Chemical Peels & Medical Grade Acids
Revitalize Your Skin with Professional Exfoliation Treatments
Chemical peels have been used to rejuvenate the skin for millennia.
They have become a globally recognised treatment modality for skin rejuvenation and the treatment of certain skin diseases.
Since the early 1990s, laser technology, with its associated promotional build-up and high levels of expectation, has done its best to displace chemical peels in Europe.
With time, however, long-term results have shown that the effects of medium/ deep chemical peels cannot be replaced by such skin rejuvenation technologies.
To date, deep phenol and TCA peels are still regarded as the international gold standard of skin resurfacing and a benchmark for other ablative methods.
Chemicals, formulae, treatment techniques, and the individual quality of the skin are the variable factors in the art of chemical peeling.
However, the multiple potential variations enable the practitioner to provide an optimal and individually tailored treatment of the patient's condition.
Chemical peels-primarily medium and deep peels-are highly effective treatment methods for the rejuvenation of the skin.
A chemical peel isn’t just about the procedure itself.
Along with the treatment performed by your practitioner, following tailored recommendations for both pre- and post-peel care at home is essential (!)
Definitions
Peeling or exfoliation are treatments aimed at the removal of diseased changes or cosmetic defects on the skin, impacting the epidermis or both the epidermis and dermis, depending on the used method.
By deliberately causing controlled damage to the outer layer of the skin (epidermis), it stimulates skin regeneration and remodeling, resulting in improved appearance and texture.
Peels can be categorised into:
- Mechanical peeling involves the abrasion of the epidermis using tools such as corundum discs, diamond discs, or corundum crystals (microdermabrasion).
- Physical peeling may use technologies like lasers, frozen carbon dioxide, nitrous oxide or liquid nitrogen.
- Chemical peels employ various chemical compounds with exfoliating properties, including salicylic acid, resorcinol, carbolic acid (phenol), trichloroacetic acid (TCA), fruit acids, glycol propylene, vitamin A acid, and Jessner's solution.
Peelings are popular procedures in the field of dermatology and aesthetics, as they can help improve skin texture, tone, therefore appearance. They have been used for many years to treat various skin conditions such as acne, hyperpigmentation, and signs of aging. However, with advancements in technology and techniques, peelings have become more precise and effective than ever before.
Depth...
The examples below highlight the different types of peels and their corresponding depth of effect:
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Very light/ superficial peels: These include low-potency glycolic, lactic, mandelic, salicylic, and retinoic acid.
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Light / superficial peels: These consist of 20% to 30% TCA, Jessner solution, and 30% to 50% glycolic acid.
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Medium peels: Combinations like 35% TCA with either Jessner solution or 70% glycolic acid fall into this category.
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Deep peels: These involve TCA exceeding 50%, as well as combinations of croton oil and phenol.
Superficial Peeling Agent: Glycolic Acid (AHA)
Reducing Fine Lines and Wrinkles - Glycolic acid has anti-aging properties, which can help to reduce the appearance of fine lines and wrinkles over time.
By promoting collagen production, glycolic acid can help to firm up the skin, smooth out texture irregularities.
It can also help to improve skin elasticity, which can make your skin look more youthful and resilient.
Pore Minimizing- Due to its exfoliating properties, glycolic acid can help to reduce the size of your pores, making them appear less visible and tight.
Brightening and Even-Toning - Another significant benefit of glycolic acid is its ability to brighten your skin, giving it a more even tone and radiance by removing the skin's top layer, allowing the fresher, brighter skin to shine through.
Acne-Reducing - Lastly, glycolic acid's exfoliating properties can help to reduce the occurrence of acne and breakouts.
Superficial Peeling Agent: Azelaic Acid (AHA)
Reduced Acne Breakouts - Azelaic acid is widely known for its fantastic ability to reduce acne breakouts. It works by reducing inflammation in the skin, which is one of the key factors related to acne breakouts.
Decreased Skin Discoloration - this compound works by blocking an enzyme called tyrosinase, which is responsible for producing melanin in the skin. When produced in excess, it can result in skin discolouration such as hyperpigmentation and melasma.
Treatment of Rosacea - Rosacea is characterized by redness, inflammation, and sometimes pimple-like bumps on the skin.
It can help to reduce redness, swelling, and other symptoms associated with this condition.
Anti-aging Properties - This compound can help to reduce the appearance of fine lines and wrinkles by increasing collagen production in the skin.
Improved Skin Texture - by exfoliating the skin's surface, this compound can help to remove dead skin cells, unclog pores and reduce the formation of blackheads and whiteheads, resulting in smoother, more radiant skin.
Possible side-effects
Mild side effects experienced may include:
temporary peeling, redness, flaking, and mild discomfort.
