TCA 10-20%,

Resorcin /Resorcinol: AccuPeel and the Obaji Blue Peel.

Solid CO2

Alphahydroxy Acids  (AHAs)

Glycolic

Lactic Acid

Medium: This type of peel goes through the epidermis, down into the upper most portion of the dermis known as the papillary dermis. Medium peels are the level when complications are more likely to start. In addition to the pre-peel use of exfoliants, the use of a skin bleaching agent, such as 4% hydroquinone, and a broad-spectrum sunscreen a month prior to the procedure, may be added for more aggressive forms of these peels, or for patients who already suffer from some form of skin discoloration. Inflammation from this level peel may temporarily produce an increase in skin tone.

Trichloroacetic Acid (TCA)

Deep: The deep peels include the TCA (or trichloroacetic acid 35%) peels, which only need to be performed once. Deeper peels go midway into the dermal layer (into the reticular dermis), almost invariably leaving a permanently lighter skin tone. Instead of being able to tan as in the past, this lighter skin often freckles instead. These deeper peels should not be undertaken lightly, and you need to make sure in advance that the peel technique will be feathered into the scalp line and performed down the neck, possibly even the décolletage, or you may find that you have a highly noticeable line marking the difference in your original skin tone and the new one that is on the face

            Phenol: Carbolic Acids

Realistic Goals of Chemical Peels:

1. Chemical peels can correct (sun) damage.
2. They can reduce mild scarring.
3. You can experience a reduction or eradication of your wrinkles.
4. Improvement of dark skin discoloration is possible.
5. Chemical peels can remove excessive or stubborn blackheads.
6. The peel may temporarily reduce excessive skin oils.

Unrealistic Goals of Chemical Peels:

1. It cannot remove or reduce the appearance of blood vessels on the skin.
2. It is impossible to truly change pore diameter. However, by removing blackheads, the pores may actually appear less pronounced after treatment.
3. This is not a procedure to get rid of keloidal types of scars
4. Chemical peels are not a facelift.
5. This is typically not appropriate for improving dark skin discoloration in people of color (Asians, African Americans, Caucasians of Mediterranean extraction, Hispanics, etc.)

TCA 10-20%,

Resorcin /Resorcinol: AccuPeel and the Obaji Blue Peel.

Jessner's Peel Solution:  (a combination of salicyclic acid, resorcinol and lactic acid mixed in ethanol): Jessner's peel is a combination of salicylic acid 14%, lactic acid 14%, and resorcinol 14% in alcohol. This agent is easy to use, with no timing necessary. Apply the agent, wait for a light frost, and then neutralize with water. Jessner's peels result in superficial skin injury and are well tolerated - the 'lunchtime' peel. They remove thin lesions on the skin surface, reducing pigment and surface dryness. The result of the first peel may be disappointing, but after repeated peels, significant improvement is usually evident.

Solid CO2:  Carbon dioxide uses a solid block of carbon dioxide ice dipped in an acetone-alcohol mixture and then applied to the skin for 5-15 seconds, depending upon the desired depth. Carbon dioxide is easier to use, and the depth of the peel can be controlled more easily than with liquid nitrogen; Carbon dioxide is at - 78°C, while liquid nitrogen is at - 196°C.

Alphahydroxy Acids (AHA’s): 

Alpha-Hydroxy Acids or AHA is a compound found naturally in many common fruits and other foods.  They are the mildest of the peel formulas and produce light peels that can often provide smoother, brighter-looking skin. Over the last decade, alpha hydroxy acids (AHAs) have increasingly appeared as ingredients in cosmetics intended to reduce the signs of aging in the skin. The main benefits of alpha hydroxy acids come from its ability to exfoliate skin. They cause the cells of the skin (epidermis) to become "unglued", degrading the lipids that hold the most outer layer of dead skin cells to slough off, making room for re-growth of younger-looking, new skin. In addition AHAs stimulate the production of collagen and elastin, which provides greater strength and protect these skin cells. The result is skin that is smooth in appearance and texture. Those with a skin type which tans easily or rarely burns through skin types which always tan or never burn, should be especially careful and avoid possibly irritating products. Because alpha hydroxy acids peel away the tough outer layers of the skin, the newer and younger skin is more susceptible to the suns UV rays. Alpha hydroxyacids have proven to be effective in treating dry skin, acne, liver or sun spots, diminishing fine facial wrinkles, decreasing pore size, and improving skin texture.

