Know your options: Chemical Peels

Chemical Peels

What’s the difference between a salicylic acid peel, a glycolic acid peel, lactic acid peel, and a TCA peel?

When we talk about acid peels, what these are doing is that they are creating a controlled chemical burn of the skin. These should be done by trained and qualified physicians.

Ideally, dermatologists or plastic surgeons. What they can do, depending on the concentration, is cause an exfoliation of the skin that will reveal healthy newer skin behind it.

Glycolic acids come in different strength. They can be as low as a 5%, up to a 70%, and depending on whether or not it’s buffered, so how neutral it is, what the pH of it is, can affect how powerful that treatment is. That needs to be neutralized in order to turn it off. So the longer you leave it on the skin, the longer the results last.

Salicylic acid is often called a beta lift or a beta peel, and this does not need to be neutralized. So we have different concentrations, it can be 20-30%, and you have to be careful, because this is absorbed into the body, so we have to limit the body surface area that we apply. We wouldn’t do the face and the back in one treatment because too much of the product would be absorbed and can cause systemic problems or problems internally. So it does need to be done in a very careful and monitored way.

But it does turn off by itself. Afterwards, you get red and you peel. I like the beta or the salicylic acid peels for people who are more acne-prone and the glycolic acids for general skin rejuvenation.

The lactic acid peels are more gentle in the alpha hydroxy or glycolic acid family of peels. They tend to be better for more sensitive and more dry skin. Trichloric acetic acid peels tend to be very strong. You have to be especially careful with these.

In as low as 10% concentration, that tends to be very gentle, but unlike the other peels, every time you apply it, you are getting a stronger concentration. So if you take a 10% peel and you keep dabbing it over the spot, you can get up to a 30-40% concentration. So there is a lot of finesse that go around these products.

It is also self-neutralizing, which is good because it turns itself off, but also, we don’t have a neutralizer for it. So if you have too strong a product on your skin, that can create a chemical burn that can be significant.

So these are treatments that should be done under the supervision or directly by your physician. You need to be evaluated to make sure that your skin is healthy enough for this treatment, and you need to know what to expect afterwards; what the downtime is, what the skincare is in order to get the best results out of them.

‘Online MD’ interviewed Robert Kolter, MD,  to get the facts about Chemical Peels and ageing.

MD: What is the recovery process for a chemical peel?

Robert Kotler, MD:

Patients need to know that there’s going to be a several month healing period, where the skin is going to look like it’s been sunburned. In other words, the immediate healing only takes 7 to 10 days. After the 10 days you can go back out into the world if you camouflage your pink face, but that pink color is going to take a couple of months to fade. Well you can’t lay out in the beach without sunscreens, because for sure your skin is going to turn brown and blotchy.

Patients have to cooperate. Again, we provide everything they need to protect themselves, sunscreens, moisturizers, whatever, but patients have to use a modicum of common sense. Let the skin settle down, let it rest, don’t torture it with direct sunlight. So, if the patient is well selected, if the patient is healthy, if the procedure is done well, and again, the after care is meticulous, because this is another procedure that requires meticulous aftercare, because we have several issues that must be dealt with after the procedure. We have to keep the face coated with antibiotic ointment to reduce any chance of infection in the first 7 days after the procedure. Then we have to use moisturizers because the skin tends to be dry. We have to use the sunscreens, and if there are any areas that aren’t behaving well, because they are forming little blisters, or little milia, little white bumps, they have to be dealt with, because we want the texture to be absolutely perfect and pristine.

We have to keep our eye out for a very rare but disturbing complication such as scarring. Very, very rare. And by the way, scars never pop up overnight, so we always ask the patient to come in and see us if there’s anything that doesn’t seem quite right, like an area that’s a little red and a little irritated. That would be the precursor to a scar that might take weeks to develop.

So if one comes in at the appropriate intervals and the predetermined intervals by the way, there’s a certain pattern of visits that we adhere to. If you follow those visits, you’re not going to drop out of the system long enough for a problem to turn up overnight. So again, postoperative care meticulously provided by the office, patient cooperation, very important. You know, a success is really the end product of team work between a conscientious physician and a compliant or cooperative patient.

MD: Those other complications, the little white bumps, the potential scarring, those are all fixable?

 Robert Kotler, MD: Yeah. Yes.

MD: If seen in time?

Robert Kotler, MD:

Yes, and even if not seen in time. Even if one developed a little, it’s not major scarring, it’s where a little scar band, little raised area. Frankly, they can be controlled with just a couple of cortisone injections or sometimes a little specific light laser treatment to make the red color fade. So these things are all, they’re controllable, but we like to avoid them. And again, by making the patient aware of the importance of our observation and the importance of reporting to us if things aren’t as predicted on the instruction sheet, we’ll steer clear of big problems

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