Chemical Peels Patient Leaflet

What is a chemical peel?

A chemical peel is a minimally invasive procedure where a solution is applied to the skin for exfoliation and to help improve a variety of skin concerns. Chemical exfoliation has been used throughout history for over 3,500 years. Lactic acid from milk and tartaric acid in grape skins were used by the Ancient Egyptians and are still found in several cosmetic products today. Chemical peels may contain a single ingredient or a blend of products to treat a range of skin issues.

There are a vast number of chemicals that can be used for skin peeling, some natural and some synthetic, targeting different depths of the skin and for different indications. Despite being described as a chemical peel or a skin peel, many modern-day treatments do not actually cause any peeling of the skin or very minor peeling.

Chemical peels can generally be classified into three different groups:

· Superficial (Epidermis only)

· Medium (Extending into the dermis)

· Deep (Deep dermal)

Make sure you ask what strength of peel and what chemicals it contains prior to having treatment.

Superficial peels are ideal to help improve skin texture, minor sun-damage, fine lines, mild acne scars, age spots and irregular skin tone, whereas deep peels should only be performed by medical professionals and are used for resurfacing. They often require a period of downtime after the procedure.

Chemical peels often feature in the top 5 list of aesthetic procedures performed in the UK.

What areas can be treated?

Chemical peels are most frequently performed on the face, but they can be used on other areas and the neck, décolletage and hands are also popular treatment areas.

Chemical peels are particularly popular for the following indications:

· Ageing skin

· Acne and acne scarring

· White-heads and black-heads

· Blotchy, flaking, dry or oily skin

· Pock marks and small scars

· Fine lines/wrinkles

· Sun damaged skin

· Age spots

· Large pores

· Uneven skin tone and texture

· Pigmentation problems

· Deeper lines and wrinkles (deep peels)

Chemical peels cannot be used for very deep lines or scars, loss of volume, lines that are caused by muscle action or sagging skin. If this is your concern, your practitioner or therapist may discuss more appropriate treatment options.

How does it work?

Different brands of chemical peels use different ingredients to achieve the desired results. Results of a chemical peel depend on the product used, the strength of the peel, how much is applied and how long it remains on the skin. The most common peels often contain one or more of the following:

Alpha Hydroxy Acids: These are naturally occurring acids derived from sugar cane (glycolic acid), sour milk (lactic acid), citric fruits (citric acid), sour fruits (malic acid) and grapes and bananas (tartaric acid) to name a few. They are generally considered mild peels and work superficially. Less acidic and more dilute forms of alpha hydroxy acids are found in home peels and some skin care products. These peels can cause some redness, irritation, dryness, stinging and mild peeling. Different brands of peel vary according to their strength and pH (amount of acidity).

Beta Hydroxy Acids: The most common used in chemical peels is salicylic acid which was originally derived from Willow tree bark. It has anti-bacterial and anti-inflammatory properties as well as being oil-soluble which makes it ideal for the treatment of acne as it also helps to control sebum production.

Retinoic Acid: A metabolite of Vitamin A that has been used in the treatment of acne since the 1960s. Retinoic acid has anti-acne and photo-ageing properties, helping treat wrinkles, enlarged pores, hyperpigmentation, and laxity.

Glutathione: Considered by some to be the master antioxidant in animals and plants. Glutathione is responsible for neutralising free-radical damage and slowing down the ageing process as well as blocking the synthesis of melanin (the pigmentation in skin) to have a lightening effect.

Kojic Acid: A fungal by-product, found in many skin care products for lightening of the skin as well as increasing collagen and elastin production for tighter and brighter skin.

Trichloroacetic Acid (TCA): TCA is a common constituent in skin peels and is an effective exfoliating agent. It can be either a superficial, mid depth or deep peel depending on the concentration used (35% TCA produces a medium depth peel and 50% or higher is used for a deep peel).

Phenol: More specifically phenol-croton oil peels (with the active ingredient being croton oil), have an extreme exfoliating effect and should only be used by medical practitioners for deep peeling.

There are many different brands of chemical peels, each with their own benefits and risks and they may contain ingredients not listed here.

Is it painful?

