HISTORY:
Civilizations ranging from Ancient Egypt to Greece and Rome had techniques for facial peeling. They commonly used a solution of alabaster, milk, and honey to achieve healthier looking facial skin, which makes the facial peel one of the oldest cosmetic procedures known to man.
During the era of Cleopatra, she was known for her beauty regime, and part of this regimen was taking a daily “milk” bath, but, did you also know the milk was from a donkey? They would use a mixture of donkey’s milk and honey, legend has it that no less than 700 donkey’s were needed to provide the quantity of milk necessary for her daily bath!
Poppaea Sabina (30 – 65 BC), second wife of Roman Emperor Nero, who is referred to in Pliny’s description of the asses’ milk virtues for the skin:
“It is generally believed that asses’ milk effaces wrinkles in the face, renders the skin more delicate, and preserves its whiteness and it is a well-known fact, that some women are in the habit of washing their face with it seven times daily, strictly observing that number.”
Poppaea, the wife of the Emperor Nero, was the first to practice this; indeed, she had sitting-baths, prepared solely with asses’ milk, for which the purpose large troops of donkeys would be brought along with her on during her journeys. Pauline Bonaparte (1780–1825), Napoleon’s sister, is also reported to have used asses’ milk for her skin’s health care.
WHAT IS A CHEMICAL PEEL?
A chemical peel is a body treatment technique used to improve and smooth the texture of the facial skin using a chemical solution that causes the dead skin to slough off and eventually peel off. The regenerated skin is usually smoother and less wrinkled than the old skin. Thus the term chemical peel is derived.
Some types of chemical peels can be purchased and administered without a medical license, however people are advised to seek professional help from a dermatologist,esthetician, plastic surgeon, or otolaryngologist (A physician specialized in diagnosing and treating diseases of the head and neck, especially those involving the ears, nose, and throat (ENT). Also called an ENT, ENT doctor, or ENT physician) on a specific type of chemical peel before a procedure is performed.
TYPES OF PEELS:
Alpha Hydroxy Acids (AHAs) are naturally occurring carboxylic acids such as glycolic acid, a natural constituent of sugar cane juice and lactic acid, found in sour milk and tomato juice. This is the mildest of the peel formulas and produces light peels for treatment of fine wrinkles, areas of dryness, uneven pigmentation and acne. Alpha hydroxy acids 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.
There are five usual fruit acids: citric acid, glycolic acid, lactic acid, malic acid and tartaric acid. Many other alpha hydroxy acids exist and are used.
- Citric acid: These peels are simple and effective, although not incredibly invasive or capable of significant improvement with one treatment.
- Glycolic acid: This acid creates a mild exfoliating action. Glycolic acid peels work by loosening up and exfoliating the superficial top layer. This peel also stimulates collagen growth. High strength peels are good in terms of efficacy but they irritate more. Some glycolic peels claim the use of strontium nitrate in order to try to reduce skin irritation. Nevertheless, strontium nitrate is a product which is strictly prohibited in cosmetic products since it has a high toxic potential
- Lactic acid: This peel will remove dead skin cells, and promote healthier skin.
- Malic acid: This peel is the same type of mildly invasive peel and can open up the pores, allow the pores to expel their sebum and reduce acne.
- Tartaric acid: This is acid is capable of delivering the same benefits as the above peels.
AHA peels are not indicated for treating wrinkles.
AHA peels may cause stinging, skin redness, mild skin irritation, dryness, and take multiple treatments for desired results.
It is becoming common for beta hydroxy acid (BHA) peels to be used instead of the stronger alpha hydroxy acid (AHA) peels due to BHA’s ability to get deeper into the pore than AHA. Studies show that BHA peels control sebum excretion, acne as well as remove dead skin cells to a certain extent better than AHA’s due to AHA’s only working on the surface of the skin.
Salicylic acid is a beta hydroxy acid.
Jessner’s peel solution, formerly known as the Coombe’s formula, was pioneered by Dr Max Jessner, a German-American dermatologist. Dr Jessner combined 14% salicylic acid, lactic acid, and resorcinol in an ethanol base. It is thought to break intracellular bridges between keratinocytes.
It is very difficult to “overpeel” the skin due to the mild percentages associated with the acid combination.
Retinoic acid is derived from retinoids.
This type of facial peel is performed in the office of a plastic surgeon or a dermatologist in a medical spa setting. This is a deeper peel than the beta hydroxy acid peel and is used to remove scars as well as wrinkles and pigmentation problems.
It is usually performed in conjunction with a Jessner; which is performed right before, in order to open up the skin, so the retinoic acid can penetrate on a deeper level. The client leaves with the chemical peel solution on their face. The peeling process takes place on the third day. More dramatic changes to the skin require multiple peels over time.
- Trichloroacetic acid peels
Trichloroacetic acid (TCA) is used as an intermediate to deep peeling agent in concentrations ranging from 20-50%. Depth of penetration is increased as concentration increases, with 50% TCA penetrating into the reticular dermis. Concentrations higher than 35% are not recommended because of the high risk of scarring.