• Smooths rough, dry skin
• Improves texture of sun-damaged skin
• Aids in control of acne
• Can be mixed with bleaching agent to correct pigment problems
• Reduce uneven pigmentation
• Can be used as TCA pre-treatment
• Reduce fine wrinkling

Considerations:

• A series of peels may be needed
• As with most peel treatments, sunblock use is recommended. In addition, the use of AHAs can increase sun sensitivity by 50% causing an interesting dilemma.
• AHA peels may cause the following: Light Stinging Sensation, Redness, Irritation, Crusting, Flaking, or Scaling, Dryness
• The problem with using fruit acids such as AHA and BHA is that either you get acids that are very weak that do not remove many dead skin cells and therefore you see little results, or they increase the strength of the acid, and once the acid has burned through the dead cells, it continues on and begins to attack your living skin
• Another problem with using acids is that the dead cells do not come off immediately; your skin gets white, flaky, and tight as the dead cells fall off over the course of a few days.
• The ideal pH is 3.0-3.5, any lower and the product may be too acidic; any higher and the product's exfoliating benefits may be nullified.

Glycolic Acid:  Most Popular, Glycolic acid which is found in sugar cane and sugar beets. Glycolic acid is the most skin-active AHA; and its primary action is to accelerate shedding of abnormal skin cells(corneocytes), in the topmost layers of the skin (stratum corneum), by decreasing their cohesiveness at the innermost levels of the surface layer of the skin by stimulating this layer of skin in its renewal process, increasing skin thickness, and promoting the formation of new epidermis and new dermal collagen. This process will result in skin shrinkage, reduction of wrinkling and "crepe-paper-like" skin, softening of "crow’s feet," and often helping to lighten hyperpigmentation. This makes the skin smoother. Additionally, it helps to remove comedones (blackheads); and, like retinol, it helps to restore the barrier function of the skin, thereby helping naturally to increase its own moisture content. It also leads to increased collagen production in the upper dermis, resulting in reduction of fine lines. It also has an anti-inflammatory effect and is able to enhance the effects of other topical agents, such as hydroquinone and salicylic acid

Lactic Acid: Lactic Acid is from sour dairy products

Malic Acid: Malic Acid is from fruit. Apples and pears. (pH adjustor)

Mandelic Acid: Mandelic Acid is the recommended AHA for those with sensitive skin since it is the most non-irritating. Can be obtained from amygdalin, a glycoside found in bitter almonds, peaches and apricots.

Citric Acid:  Citric Acid is derived fermentation of carbohydrates in oranges and lemons.

Tartaric Acid – Tartaric Acid is derived from grapes.

Salicylic Acid:

Beta Hydroxy acids are somewhat different from alpha hydroxy acids in their structure and mode of action. Salicylic acid, a common beta hydroxy acid, has been used for treating acne for decades. In fact, acne treatment remains the primary use for beta hydroxy acids. There are no studies showing that beta hydroxy acids are superior or even equal to alpha hydroxy acids in skin exfoliation or reducing fine wrinkles however for acne, beta hydroxy acids are clearly superior to alpha hydroxy acids. Its effect on the epidermis and upper dermis are similar to those of Retin-A, but with less irritation. It is soluble in oil and can exfoliate oily skin areas, even within oil-rich pores. Therefore, it has a beneficial effect on acne, pigmentary disturbances, and sun damaged skin. Because it does exfoliate, it has recently been added to formulations for chemical skin peel(s).  It has been claimed that BHAs are effective in reducing the appearance of fine lines and wrinkles, and improving overall skin texture, without the occasional irritation associated with the use of AHAs. Beta Hydroxy Acid or BHA is a derivative of aspirin and is often used in skin care products to accelerate skin cell turnover and help clear pores. It can penetrate more deeply than Alpha Hydroxy Acid and is gentler.  The salicylic acid peels are often more intense than the glycolic acid peels. Good for Melasmya.

Beta Hydroxy Acid is salicylic acid. This occurs in nature in sweet birch and in wintergreen leaves. Its effect on the epidermis and upper dermis are similar to those of Retin-A, but with less irritation. It is soluble in oil and can exfoliate oily skin areas, even within oil-rich pores. Therefore, it has a beneficial effect on acne, pigmentary disturbances, and sun damaged skin. Because it does exfoliate, use of sun protection is needed. BHA ingredients may be listed on packaging inserts as:

• Salicylic acid
• Salicylate
• Sodium salicylate
• Willow extract
• Beta hydroxybutanoic acid
• Tropic acid
• Trethocanic acid

Currently, the most commonly used BHA in cosmetics is salicylic acid. On rare occasions, citric acid is also listed as a BHA in cosmetic formulations; although, citric acid is more commonly considered to be an AHA.  Salicylic acid is lipid soluble; therefore, it is a good peeling agent for comedonal acne. The salicylic acid is able to penetrate the comedones better than other acids. The anti-inflammatory and anesthetic effects of the salicylate result in a decrease in the amount of erythema and discomfort that generally is associated with chemical peels. The most common concentration used today is 20-30%.