Superficial chemical peels are usually pain free or create a mild stinging sensation when they are applied. If you have sensitive skin, you may experience some discomfort and burning with superficial or mid depth peels. Deeper peels are generally more painful, have greater downtime and a higher potential to cause complications. Deep peels may require sedation, analgesia, and monitoring of your heart rate.

Many peels need neutralising or washing off to reduce their action when the desired effect has been achieved and to lessen the risk of adverse effects. Whilst having treatment, your practitioner or therapist will be monitoring your skin for signs of action (for example, some chemical peels will cause a frosting effect to appear on the skin) and will also usually have a timer measuring how long the peel has been on for. If you experience pain or discomfort, the chemical peel can usually be neutralised or washed off to prevent any further action on the skin. Some practitioners and therapists may use a fan to cool the skin whilst the peel is applied and cool the skin afterwards using ice-soaked compresses.

Immediately after treatment, the skin might be a little red, blotchy, and warm and feel tight, but in the case of a superficial peel, this usually settles quickly and generally does not last more than a few days. There may be a patchy white frosting appearance which remains for a few hours after certain types of peel. Medium depth peels may take up to 6 weeks for your skin to fully return to normal and may be even longer for deep peels.

Often a course of skin peels is recommended to achieve better results, typically a course of 4 – 6 peels at 4 – 6 weekly intervals.

We do not recommend clinic strength chemical peels are performed in a non-clinical environment.

Is it safe?

Generally, side-effects are uncommon from superficial chemical peels and if they do occur, they are often mild and usually resolve within a few days after treatment. The deeper the peel, the greater the risk of adverse effects.

Possible side-effects include:

· Redness of the skin, like sunburn

· White discolouration/blotchiness of the skin

· Itching of the skin

· Dryness, flaking of the skin

· Swelling, particularly in the under-eye area

· Infection due to skin disruption

· An outbreak of cold sores (in some cases, preventative medication may be prescribed prior to your peel)

· Pigmentation developing after treatment (hyperpigmentation)

· Reduced/lack of pigmentation of the skin (hypopigmentation)

· Persistent redness, lasting for weeks

· Brown spots may appear a few days after treatment (medium and deep peels) as pigmentation is lifted into the superficial layers of the skin

· Scarring is very rare, but there is a higher risk with deep peeling

Following a deep chemical peel, it is normal to feel a little unwell post-procedure, like sunstroke, and it is recommended to have someone with you to take you home after the treatment. You are likely to experience moderate to severe pains for several days and you may be prescribed analgesia by your practitioner. There may be considerable itching and peeling and it is often recommended to arrange at least 2 weeks of downtime after a deep chemical peel.

If you develop any unexpected side-effect after treatment, it is important to contact your practitioner or therapist for a review as soon as possible.

What does the procedure involve?

Prior to treatment, you should complete a medical history with your practitioner or therapist. You should receive all the information you need to decide whether to go ahead with treatment or not as well as possible side-effects specific to your treatment and the costs involved. A skin analysis or photographs may be taken prior to having the procedure to document improvements over time. Any photographs taken will be part of your medical record and should not be used for any other purpose without your explicit permission.

You should have a comprehensive consultation with your treating practitioner or therapist about your skin, products that you use on your skin, and previous aesthetic treatments that you may have had. They will discuss your skin concerns as well as examining your skin to decide on the most appropriate treatment for you. They should discuss the procedure with you, what you should expect and the anticipated results. A paper or electronic consent form should be signed before undergoing any treatment.

Do not feel pressurised or coerced into having treatment at the same time as your consultation.

Prior to having a chemical peel, the area will be cleansed and disinfected to remove the skin’s natural oils to allow the peel to be more effectively absorbed into the skin. The practitioner or therapist may apply Vaseline® or another oil-based gel around the eyes, lips, or other sensitive areas to protect the area from the effects of the peel. A pre-peel solution may be applied prior to the actual treatment. The whole area will be systematically treated in specific areas and several passes (layering) may be applied. The peel is often applied to the skin, using either a brush, gauze, cotton stick or a gloved hand, and usually a timer started. This allows sufficient time for the chemicals to penetrate the skin to a controlled depth. Many peels will then be neutralised with either water or a specific neutralising agent. Some peels, such as many beta hydroxy acids, do not need to be neutralised. Treatment time is generally between 20 – 40 minutes.

