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Chemical Peel
Chemical Peel

Chemical Peel

Chemical peel is helpful for those individuals with facial blemishes and wrinkles, along with mild scarring and uneven skin pigmentation, which may have resulted from electrolysis. A peel is performed by a dermatologist or plastic surgeon who uses a chemical solution to smooth the texture of the facial skin by removing its damaged outer layers. 

Most peels are performed on the face and neck, but can be performed on the chest, hands, arms and legs. Also, a chemical peel may be performed in conjunction with a facelift.

There are different types of chemical peels which produce different results, but all are similar in that an acidic solution is applied to remove the damaged outer layers of skin. The goal being that new, regenerated skin replaces these old damaged layers.  As a general rule, the deeper the peel, the more profound the results, but at the sacrifice of a more intrusive procedure, and accordingly, a longer recovery time.

Light Peels

Alphahydroxy Acids (AHAs)

Alphahydroxy acids (AHAs) include glycolic, lactic, or fruit acids, and are mild chemical solutions that lightly peel skin, often resulting in brighter-looking, smoother skin. These “lunch hour” peels are often done repeatedly over time, and can even out fine wrinkling, uneven pigmentation, and smooth out rough, dry skin or a mild acne problem. An alphahydroxy acid, such as glycolic acid, can also be mixed with a facial wash or cream in lesser concentrations as part of a daily skin-care regimen to improve the skin’s texture.

Uses:

  • Smoothes rough, dry skin
  • Improves texture of sun-damaged skin 
  • Aids in control of acne
  • Can be mixed with bleaching agent to correct pigment problems
  • Can be used as TCA pre-treatment (see below)

Considerations:

  • A series of peels may be needed
  • As with most peel treatments, sunblock use is recommended

Medium Peels

Trichloroacetic Acid (TCA)

Trichloroacetic acid (TCA) is used when a medium depth peel is indicated for skin that has moderate sun damage, fine lines and weathered skin. TCA peels can correct pigment problems and superficial blemishes, and sometimes two or more treatments, spaced out over weeks or months, are required for best results. A full-face TCA peel usually takes about 15 minutes. 

Uses:

  • Smooths out fine surface wrinkles
  • Removes superficial blemishes
  • Corrects pigment problems

Considerations:

  • Can be used on neck or other body areas
  • May require pre-treatment with Retin-A or AHA creams
  • Treatment takes only 10-15 minutes
  • Preferred for darker-skinned patients
  • Peel depth can be adjusted
  • Repeat treatment may be needed to maintain results
  • Sunblock must be used for several months
  • Healing is usually quick (much quicker than with a phenol peel)

Deep Peels

Phenol

Phenol acid is the strongest of the chemical solutions and causes a deep peel. A phenol peel is a drastic, one-time procedure that offers dramatic and long-lasting results. Anyone with extensive wrinkling, lots of brown age spots, mild scarring or with pre-cancerous growths, could be a candidate for this procedure. A full-face phenol peel can take from one to two hours. The phenol peel results in permanently lighter skin. To protect it, a sunblock must be used at all times.

Uses:

  • Corrects blotches caused by sun exposure and aging
  • Smoothes out coarse wrinkles
  • Removes pre-cancerous growths

Considerations:

  • Used on the face only
  • Not recommended for dark-skinned individuals
  • Procedure may pose risk for patients with heart problems
  • Full-face treatment may take one hour or more
  • Recovery may be slow  (complete healing may take several months)
  • May permanently remove facial freckles
  • Sun protection, including sunblock, must always be used
  • Results are dramatic and long-lasting
  • Permanent skin lightening and lines of demarcation may occur

All chemical peels carry some unpredictability and risk. Chemical peel is normally a safe procedure, but risks include infection and scarring.

Finding a physician

In some states, no medical degree is required to perform a chemical peel, including the strongest phenol peels. Many states have laws that permit non-physicians to administer certain peel solutions, but regulate the strengths which they are permitted to apply. You should be warned that phenol and TCA peels may be offered by inadequately trained practitioners. To assure the best results, it is very important that you find a physician who has adequate training and experience in skin resurfacing. 

