Chemical Peels: A Comprehensive Guide

With advancements in our understanding of skin physiology and a growing concern for skin health and appearance, the beauty industry has seen a rise in skin rejuvenation treatments, including chemical peels. The natural aging process, combined with intrinsic factors such as hormonal changes and genetic alterations, as well as extrinsic factors such as sun exposure, smoking, alcohol consumption, and dietary habits, can lead to a range of skin changes. These changes include dryness, flaccidity, wrinkles, a decrease in skin thickness, and an increase in pigmented spots and malignant lesions.

Moreover, exposure to UV radiation and the use of multiple cosmetic products can contribute to the formation of free radicals, which increase the risk of oxidative damage and premature aging. As skin ages, the rate of cellular renewal slows, leading to a decline in skin texture and appearance.

Chemical peeling is a cosmetic procedure that uses chemical substances to promote the controlled destruction of the skin's outer layers, leading to cellular renewal and a more youthful, refreshed appearance. The process involves applying one or more caustic agents to the skin, resulting in the controlled destruction of the epidermis and upper layers of the dermis, and the re-epithelialization of the epidermis.

Chemical peels are categorized into three types: superficial, medium, and deep.

Superficial peels work on the epidermis and can be performed using active substances such as alpha-hydroxy acids (AHAs), beta hydroxy acids (salicylic acid), trichloroacetic acid (TCA), resorcinol, azelaic acid, and tretinoin. These peels are ideal for treating acne, light photoaging, hyperkeratotic eczema, actinic keratosis, fine wrinkles, and melasma.

Medium peels act on the papillary dermis and can be performed using TCA or AHAs, and Deep peels work on the reticular dermis and use active ingredients such as TCA at 50% and phenol (Baker/Gordon solution), among others. These peels are recommended for the treatment of blotches, scars, moderate wrinkles, keratosis, and lentigos.

The peeling process occurs as the caustic chemical substance used in the peel causes the chemical denaturation of proteins in the skin, leading to a physical appearance of peeling as the denatured protein layer is rejected by the immune response.

At SkinSpring, we believe in delivering only the best to our customers, which is why we have developed our R3 Formulation. Our unique and natural ingredients made from cutting-edge technology is designed to deliver maximum results with minimal downtime, and can be used before a chemical peel procedure to prepare your skin as well as after to accelerate the healing process.

Superficial peeling is a type of chemical peel that only affects the epidermis, making it suitable for all skin types and body areas. One of the substances commonly used for this type of peel is TCA, which can also be used for medium depth peeling when used in concentrations of 10% to 20%.

Alpha-hydroxy acids (AHAs) are a group of substances commonly used for superficial peels. They are effective in treating issues such as wrinkles, skin dehydration, thickening, and uneven pigmentation.

Glycolic acid (GA) is a widely used ingredient in cosmetic formulas. Due to its small molecular size, it has a greater ability to penetrate the skin compared to other AHAs. The effectiveness of GA also depends on the pH value of the preparation, which can range from pH 2.0 to 4.0. The lower the pH value (more acidic), the more powerful the exfoliating effect. An ideal pH of 3.5 is recommended for good exfoliation. It is important to use sunscreen after treatment to protect the skin during the day.

Although there have been several studies on the clinical effects of GA, the exact biological mechanism is still mostly unknown. Studies done at Kobe University in Japan suggest that GA can help improve the appearance of photodamaged skin through various effects, depending on the type of skin cell. The research found that GA caused minimal inflammation in the epidermis and upper dermis and increased collagen deposition, suggesting a direct stimulation effect by the agent.

Medium peeling is used for removing actinic keratoses, wrinkles, pigmentary dyschromia, and improving the appearance of scars. The traditional chemical agent used for this type of peel was TCA, used in concentrations of 20%. However, TCA can cause skin problems such as scars and hypopigmentation. To avoid these side effects, TCA is sometimes used in combination with other substances, such as glycolic acid, to reduce the concentration of TCA needed. TCA works on both the epidermis and dermis, exfoliating the skin and destroying the outer layer of cells through cellular renewal.

Deep peeling reaches the lower papillary or reticular dermis and is often achieved using phenol peels. Phenol peels are popular for their intense facial rejuvenation effects when used correctly. Phenol acts as a coagulant for skin proteins, has bacteriostatic effects at low concentrations (up to 1%) and bactericidal effects at higher concentrations. It also acts as a local anesthetic on nerve endings in the skin. Phenol is soluble in oils and fats and can be easily removed from the skin in case of accidental contact using glycerin, vegetable oils, or 5% ethyl alcohol. The most well-known phenol-based peel is the Baker-Gordon formula from 1962, which dilutes phenol to a concentration of 45% to 55%.

PRECAUTIONS

Deep peels are recommended for the following conditions:

• Skin lightening
• Wrinkles
• Hyperpigmentation or uneven pigmentation
• Acne scars
• Scars
• Actinic lentigos.

However, patients with the following conditions should not undergo phenol peels:

• Heart, kidney, or liver disease
• Active herpes outbreaks
• Continuous exposure to UV rays
• Recent use of isotretinoin
• Psychological instability
• Keloid formation tendency
• Fitzpatrick skin types IV to VI or Glogau wrinkle types.

The ideal candidate for deep peels would be someone with light-colored skin, fine and dry, or those with Fitzpatrick skin types I and II with fine wrinkles. Women tend to have better results with deep peels compared to men, who typically have thicker skin, reducing the effectiveness of the treatment.

COMPLICATIONS:

Chemical peels can result in both immediate and delayed complications. Immediate complications, which occur within minutes to hours after the peel, include irritation, burning, itching, pain, persistent redness, swelling, blistering, and more. Delayed complications, which can occur within a few days to weeks after the peel, include infections, scarring, delayed healing, textural changes, hyperpigmentation, hypopigmentation, loss of cutaneous barrier, acneiform eruptions, and more. These complications are more common in dark-skinned individuals and in cases of medium to deep peels.

PREVENTION AND TREATMENT OF COMPLICATIONS:

The complications related to chemical peels are primarily caused by problems with infection, inflammation, or healing. To prevent these complications, the SkinSpring R3 Formulation should be used as a standard pre- and post-operative application to the wound area. This will help to prevent infection and control inflammation, and will also lead to faster healing.