common side-effects of chemical peels are scarring and uneven pigment.
The mildest of the peels used in practice is glycolic acid. It is a timed peel, in that it is placed on the skin and left on generally for 5-6 minutes and then cool water is applied to neutralize any effect not desired. The concentration of the acid will determine how deep it will go, how great the benefit and of course whether or not scarring will occur—very rare with the use of glycolic acid. Usually the peels are less than 35% and are performed every week for a period of 6 weeks.
The next most common acid used in clinical practice is TCA (trichloroacetic acid). This is deeper than glycolic and the higher the concentration, the deeper the peel. Usually it is used at 20-35% and rarely any higher. It is not a timed peel, but a peel during which the skin turns white when it is applied. This is an indication of protein precipitating and the more passes that are done over the face, the deeper it goes—up to a point. At some point the precipitation of the protein keeps the acid from going deeper. Once the white is complete and covers the face, then ice cold water is applied to neutralize. Peels can also be done on the neck and on the decolette; however, once the mandibular line is crossed one must be very careful and use low doses to start with. TCA peels can produce significant results and can be repeated if needed , but wait 4-6 weeks before doing so.
After care of this type of peel is to stay out of the sun, apply Vaseline frequently and shower and let the water run down over the face. Sometimes it is necessary to prescribe pain medicine and systemic steroids. Any skincare line should be discontinued until the entire area is healed. Assiduous use of sunscreen after healing is very important.
There are many other types of peels used. Salicylic acid 20-30 percent is the best peel for acne as it gets into the pores and cleans them out. It can be performed weekly until clear. Patients allergic to aspirin cannot undergo this peel. Also, it gives a strong smell of menthol as it is being done.
The Miami peel is becoming popular. It is for sundamaged and skin with uneven pigment. Invented by two dermatologists in Miami it contains a combination of chemicals to smooth the skin and even the color.
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