Chemical peeling is a procedure used for the cosmetic improvement of the skin or for the treatment of some medical skin disorders. A chemical exfoliating agent is applied to the skin to destruct specific portions with the subsequent regeneration and rejuvenation of its components. There are a number of different peeling types — defined as either superficial, medium, or deep — that the aesthetic practitioner can use as a non-invasive treatment modality for facial rejuvenation. In spite the great variety of treatment choices currently available on the aesthetic market, the chemical peel should not be discounted as an effective option for the improvement of a patient’s appearance and skin health.
Chemical peels have been used since the ancient Egyptian, Greek and Roman times for skin enhancement. Dermatologists pioneered skin peeling for therapeutic purposes during the 1800s, treating pigmentations and scars by using chemicals in different combinations and concentrations. Histological studies supporting clinical results have been published with regard to the use of chemical peels by both dermatologists and plastic surgeons. The introduction of light-based technologies, at the end of 20th century, allegedly decreased the demand for chemical peels; yet according to statistics published annually by official scientific societies, chemical peels are still among the top five most popular non-surgical procedures1, 2.
Chemical peeling is a procedure used for the cosmetic improvement of the skin or for the treatment of some medical skin disorders. A chemical exfoliating agent is applied to the skin to destruct specific portions with the subsequent regeneration and rejuvenation of its components.
Classification of chemical peels
Chemical peels are divided into three categories depending on the depth of the wound created by the peel: superficial, medium or deep. Superficial peels penetrate the epidermis only; medium depth peels damage the entire epidermis and papillary dermis; while deep peels create a wound to the level of mid‑reticular dermis.
The depth of the peel depends on a number of factors, such as the chemicals used, their concentration, mode of application, and condition of the skin. There is a direct correlation between the depth of the procedure, level of discomfort and post-peel healing time, risk for potential complications and the intensity of overall skin improvement.
When are chemical peels indicated?
Normal human skin has an inherent mechanism of renewal. Newly-formed epidermal cells mature and move up from the basal to corneal layer over a period of 28 days. A complex enzymatic process causes their separation and shedding from the epidermis to be substituted by younger cells. This is a normal peeling process of young skin. As we age, this process becomes less efficient. As a result, the corneal layer thickens and the skin loses its natural luminosity. In addition, abnormal pigment is deposited in the skin layers and fibroblast function slows down, negatively affecting the renewal of the extracellular matrix. External factors, such as sun exposure and smoking, further deteriorate the appearance of the skin.
Chemical peels replace the pathological components of the skin with younger and healthier cellular and acellular components. Therefore, peels are indicated in both cosmetic and medical skin conditions. Cosmetic indications include dull skin appearance, uneven tone, dyschromia, and skin wrinkling. Medical conditions that can benefit from chemical peels include solar keratosis, active acne and acne scars, and extensive stable facial vitiligo. Chemical peels can be performed locally, such as in cases of periorbital pigmentation or rhinophyma. Bodily peels require extra caution, as these areas will often heal poorly in comparison to the face.
Proprietary or compounded?
Chemical peel solutions can be compounded pharmaceutically or purchased as ready-to-use preparations. This is generally true with regard to superficial products. Deeper peels usually need to be compounded, unless provided as part of an educational event. Experienced peelers prefer to prepare their own solution, sometimes combining different concentrations for different skin areas. For beginners, proprietary peels are usually a safer choice.