What is a chemical peel?
A chemical peel is a skin resurfacing procedure. It involves applying a chemical solution, which causes the top layers of skin to peel off over several days. As the skin heals, new skin grows back smoother and with a more youthful appearance.
There are three different types of chemical peels based on their depth:
- Light chemical peel uses a mild acid, such as alpha-hydroxy acid. It removes the epidermis—or outermost layer of skin. Other names for this peel include superficial peel and lunchtime peel. You can repeat these mild peels as often as every 2 to 5 weeks.
- Medium chemical peel uses a stronger acid, such as glycolic or trichloroacetic acid. It goes deeper into the upper portion of the dermis—the middle layer of skin. You can repeat this type of peel every 3 to 9 months.
- Deep chemical peel uses a very strong acid, such as phenol. It can penetrate to the lower portion of the dermis. You can only have a deep peel once.
Using chemical peels on the face to improve the look of skin is the most common application. Chemical peels can also enhance skin appearance on the neck and hands. The deeper the peel, the more noticeable you can expect the results to be. Keep in mind, deeper peels will have a longer and more involved recovery. There is also a higher risk of complications with deeper peels.
Why is a chemical peel performed?
Chemical peels can treat skin discoloration, sun damage, wrinkles or lines, minor blemishes, uneven skin texture, and superficial scars. They will not improve the look of deep wrinkles or lines, deep scars, or sagging skin.
The different chemical peel depths can accomplish different things:
- Light chemical peels can improve mild skin discoloration, fine lines or wrinkles, acne, and dry or rough skin.
- Medium chemical peels can treat age spots, freckles, moderate skin discoloration, uneven skin tone, moderate scarring from acne, and fine lines or wrinkles.
- Deep chemical peels can address moderate wrinkles, darker age spots and freckles, and shallow scars.
Doctors may also recommend a medium or deep peel to treat precancerous growths called actinic keratoses. Talk with your doctor to find out which chemical peel is best for you based on the results you desire. For example, if you want a chemical peel for acne, make sure you understand which peel will also address acne scars if that is important to you.
Who performs a chemical peel?
Dermatologists and plastic surgeons perform chemical peels. Dermatologists specialize in the medical and surgical care of the skin, hair and nails. A plastic surgeon specializes in correcting physical defects that affect a person's appearance or ability to function. These types of doctors perform both medically necessary procedures and purely cosmetic procedures.
It’s important to choose a doctor with plenty of experience performing chemical peels. This is especially true for medium and deep peels, which carry more risk than light peels.
How is a chemical peel performed?
A chemical peel usually takes place in an office or outpatient surgery center. A light peel generally does not require any pain relief or anesthesia. For medium peels, you may receive a sedative and a pain reliever. Deep peels may require sedation and local or regional anesthesia. In some cases, doctors recommend using general anesthesia.
What to expect the day of your chemical peel
In general, you can expect the following:
- Your face will be cleansed.
- Your doctor will apply the chemical to your face and leave it in place for a specific period of time. For light and medium peels, you may feel tingling or stinging during the application. For deep peels, your doctor may only treat one area at a time to limit your exposure to the chemical. This process can take up to 1.5 hours for a full facial chemical peel. You should not feel pain due to the anesthesia.
- Your doctor will wash off the chemical and neutralize it, if necessary. Skin may appear white or gray immediately afterwards.
- For medium peels, your doctor will apply cold compresses. Deep peels require surgical dressing with either ointment or surgical gauze or bandages.
What are the risks and potential complications of a chemical peel?
Cosmetic procedures carry some level of risk. Most chemical peels go smoothly, but complications are possible. Potential chemical peel risks include:
- Darkening of the skin, which is usually temporary
- Infection in rare cases
- Lightening of the skin, which tends to occur with medium and deep peels in people with darker skin. This change can be permanent.
- Reactivation of cold sores
- Redness that may persist for several months as part of the normal healing process
- Scarring in rare cases
The use of phenol for deep peels can cause heart, liver and kidney problems. Applying phenol to small sections at a time will help limit exposure to it.