Medium: Trichloroacetic Acid (TCA)

• Removes superficial blemishes
• Corrects pigment problems
• Smooths out fine surface wrinkles

Considerations:

• Can be used on neck or other body areas
• May require pre-treatment with Retin-A or AHA creams
• Treatment takes only 10-15 minutes
• Preferred for darker-skinned patients
• Peel depth can be adjusted
• Repeat treatment may be needed to maintain results
• Sunblock must be used for several months
• Healing is usually quick, much quicker than with a phenol peel

TCA can be used on the neck or other body areas, and may require pretreatment with Retin-A or AHA creams. This procedure is preferable for darker-skinned patients.

Anesthesia is not usually required for TCA peels because the chemical solution acts as an anesthetic. Although, sedation may be used before and during the procedure to help the patient relax. Two or more TCA peels may be needed over several months to obtain the desired result, although mild TCA peels may be repeated more frequently.

The results of a TCA peel are usually less dramatic than and not as long-lasting as those of a phenol peel. More than one TCA peel may be needed to achieve the desired result.

TCA (10-35%) has been used for many years and is safe to use at lower concentrations. At higher concentrations, such as 50% and above, TCA has a tendency to scar and is less manageable than other agents used for superficial peels. TCA is found in several proprietary peels at varying concentrations, and some kits have instructions and buffering agents so the peel can be diluted as deemed necessary.

Phenol

• Smooths out coarse wrinkles
• Corrects blotches caused by: sun exposure, birth-control pills, aging
• Removes pre-cancerous growths

Considerations:

• Used on the face only
• Not recommended for dark-skinned individuals
• Procedure may pose risk for patients with heart problems
• Full-face treatment may take one hour or more
• Recovery may be slow - Complete healing may take several months
• May permanently remove facial freckles
• Sun protection, including sunblock, must always be used
• Results are dramatic and long-lasting

Deep peels with stronger chemicals get rid of large wrinkles and can have results as dramatic as a face-lift. This type of peel has a recovery time of 1-2 months. This peel is being done less since the introduction of laser resurfacing.

Superficial peels do not interfere with your normal everyday activities, so you need not take time off work or stay at home out of the public eye. In other words, these peels are a full treatment program over several months. The peels should be performed weekly, as they contain a concentration of ingredients which are far higher than those sold over the counter or applied by beauty therapists. It is also important not to abandon this treatment prior to having had the full course, because the treatments are cumulative and the previous one enhances each subsequent treatment. The ideal number of treatments is six.

Herpes is something to be aware of before a chemical peel.  Treating patients who have a history of herpes simplex with acyclovir is prudent. Acyclovir (400 mg) should be started 2 days prior to the peel and continued for 5 days after the peel to reduce the risk of recurrent herpes infection

Patients may treat the skin before and after a peel with such agents as tretinoin, hydroquinone, or an alpha hydroxy acid. These may help the skin heal faster and also allow the chemical peel agent to achieve better penetration.

Several days after each of the peels, flaking or light peeling of the skin will occur. Subsequent weekly peels have their strength and length of application adjusted according to your individual previous response. It may be important to combine the regular applications at the clinic with an ongoing treatment, which you perform yourself, using special creams, on a daily basis. After your treatment, it is recommended that you have a peel done every 2 to 3 months as on-going maintenance.  Patients may treat the skin before and after a peel with such agents as tretinoin, hydroquinone, or an alpha hydroxy acid. These may help the skin heal faster and also allow the chemical peel agent to achieve better penetration.

Looking after the skin after the peel

• Keep treated areas cool (use a water spray).
• Do not pick! Picking delays healing and causes scarring
• Moisturise - use light preparations after a superficial peel, thicker moisturizers after a deeper peel
• Protect from the sun - especially for the first 6 months
• If advised to do so, continue to use tretinoin, glycolic acid and/or hydroquinone at night long term

GETTING BACK TO NORMAL

With an AHA peel, the temporary redness, flaking and dryness that you experience will not prevent you from working or engaging in your normal activities. A fresher and improved skin texture will result with continued AHA treatments. Remember, protecting your skin from the sun is also important following these mild acid peels. Ask your doctor to recommend a sunblock with adequate UVA and UVB protection and use it every day.  Superficial peels result in mild facial redness and occasional swelling which usually resolve within 48 hours. The peeling is similar to sunburn. Most people can continue their normal activities. Make-up can be applied a few hours after the procedure.