On the other hand, less common side effects can be more severe such as hyper or hypopigmentation, scarring, or burns in rare cases.
Risks can be minimised by following the recommended skin care regimen, use of post-treatment recovery kits (if being provided), informing the professional of any pre-existing or new skin problems, and being honest during consultations.
How often should you peel ?
Very Light (very superficial) peels, also known as cosmetic peels can be performed regularly, even once or twice a month, making them convenient for people who want to maintain their skin's appearance.
These peels involve the application of a mild acid solution which exfoliates the top layer of dead skin cells and promotes cell turnover. They are also relatively painless and require little to no downtime.
However, for more significant results, one should consider TCA (trichloroacetic acid) peels.
TCA peels are medium-depth chemical peels that can address deeper skin concerns such as deep wrinkles, scars, and sun damage.
Unlike superficial peels, TCA peels (depends on the strength) should only be performed every 6 - 12 month to prevent over-exfoliation.
Superficial Peeling Agent:
Lactic Acid (AHA)
Promotes collagen production - Lactic acid stimulate collagen production, which results in plumper, moother, and healthier-looking skin.
Targets hyperpigmentation - It's a challenging issue to treat, but lactic acid peels help in fading dark spots and even out skin tone. The peel solution seeps deep into the skin layers and breaks down the cells that produce melanin, thereby lightening the pigmentation.
Minimizes fine lines and wrinkles - Regular lactic acid peels help in making skin smoother and improving skin texture. It's a non-invasive way to reduce signs of aging, and results appear naturally over time.
Improves skin hydration: Along with exfoliating, it also hydrates and nourishes the skin. The results are impressive, as the skin feels softer and smoother. It's a great way to prep your skin before a big event or after a long day out in the sun.
Superficial Peeling Agent:
Salicylic Acid (BHA)
Brightens and Evens out Skin Tone - exfoliates and also stimulates cell turnover. It promotes the growth of new cells, which replaces the dull, damaged skin with fresh and healthy cells. This, in turn, brightens the skin and gives it a more youthful, radiant glow.
Reduces Inflammation and Redness - it has anti-inflammatory properties that help to reduce the redness and inflammation associated with acne and other skin issues. It calms down the skin, making it less irritated and sensitive. Additionally salicylic acid has keratolytic properties, it softens and removes the dead skin cells that clog the hair follicles and cause inflammation. This leads to fewer breakouts, less redness and puffiness.
Boosts Collagen Production - Collagen is a structural protein that gives the skin its elasticity, firmness, and plumpness. Salicylic acid peel can help to boost collagen production by stimulating the fibroblast cells in the skin.
Salicylic acid cannot be used by cthose who are allergic to salicylates like aspirin or pregnant women.
TRICHLOROACETIC ACID (TCA)
TCA the high-performance chemical peel for true Skin Rejuvenation.
If you are looking for an effective way to improve the appearance of your skin, then a Trichloroacetic Acid Peel can be an option for you.
"TCA Peel" is used to treat various skin conditions such as wrinkles, fine lines, acne scars, uneven skin tone and hyperpigmentation (sun damage)
This procedure can be done on various parts of the body, including the face, neck, chest, and hands.
What is TCA ?
Trichloroacetic (TCA) is a light to medium-strength medical-grade peel, is a powerful substance obtained through the distillation of chloral acid with nitric acid steam.
Despite its potency, TCA is surprisingly non-toxic. With the lowest pKa value among all acids used in chemical peels, TCA boasts exceptional strength.
The depth of the peel will depend on:
- the concentration of TCA used
- the number of "layers" applied
- pressure applied
- the patients skin's thickness
- skin preparation
Superficial Peeling Agent:
Mandelic Acid (AHA)
Exfoliation and Cell Renewal - Unlike other AHAs, such as glycolic or lactic acid; Mandelic Acid has a larger molecular size, which means that it penetrates the skin more slowly and deeply.
This results in a more gradual exfoliation process that is less likely to cause irritation or redness. Moreover, Mandelic Acid stimulates cell renewal, which helps to improve skin texture.
Anti-Acne Properties - potent antiseptic and antibacterial agent that can help to treat acne-prone skin. It works by regulating oil production, unclogging pores, and killing acne-causing bacteria.
Hyperpigmentation Reduction - effective reduction of hyperpigmentation. It works by inhibiting the production of melanin. Mandelic Acid is also safe for darker skin tones, as it does not trigger post-inflammatory hyperpigmentation (PIH) or cause skin sensitivity.
Safe for Sensitive Skin - Mandelic Acid is a gentle acid that is safe for sensitive skin. It has a larger molecular size than other AHAs, which means that it does not penetrate the skin as deeply. This reduces the risk of irritation or redness, making it an ideal choice for those with sensitive or reactive skin.
