Application of Chemical Peels in Aesthetic Resurfacing
Chemoexfoliation, also known as chemical peeling, is a method of controlled skin injury through the application of caustic substances. It is relatively inexpesive, quick and safe therapy, which makes it one of the most common facial skin resurfacing procedures, along with laser therapy, dermabrasion, and microneedling.
Chemical peels can be used to refresh and rejuvenate skin and to target a variety of conditions, according to the peeling penetration. Superficial peels, penetrating only the epidermis, can be used to support treatment of actinic keratoses, solar lentigines, ephelides, dyschromias, rhytides (wrinkles), acne scars, and photoaging. Medium-depth peels, penetrating to the papillary dermis, may be used for dyschromia, multiple solar keratoses, superficial scars, and pigmentary disorders. Deep peels, affecting reticular dermis, may be used for severe photoaging, deep wrinkles, or scars.
The caustic agents used for chemical peels cause controlled keratocoagulation and denaturation of the proteins within the epidermis and dermis, resulting in the release of proinflammatory cytokines and chemokines. Such targeted inflammation, much similar to the one, caused by microneedling, activates the normal healing signal cascade, including stimulation, development and deposition of new dermal collagen and elastin, and regeneration of new keratinocytes. This results in rejuvenation and thickening of the epidermis and an increase in dermal volume.
Selection of chemical peeling agent type is determined by a number of factors, including treatment indication, desired depth of ablation, skin type, and relevant dermatologic history of the patient. When used for the appropriate indication with the proper technique, nearly all peel solutions and depths have demonstrated excellent clinical success in improving skin tone and texture, and are cost-effective compared to invasive procedures.
Superficial peels are safe and tolerated with mild discomfort, such as transient burning, irritation, and erythema. Scarring is really rare in superficial peels, as is infection. In medium and deep peels, lines of demarcation can occur. Care should be taken to feather peel solution at junctions with nonpeeled skin to avoid this effect. Side effects of deeper peels can also include pigmentary changes, infections, allergic reactions, etc.
Pretreatment can help to enhance outcomes and is often started two to four weeks prior to the peel and discontinued three to five days before the procedure. Postpeel, patients should use a broad-spectrum sunscreen on a daily basis and implement a gentle cleansing regimen with toner and peel serum as prescribed. Moisturizers may also be recommended. A long-term maintenance program will preserve the results of chemical peels in most patients. Patient participation and education is required, emphasizing the importance of sun protection and the use of appropriate skin care regimens that include cleansing, toning, exfoliation, and moisturizers. Patients need to have realistic expectations and understand that achieving benefits from peels requires repeated procedures.
Using peels less frequently but on a continuing basis is beneficial to help keep improvement ongoing, especially for superficial peels. Medium peels and deep peels are used more judiciously over time, but can address particularly difficult conditions effectively over the course of several treatments.
Credits go to MDA Inc for helping with this article.