Reducing your risk of complications
Working with an experienced doctor can help lower your risk of complications from a chemical peel. You can do your part to reduce the risk of certain complications by:
- Avoiding unprotected sun exposure and using sunscreen as directed both before and after the peel
- Caring for your skin as directed both before and after surgery
- Going makeup-free until your doctor recommends wearing it
- Informing your doctor if you have a history of keloid scars, cold sores, or heart, liver or kidney problems. Also, tell your doctor if you have used isotretinoin (Amnesteem, Claravis, others) in the last six months.
- Not scratching or picking at the skin as it heals
- Taking your medications exactly as directed. For a chemical peel, this may include antiviral medications before and after the procedure.
- Telling all members of your care team if you have allergies
Talk with your doctor about chemical peel benefits and risks to decide if the procedure is right for you.
How do I prepare for a chemical peel?
Your doctor will give you specific instructions to prepare for your chemical peel, depending on the type of peel and your medical history.
In general, you should prepare for a chemical peel by:
- Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
- Avoiding certain skin treatments for about a week beforehand, including waxing, depilatory hair removal, and facial scrubs and massages.
- Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
- Taking medications to prepare and protect your skin. This may include antiviral medicines, retinoid creams, and a bleaching agent to prevent skin darkening.
- Wearing sunscreen and avoiding the sun as much as possible for four weeks beforehand
Questions to ask your doctor
When preparing for a chemical peel, it’s important to get your questions answered. Here is a list of questions you may want to ask:
- What kind of chemical peel is most likely to give me the results I want? Are my desired results realistic?
- Are there other procedures you recommend instead of or in addition to a chemical peel?
- How many chemical peels like the one you are recommending have you performed? How many have you performed on people with my skin coloring?
- Do you have before and after photos of your cases I can see?
- What side effects do you typically see and how often?
- What steps can I take before and after the peel to minimize side effects and maximize healthy healing?
- How long will it take to recover and what can I expect?
Cost is also a factor to consider when you are preparing for a chemical peel. Health insurance generally does not cover cosmetic procedures. Ask your doctor about the cost and find out if payment plans are available.
What can I expect after a chemical peel?
Knowing what to expect makes it easier to plan and prepare for a successful recovery.
How long will it take to recover and what can I expect during recovery?
The length of your recovery will depend on the depth of the peel. For light peels, skin usually heals within a week. It may appear red, irritated, and dry or scaly while it is healing. Your doctor will likely recommend applying a cream or lotion and then a daily sunscreen. In general, you can wear makeup the next day.
Medium peels can take up to two weeks to heal. You may have significant redness and swelling in the first 48 hours. Skin may also blister, ooze and crust before peeling off. You will soak your skin daily and apply an ointment. You will also need to take an antiviral medication for 7 to 14 days. In general, you can apply makeup after 5 to 7 days. You must avoid all sun exposure until your skin is fully healed. Redness can last for several weeks. You will have a follow-up appointment to monitor your healing.
For a deep peel, healing can take up to three weeks. Your skin will have a surgical dressing or bandages to cover the peeling and crusting. You will need to soak your skin several times a day and apply a protective ointment for the first two weeks. Then, you can switch to a thick moisturizer for two weeks after that. You will also need to take antiviral medication for the first two weeks. Your doctor may allow makeup after two weeks. You must avoid all sun exposure for up to six months afterwards. You will see your doctor several times to check your progress.
Will I feel pain?
For light peels, your skin will just feel irritated or tingly for a short period of time. Medium peels are more uncomfortable and your skin may feel very tight or sting. Over-the-counter pain medicines can relieve any discomfort. Deep peels cause the most discomfort. Your skin may throb or burn and your eyes may swell shut. Your doctor may prescribe medication to improve your comfort.
When should I call my doctor?
For medium and deep peels, you will have follow-up appointments with your doctor. If you have questions between appointments, contact your doctor during normal business hours. Call your doctor right away if you have concerns, such as an increase in pain, fever, or signs of infection.
How might a chemical peel affect my everyday life?
A light chemical peel will have subtle results that may increase with repeated treatments. Medium peels will have more noticeable and longer-lasting results. Deep peels can dramatically improve the look of your skin. The effects can last up to 10 years. However, no results are permanent. As you age, your skin will continue to change.
Sun exposure, including indoor tanning, will also play a role in the quality and longevity of your results. Avoid sun exposure until new skin has healed completely. Avoid indoor tanning altogether. Wear a daily sunscreen to help preserve the new look and feel of your skin.