Preparing for your chemical peel

Sometimes Retin-A is used to pre-treat the skin. This prescription medication thins out the skin’s surface layer, allowing the TCA solution to penetrate more deeply and evenly. If your skin will not tolerate Retin-A pre-treatment, an AHA cream may be used instead. Hydroquinone, a bleaching agent also found in “fade creams,” is sometimes used in conjunction with Retin-A or AHA pre-treatment, especially if you have blotchy skin areas or pigmentation problems. You may have to spend a month or more in this pre-treatment phase before your the peel is performed.

You will need to arrange for someone to drive you home and help you out for a day or two if you are having a phenol or deeper TCA peel. But, you probably will not need any extra assistance if you are having an AHA peel or superficial TCA peel.

The Peel Procedure

Most often, chemical peels are performed in the doctor’s office or outpatient surgical center. But, if your surgeon is performing other cosmetic procedures, you may want an overnight stay at the facility or hospital.

Anesthesia isn’t required for phenol or TCA peels because the chemical solution acts as an anesthetic. However, some sedation may be used to help relax you and keep you comfortable. No anesthesia is needed for AHA peels since these peels cause only a slight stinging sensation during chemical application.

For the AHA peel, your doctor will apply the solution to your cleansed facial skin, a process that usually takes no more than 10 minutes. No “after-peel” ointment or covering is required. Depending on the strength of the peel, periodic treatments may be necessary until the desired effects are achieved. For some patients, the application of an AHA-based face wash or cream once or twice a day at home will be sufficient to accomplish the desired goal. Your surgeon may add Retin-A or a bleaching agent to your at-home treatment schedule. After several weeks of at-home use, your doctor will examine your skin to determine if your regimen needs adjustment.

With phenol and TCA peels, typically the skin is first thoroughly cleansed. Then, the surgeon will apply the phenol or TCA solution. You may feel a stinging sensation as the peel solution is applied, but this feeling will quickly pass. A full-face TCA peel usually takes no more than 15 minutes. Two or more TCA peels may be needed to obtain the desired result, with treatments likely spaced out over several months. Mild TCA peels may be repeated as often as every month.

If phenol solution has been used, your surgeon may coat the treated area with petroleum jelly or a waterproof adhesive tape. With lighter peels, no protective covering is necessary. A full-face phenol peel generally takes one or two hours to perform.  But a phenol peel administered to a smaller facial region such as the skin above the upper lip may take only 10 or 15 minutes. A single treatment usually is sufficient.

After treatment

After an AHA peel, it is common to experience some temporary flaking or scaling, redness and dryness of the skin, but these effects will not prevent you from working or engaging in your normal activities. Protecting your skin from the sun is also important following these mild acid peels. Ask your doctor to recommend a sunblock.

After a phenol or TCA peel, a mild pain medication may be needed to relieve any tingling or throbbing you may feel. If tape was used to cover your face, it will be removed after a day or two. A crust or scab will form on the treated area.  You will likely be given specific post-operative instructions to guide you through this process.

A TCA peel may also cause significant swelling, depending on the strength of the peel used. With a TCA peel, the moderate discomfort and mild swelling you may experience will subside within the first week. In about a week to ten days, your new skin should be healed sufficiently to return to your normal activities. It is best to avoid sun exposure unless you are adequately protected.

With a phenol peel, your face may become quite swollen to the point that your eyes may even be swollen shut temporarily. You surely will need someone to help care for you for a day or two. You may also be limited to a liquid diet and advised not to talk very much during the first few days following treatment.  New skin will begin to form in about seven to ten days. About two weeks after treatment, you may be able return to work and resume some of your normal activities.  At this point, your skin will be healed enough for you to wear makeup.  At first your face will be very red, then gradually fading to a pinkish color over the following weeks to months.  It is especially important that you use a sunblock, or blotchy, irregular skin coloring may result.

The Final Outcome

Improvements from AHA peels may be very subtle at first.  With continued treatments, you will notice a general improvement in the texture of your skin. 

The results of a TCA peel are usually not as long-lasting as those of phenol peel, but your skin will be noticeably smoother.

The phenol peel will likely produce a more dramatic improvement in the surface of your skin, reducing fine wrinkles, blemishes and any minor scarring, producing a more even complexion. Also, the results will be longer lasting.

But whether chemical peel or another process, remember that a second, or even third, surgical opinion increases your odds in making the correct decision.

Source: Transgender Care

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