With a TCA peel, the moderate discomfort and mild swelling you may experience will subside within the first week. In about a week to ten days, your new skin will be apparent and you should be healed sufficiently to return to your normal activities. It is best to avoid sun exposure unless you are adequately protected.  Moderate depth peels result in intense inflammation and swelling, which resolve within a week. The peeling is more marked. Mild redness can persist for several weeks. Most people take a week off from work after a moderate depth peel.

With a phenol peel, new skin will begin to form in about seven to ten days. Your face will be very red at first, gradually fading to a pinkish color over the following weeks to months. During this time, it is especially important that you use a sunblock or blotchy, irregular skin coloring may result.

Medium peels are typically not appropriate for people with darker skin tones or of ethnic background again due to the risk of irregular pigmentation following the procedure.

Because phenol peels result in permanently lighter skin, they are not recommended for most patients with very dark skin tones, such as Mediterranean or Black skin.

Phenol chemical peel treatment will induce post-inflammatory hypo-pigmentation (lightening) and/pr hyper-pigmentation (darkening) of the skin. This may lead to uneven pigmentation, which may manifest itself as a "blotchy" appearance, and also a visible line of demarcation where the treatment was performed may be visible. This renders the treatment counterproductive. Additionally, taking birth control pills, pregnancy, or a family history of brownish discoloration on the face may increase the possibility of developing this abnormal pigmentation.

If a deep peel is necessary, discussing the likely probability of change in pigmentation with the patient is best to ensure that when it occurs it is an acceptable result. It is usually necessary to do a test spot in areas other than the face, to evaluate the color changes that might occur from the chemical peel.

Acne is a skin condition, which discerns itself as plugged pores (blackheads and whiteheads), inflamed pimples (pustules), and deeper lumps (nodules). Acne lesions are most common on the face, but they can also occur on the neck, chest, back, shoulders, scalp, and upper arms and legs.  Salycylic Acid is best for Acne.

Two of the most popular revitalization methods are chemical peels and micro dermabrasion. Both chemical peels and micro dermabrasion focus on superficial skin irregularities such as finer wrinkles rather than deeply imbedded lines. Both of these methods address the top surface of the skin, but differ in their delivery method to aid in the removal of the top skin layer(s).

Chemical peels are caustic solutions such as glycolic acid, trichloracetic acid or phenol, and is applied directly to the skin. These chemicals change the composition of the skin, delivering a very controlled type of superficial tissue destruction that removes the outer layers of the skin. Deeper peels can also reconstitute the lower, collagen and elastin layers of the skin to remove deeper wrinkles. The consequence of chemical peel treatment is the removal of the other skin layer, allowing the new, regenerated, underlying skin to be shown.

Microdermabrasion is a non-chemical procedure that is slightly more aggressive.  Microdermabrasion involves "sanding" the skin with small microscopic crystals made of aluminum oxide, similar to grains of sand on a beach. A special high-powered instrument passes the crystals over the surface of the skin and then removes them quickly to "buff" superficial skin irregularities. The technique is similar to dermabrasion, although micro dermabrasion is performed more superficially and causes no bleeding.

There are also differences in the regiment schedule of treatment. Microdermabrasion procedures are usually repeated at one to two week intervals with six to eight sessions suggested for optimal results. For mild chemical peels, treatment regiment is similar to microdermabrasion. For medium chemical peels, treatment lasts for a few months before it should be repeated. For deep chemical peels, one treatment should be sufficient.

Both are these procedures are similar in that they produce redness and slight discomfort following the treatment. With microdermabrasion, the redness generally subsides within about 30 to 60 minutes. Depending on the type of chemical peel treatment, redness and last from an hour (mild chemical peels) to a couple of weeks (deep chemical peels). The side effects associated with chemical peels are much more severe if a deep chemical peel is applied. Deep chemical peels can be likened to dermabrasion, where a permanent change in pigmentation is often a result. For this reason, individuals with darker skin are not usually recommended to undergo this treatment.

Pre and Post Peel Product Support: Available for purchase at New Image