Skin Peels

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Skin peels are designed to enhance skin quality by removing the damaged outer layers, in order to allow the new skin underneath to create a smoother surface and improve its texture.

What conditions can skin peels be used to treat?
Skin peels can be used to treat the following skin conditions:

  1. Facial blemishes
  2. Wrinkles
  3. Uneven pigmentation
  4. Precancerous skin growths
  5. Acne

How do skin peels work?
Peels can be done using chemicals, abrasives or lasers. Furthermore, skin peels are an excellent addition to facial procedures such as blepharoplasty, face lift and laser skin resurfacing. It is frequently the combination of treatments that produces desired results as each facial concern is addressed with appropriate modality.

Using chemical exfoliants such as glycolic, salicylic and trichloroacetic acid, sun-damaged skin is removed and new skin growth is stimulated in a controlled manner. The resulting exfoliation provides for smoother and brighter skin through the removal of dead cell layers. Underlying collagen regeneration subsequently works to reduce fine lines, refine pores, correct uneven skin texture and improve acne, reduce acne scarring, facial blemishes and pigmentation.

The depth of the peel depends on the type of chemical used. Mild peels are performed using alpha hydroxy acid (AHA), glycolic acid or some fruit acids. The strongest and deepest peels use phenol.

A chemical solution (in the form of a clay mask, lotion or liquid) is applied to the skin to accelerate the removal of old, damaged skin cells at the surface of the skin. The ‘old’ skin will blister off over a period of up to 14 days: during this process new cell growth begins, resulting in a brighter and smoother skin layer.

The solution can be targeted at a very specific area or all over the face, arms, hands and neck. This type of procedure is particularly useful for reducing fine lines around the mouth and eyes. A Skin peel procedure can last from a few minutes to over thirty minutes, depending on the type of peel that you are undergoing.

Results obtained depend on the strength of the acid, the duration of contact with the skin and the type of acid used: all this will be discussed in detail during your consultation with the Consultant Plastic Surgeon.


The structure of the skin

Are there different types of skin peels?
The different kinds of skin peel include:

  1. Light to Medium Peel
  2. Deeper Peels

(i) Light to Medium Peels
The Consultant Plastic Surgeon will select the best chemical or chemical mix for the individual patient. A solution is applied using a sponge, cotton pad, cotton swab or brush to the areas to be treated (or the entire face, avoiding the eyes, brows and lips). Generally, the most superficial peels are those using alpha hydroxy acids (AHA), such as glycolic, lactic or fruit acid. Various concentrations of an AHA may be applied weekly or at longer intervals to obtain the best result.

Key Points regarding Light to Medium Peels Using AHA

  • AHAs are often referred to as fruit acids derived from natural products such as sugar cane (glycolic peel), milk (lactic acid peel) citrus fruits and grapes
  • At lower concentrations (less than 20%) mild exfoliation occurs in the outer epidermal layers. This concentration is typically found in products sold over the counter or used in beauty salons.
  • However, recovery time remains short, and usually only consists of some flaking and redness for a few days.

What happens before the Treatment (Light to Medium Peel)?
During your initial consultation, the Consultant Plastic Surgeon will perform a full facial analysis and discuss in detail the proposed treatment plan and your cosmetic expectations. About two to three weeks before undergoing a chemical peel, a patient must prepare his or her skin by applying a cleansing lotion twice daily. A special moisturizer and sunscreen should also be applied. Depending on your skin type and condition your Consultant Plastic Surgeon may prescribe Tretinoin (Retin-A) for you to take each day. Following the Consultant Plastic Surgeon’s skincare advice will prepare the skin and should optimise outcomes.

What happens during the Treatment (Light to Medium Peel)?
The actual treatment takes approximately 20 minutes. First the skin is thoroughly cleansed with an agent that will remove excess oils, whilst protecting the hair and skin. Depending on your condition, the chemical peel solution can be applied to the entire face or specific regions, such as the “crow’s feet” area or near the nasolabial folds. It is applied using a sponge, cotton pad or depending on the size of the area, a cotton swab or brush. The Consultant Plastic Surgeon will carefully observe the skin and, based on the changes, will decide how long the solution should stay on.

