Last week I received a call from a friend of mine who was hysterical because she had purchased a chemical peel from a website, applied it to her face, and had the rapid onset of burning, redness, pain, and discoloration. I asked her what she had ordered and how she put it on. It turns out that she ordered a 35% trichloroacetic acid (TCA) peel and applied it directly to her cheek. Not all peels are created equally, and if you’re not sure what you are ordering, application should be left to health care professionals such as dermatologists and plastic surgeons. In general, it is a good idea to consult a doctor prior to using any chemical peel because certain aspects of your skin, your medical history, and your expectations will dictate what type of peel is best for you.
What is a chemical peel? A chemical peel is a chemical applied to the skin that does exactly what the name implies – it damages the layers of the skin such that the remaining layers are stimulated to replace them with fresh skin. Blemishes or changes in skin color, fine wrinkles, sun damage, and superficial scars can all be improved through this process, particularly if a series of peels is performed.
The action of a peel is related to how strong the chemical is and how it is applied. The deeper the peel, the more dramatic of a result, but this comes along with a higher risk for complications such as undesired changes in color or permanent scarring.
Peels are divided into superficial, medium, and deep depths depending on the specific chemical used and its concentration. A superficial peel only penetrates to the very outer layer of skin and gently exfoliates. The most common of these are the alpha-hydroxy acids (AHA), used at lower concentrations, such as glycolic acid and lactic acid. The recovery time is quick and the risk of serious complications is low. Beta-hydroxy acid (BHA) peels, such as salicylic acid at lower concentrations, also fall in the superficial category.
Medium peels penetrate through the outermost layer and into the top parts of the second layer of skin. Higher concentrations of the AHAs and BHAs, as well as lower concentrations of TCA, are examples. These peels have a greater effect than the superficial peels, take a longer recovery period, and carry a moderate risk for complication.
Deep peels such as higher concentrations of TCA and phenol can have a remarkable effect on skin but carry the highest risk for serious complications and should only be performed by a trained professional.
Determining what type of peel might benefit you the most should take many factors into account. If you have never had a chemical peel, the initial decision should be made by a physician after a consultation. Each person’s skin can react differently, even to the same chemical peel, and a physician will be able to watch the progress of a peel under his or her supervision and make any appropriate changes. You may need to take certain medications beforehand, and there will likely be some level of aftercare or follow-up visits. If you have used superficial peels several times and tolerated their application, it may be okay to have a non-physician provider such as an aesthetician apply the peel. Under no circumstances should a person self-apply a medium or deep chemical peel. These should only be applied by trained physicians.
As for my friend, hopefully the changes to her skin are not permanent. I instructed her to wash the area gently with warm water and mild soap, keep the area moist with ointment such as petroleum jelly, and strictly avoid sun exposure to the area until it heals. She learned a hard lesson and I’m sure will not be self-applying any more chemical peels.