Following the procedure, your practitioner or therapist will often apply a moisturiser or other serum as well as a good sun protectant as the skin’s natural barrier may be compromised. You should continue to use sun protection following the treatment as advised by your treating practitioner or therapist.

After treatment, the skin will feel much cleaner, fresher, and firmer. It is usual to get a slightly reddened complexion immediately after treatment.

Ensure you consistently apply a broad-spectrum sun protectant of at least SPF 30.

Am I suitable for treatment?

As chemical peels are non-invasive, most people are suitable for superficial or medium depth treatment. Deep peels should only be conducted after a full medical assessment and with appropriate advice and aftercare.

You may not be suitable for treatment if any of the following apply:

· Recent aesthetic treatment, including laser/IPL, microdermabrasion, micro-needling, botulinum toxin or dermal fillers.

· If there is an infection or inflammation in the treatment area, including warts or cold sores.

· If you have been using Roaccutane (isotretinoin) in the previous 12 months.

· If you have an underlying medical condition or autoimmune disease that may affect treatment.

· If you have eczema, dermatitis, sunburn or previous radiation therapy in the area.

· If you have a history of keloid or hypertrophic scarring.

· If you have severe pigment problems such as vitiligo.

· If you are pregnant or breast feeding (although certain peels are possible in pregnancy, make sure your practitioner/therapist is aware that you are pregnant or trying to conceive).

· Allergy to aspirin if the peel contains salicylic acid (a beta-hydroxy acid often used for acne).

· If you have a darker skin type as you will be at a higher risk of pigmentation problems following a chemical peel. We recommend that you should seek out a practitioner or therapist experienced in the treatment of darker skin.

· For deep peels, particular phenol peels, you may need to have blood tests to check your kidney and liver function prior to treatment.

It is important to be honest about your medical history, previous procedures, skin care products used and any medication taken so that you can have a safe and effective treatment.

Pre-treatment advice

· Avoid skincare products containing retinol for 7 days prior to treatment.

· If you are planning any medical aesthetic treatments before or after your chemical peel, these should be discussed with your treating practitioner or therapist in advance.

· You may be required to use active skin products to prepare your skin prior to your peel for optimum results and to reduce the risk of a complication, this will be discussed with you during your consultation.

· If you are unwell on the day of your appointment, even with a cough or a cold, please contact your practitioner or therapist to reschedule.

· Do not plan to have treatment immediately before an important social event in case you develop any prolonged redness or other side-effect.

Post-treatment advice

· Following your chemical peel treatment, you may experience some redness on the treated areas accompanied by a warm glow. This will last for several hours but should have settled by the following morning.

· Peeling does not generally occur with superficial treatments, but if peeling does occur, it generally starts after 48 hours and may last from 2 to 5 days and sometimes longer. Your practitioner or therapist will be able to advise you more specifically depending on your skin condition and the chemical peel used.

· Make-up or your usual skin care products should not be applied for at least 12 hours after your treatment, unless otherwise advised by your practitioner or therapist.

· Ensure your practitioner or therapist is aware of any skin care products that you are using so they can advise you on when they can be safely restarted.

· Do not pick, peel, scrape, scratch or wax your skin as this may lead to infection, bleeding, pigment change, delayed recovery or scarring.

· Avoid abrasive sponges and exfoliating skin care products for one week after treatment.

· Avoid other cosmetic procedures without the specific guidance of your practitioner or therapist, including waxing or electrolysis.

· Wash with a very mild soap, rinse with warm water and pat dry. Remember to moisturise regularly following the treatment as you may experience some dryness for a few days.

· Avoid sun-exposure and use a broad spectrum (UVA and UVB) sun-cream of at least SPF30 for 6 weeks post-treatment as your skin’s natural barrier may have been compromised.

· Avoid the use of alpha and beta-hydroxy acids, retinoids, retinols, fragranced products and any creams or serums that are in any way irritating for at least a week.

· Pain killers may need to be taken following deeper chemical peel treatments.

· You may be required to use anti-viral medication or an antibiotic cream following a medium depth or deep peel after the treatment to reduce the risk of infection.

· Your practitioner or therapist may recommend an antihistamine medication after treatment if itching is problematic.

For best results, a course of treatments may be recommended by your practitioner or therapist.