A slight burning or stinging sensation may be felt during application but this usually subsides immediately once the solution is removed or neutralised - usually within 2 minutes. Your skin may feel a little tight for a couple of hours after the procedure.

What happens after the Treatment (Light to Medium Peel)?
It is essential to completely avoid sun exposure for at least 48 hours post-treatment. A high SPF is recommended on an ongoing basis to maintain results. You can return to work almost immediately after your treatment.

(ii) Deep (Phenol) Peels
A deep chemical skin peel, or phenol peel, is the strongest of chemical peels, and is reserved for individuals with deep wrinkles from sun exposure or is used to treat skin wrinkling around the lips and chin area. The procedure diminishes imperfections in sun-damaged, unevenly pigmented, or coarsely wrinkled facial areas by peeling away the skin's top layers.

What happens before the Treatment (Deep Peel)?
During your initial consultation, the Consultant Plastic Surgeon will perform a full facial analysis and discuss in detail the proposed treatment plan and your cosmetic expectations. About two to three weeks before undergoing a chemical peel, a patient must prepare his or her skin by applying a cleansing lotion twice daily. A special moisturizer and sunscreen should also be applied. Depending on your skin type and condition your Consultant Plastic Surgeon may prescribe Tretinoin (Retin-A) for you to take each day. Following the Consultant Plastic Surgeon’s skincare advice will prepare the skin and should optimise outcomes.

If you decide to proceed with the operation you will be required to confirm your understanding of all aspects of the surgery and agreement to proceed with the operation by signing a Consent Form.

What happens during the Treatment (Deep Peel)?
A full-face deep chemical peel takes 1 to 2 hours to perform. A more limited procedure (such as treatment of wrinkling above the lip) will generally take less than a half-hour. A solution is applied to the area to be treated (avoiding the eyes, brows and lips). There is a slight burning sensation, but it is minimal since the solution also acts as an anaesthetic. After the peel solution has worked on the skin, it is neutralized with water. Approximately one hour later, a thick coating of petroleum jelly is layered over the patient's face, covering the protective crust which develops rapidly over the area. This stays in place for 1 to 2 days. In an alternative technique, the patient's face is covered by a "mask," composed of strips of adhesive tape, with openings for the eyes and mouth (this is particularly effective in cases of severe wrinkling).

What happens after the Treatment (Deep Peel)?
Some patients experience discomfort after a deep chemical peel, but this can be controlled with medication. A few days after the procedure, new skin with a bright pink colour akin to sunburn will emerge; the pinkness will fade within a few days. Post-operative puffiness will also subside in a few days, but the skin will remain sensitive. Patients should avoid exposure to sunlight and continue to use sun block.

How many treatments will I need?
Results of a superficial peel are temporary: an initial series of 6 treatments performed at 2-3 week intervals is recommended to obtain optimum results. After completion of this series of treatments, a maintenance treatment every 6-8 weeks will keep pores unclogged, control breakouts and dramatically enhance the overall texture and quality of your skin.

How safe is it?
Light to Medium and Deep peels are considered very safe treatments. However, there are some associated risks, including infection, skin colour changes and scarring. The treated skin may appear darker or be tight or swollen for a time. You will need to avoid exposure to the sun for some time after your treatment. Your Consultant Plastic Surgeon will provide you with detailed information on your optimum post treatment care.

Other points to note:

  • Chemical peels cannot be used on the neck or other parts of the patient's body and may not as effective in treating individuals with dark, oily complexions
  • Some facial skin disorders do not respond to chemical peeling
  • Skin pores may appear larger, and the skin may not tan properly
  • Chemical peels can activate latent cold sore infections
  • All forms of deep skin peels include the risk of delayed healing and scarring

For additional information regarding this procedure please consult with your Consultant Plastic Surgeon.

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