Trichloroacetic acid peels:
- are preferred for darker-skinned patients over Phenol
- smooth out fine surface wrinkles
- remove superficial blemishes
- correct skin pigment problems
Trichloroacetic acid peels may:
- require pre-treatment with Retin-A or AHA creams
- require repeat treatment to maintain results
- require the use of sunblock for several months (this is a must)
- take several days to heal depending on the peel depth
Phenol is the strongest of the chemical solutions and produces a deep skin peel. Some publications claim that phenol peel affect could be due to the action of croton oil and that phenol would not be effective without this oil. In reality, many phenol peel solutions exist that do not contain croton oil. This last is only a penetration enhancer, acting at the epidermal very superficial layers. Croton oil is not the only penetration enhancer that can be used. Effects of a phenol chemical peel are long lasting, and in some cases are still readily apparent up to 20 years following the procedure. Improvements in the patient’s skin can be quite dramatic. A single treatment usually achieves the desired result.
Phenol peels are used to:
- correct blotches caused by sun exposure or aging
- smooth out coarse deep wrinkles
- remove precancerous growths
Phenol peels may:
- pose a risk of arrythmias if applied without following strict rules
- permanently remove facial freckles
- many formulas cause permanent skin lightening by reducing the ability to produce pigment
- require increased protection from the sun permanently
PAIN MANAGEMENT & SIDE EFFECTS:
The side effects you may experience and how long your recovery will last depend on the type of facial peel you have done. Salon and commercial systems have very little side effects and the recovery time is no longer than a day or two.
Facial peeling performed by a plastic surgeon will cause redness, flaky skin, and general skin irritation which can last a month or more with Phenol peels. Recovery is usually a week or two with other peels, however, there are a few peels that can last longer. You may also have to limit your activities, meaning being outside, sometimes even at all for days, your daily work-outs may be interrupted, even your diet. It’s not a good idea to have this procedure if you have something coming up soon after having it done. Always plan accordingly and always make your Esthetician or Medical Professional of your medical history and the medications you are taking. You must do this in order to make certain you have an effective and safe procedure.
Light chemical peels like AHA and glycolic acid peels are usually done in a Spa setting, medical Spa, or medical office. There is minimal discomfort so usually no anesthetic is given because the patient feels only a slight stinging when the solution is applied. No pain killer is needed.
Medium peels like TCA are also performed in the doctor’s office or in an ambulatory surgery center as an outpatient procedure and are a bit more painful. Frequently, the combination of a tranquilizer like Valium and a pain pill usually suffice. TCA peels often do not require anesthesia even if the solution itself has – at the contrary of phenol – no numbing effect on the skin. The patient usually feels a warm or burning sensation.
Phenol is the classic deep chemical peel. Old phenol peel solutions are very painful and most practitioners will perform it under either general anesthesia, administered by an MD-anesthesiologist or nurse anesthetist. More recent formulas easily allow a simple heavy sedation, usually intravenous. Recent phenol peel formulas can be applied locally (chemical blepharoplasty or cheiloplasty)without any kind of anaesthesia.
DANGERS:
The deeper the peels the more complications that can arise. Chemical peels are risky and should always to be administered by a licensed professional or an M.D. specializing in skin care such as a dermatologist.
The possible complications include prolonged erythema, pigmentary changes, milia (white heads), skin atrophy and textural changes.
I recommend if you plan on doing ANY home PEEL, to first consult your local Esthetician, or medical professional to get advice on what you should start with initially. Most of the time even if you go to an Esthetician and they are unaware of your skin type, they will start with a lower solution rate, and then build you up.
As a licensed Esthetician, I am allowed to service my clients without medical supervision, a 30% solution or lower. Anything higher you would always want to be in a more medical surrounding with professionals that are specializing in Medical Skin Care Therapy. There are a wide variety of solutions and depending on the skin, and what you are wanting out of the peels is dependent upon what will be placed on said skin.
I would definitely recommend to prevent any damage or infection to seek professional advice, or go to a professional for your first experience in getting a Peel. Remember you are putting acid onto your skin, your face for that matter, this isn’t something you want to do wrong.
If you are a budget and need to save money, seek out local Esthetic schools in your area, they may have “new” people administering these products, but they always have licensed, well educated professionals teaching and watching over them making certain that the products being applied is correct and done in a safe manner for their clients. You will definitely save money by going this route and probably learn something as you will be in a teaching facility too!
CONTRAINDICATIONS:
You will be well informed as to what you can and cannot do during peeling. It will be your responsibility to follow this advice since you will be caring for your skin at home.
There are certain conditions that may require postponement of your peel.
These include:
• accutane within the past year
• inflamed acne lesions
• open cuts or scratches on your face
• any facial surgery within three months, including a facelift or eyelid surgery
• recent or upcoming intense sun exposure
In addition, if you are under severe physical or mental stress, it is not a good time for a peel. It is important that you can devote all of your energies to your peel and are not distracted by other physical or mental needs.
It is extremely important that you do not pick, scratch, pull or rub your skin during your peel. If you do, you may damage the underlying new skin and cause scarring or changes in your pigmentation.
Please realize that these warnings are for your protection. If you are not sure if you should do something or don’t understand the directions, seek knowledge and call your professional before you do anything!
Am I A Good Candidate For A Facial Peel?
The facial peel is indeed an effective treatment for acne, acne scars, uneven pigmentation, and deep wrinkles. If you suffer from one of these skin conditions, a facial peel is definitely something to consider. If you feel your condition is too severe to be treated with commercial products, consult with a plastic surgeon or dermatologist. They will help you decide which peel is best for you.
As with all things in life, you should have realistic expectations. Face peels can dramatically improve the appearance of your skin, but they are not a cure for chronic skin conditions and they do little for deep scarring. The results you do experience will not last forever, so subsequent treatments will be necessary.
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