Chemical peels employ a variety of caustic chemicals to selectively destroy several layers of skin. The peeling solutions are "painted on," area-by-area, to ensure that the entire face is treated. After the skin heals, discoloration, wrinkles, and other surface irregularities are often eliminated. Chemical peels are divided into three types: superficial, medium-depth, and deep. The type of peel depends on the strength of the chemical used, and on how deeply it penetrates. Superficial peels are used for fine wrinkles, sun damage, acne, and rosacea. The medium-depth peel is used for more obvious wrinkles and sun damage, as well as for precancerous lesions like actinic keratoses. Deep peels are used for the most severe wrinkling and sun damage.
Preparation for the chemical peel begins several weeks before the actual procedure. To promote turnover of skin cells, patients use a mild glycolic acid lotion or cream in the morning, and the acne cream tretinoin in the evening. They also use hydroquinone cream, a bleaching product that helps prevent later discoloration. To prevent reappearance of a herpes simplex virus infection, antiviral medicine is started a few days before the procedure and continues until the skin has healed.
Patients arrive for the procedure wearing no makeup. The physician "degreases" the patient's face using alcohol or another cleanser. Some degree of pain accompanies all types of peels. For a superficial peel, use of a hand held fan to cool the face during the procedure is often sufficient. For medium-depth peels, the patient may take a sedative or aspirin. During the procedure, cold compresses and a handheld fan can also reduce pain. Deep peels can be extremely painful. Some physicians prefer general anesthesia, but local anesthetics combined with intravenous sedatives are frequently sufficient to control pain.
Within a day or so following a superficial peel, the skin will turn faint pink or brown. Over the next few days, dead skin will peel away. Patients will be instructed to wash their skin frequently with a mild cleanser and cool water, then apply an ointment to the skin to keep it moist. After a medium-depth peel, the skin turns deep red or brown, and crusts may form. Care is similar to that following a superficial peel. Redness may persist for a week or more. Deep-peeled skin will turn brown and crusty. There may also be swelling and some oozing of fluid. Frequent washing and ointments are favored over dressings. The skin typically heals in about two weeks, but redness may persist.