Recovery time
When it comes to peels, the recovery time can vary significantly.
Gentle peels (AHA, BHA) may require little to no downtime, while more intensive treatments like (TCA) can necessitate a 7 - 10 days of recovery.
It's crucial to consider this factor before scheduling your appointment, ensuring that you allow yourself enough time to fully recuperate.
Ignoring proper healing time can result in negative outcomes and even permanent damage to your skin.
What are the benefits of TCA peel ?
TCA helps reduce the appearance of wrinkles, fine lines, and sun damage, hyperpigmentation, shallow acne scars.
It also improves skin tone and texture, making your skin appear smoother, brighter and more youthful.
After the procedure, there is a significant increase in collagen and elastin production for over a 3-month period. This leads to an expansion of the papillary dermis and the formation of thick fibers in the mid-dermis.
This is what we call: ANTI-AGEING treatment.
What are the risks and side-effects associated with TCA peel ?
As with any cosmetic treatment, Trichloroacetic peel come with potential unpleasant effects that you need to be aware of.
During procedure you may experience common side-effects include mild redness, !stinging and !burning sensation which typically subside within minutes. (read: severe but very short lasting)
In some (rare) cases, patients may experience more severe side effects such as blistering, scabbing, scarring, infection, hyper- or hypopigmentation.
To minimise the risks associated with the TCA peel, it is important to choose a reputable skincare professional with experience in performing chemical peels. This will ensure that the treatment is performed safely and effectively.
Curious about how a TCA work ?
This powerful acid coagulates skin protein, leading to a gradual peeling process.
Applied in a controlled manner with a brush or sponge, the solution penetrates the skin for a specific duration.
Depending on the strength and depth of the peel, expect peeling to begin within days and last up to a week or more.
Plus, enjoy the added benefit of collagen production for healthier, more youthful-looking skin.
Is it painful ?
When it comes to TCA peels, you may experience discomfort or a stinging-like sensation.
However, the discomfort is usually mild to severe and its short-lived, lasting only a few minutes.
It's comparable to the discomfort felt during waxing.
Don't worry about redness around the treated areas either; it should fade within 60-100 minutes after the treatment.
The best part? You'll see remarkable improvements in texture and appearance, with the treated areas noticeably brighter.
Aftercare
Following a TCA peel, it is essential to take care of the skin properly to ensure proper healing and optimal results.
This means reapplying provided skin products (4-6 times a day), absolute avoidance of sun exposure, allowing your body to recover by prioritising sleep and resist the temptation to pick off any detached skin layers or scabs.
It is essential to take note of any instructions provided by the aesthetician and follow them as closely as possible.
Recovery after TCA Peel may take anywhere from 7-10 days sometimes longer (very rarely) before your skin has healed completely enough for full makeup cover-up (which you may not need anymore) or regular exercise.
Tobacco use can significantly decrease the effectiveness of the procedure and impair wound healing. It is crucial to stop or greatly reduce amount of tobacco especially during recovery period.
As a healthcare professional, I understand the importance of constantly monitoring and assessing the progress of healing. This is especially crucial in cases where clients have undergone intensive treatment.
Therefore, to ensure your recovery stays on track, I ask my patient to send me a photo of their face every 12 hours. This allows me to monitor their progress closely and address any concerns promptly until the healing is completed.
Are you considering TCA peel?
It's a fantastic option for most people, but there are a few factors to consider.
If you're pregnant or breastfeeding, have active skin infections or inflammation, a history of keloid scarring or abnormal scarring, or are taking specific medications, you may not be eligible for the treatment.
Preparing for TCA Peel
Get ready by taking these important steps to prepare your skin.
Your aesthetician will provide specific instructions, but here are some general tips to keep in mind:
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Avoid sun exposure at least four weeks before the treatment.
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Stop using retinoids, exfoliating products, and facial hair removal methods for at least one week.
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Plan time off from work.
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Stay hydrated
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Maintain a healthy diet and lifestyle.
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In some cases, use prescribed topical products to prepare your skin for the peeling process.
Follow all pre-treatment instructions and post-treatment care to achieve optimal results and minimize any side effects.
Contraindications
Absolute contraindications:
- History of allergy to ingredients of the peel or the adjuvant topical therapy
- Unrealistic expectations
- Poor compliance (!)
- Pregnancy
- Excessive sun exposure
- Systemic retinoid treatment
- Infectious skin diseases in the treatment area
- Oestrogen therapy with concomitant intensive UV exposure
Relative contraindications:
- Patients with Fitzpatrick skin types IV - VI
- Heavy smoking
- Regular drinker
- Diabetes mellitus
- History of an increased risk of scarring (predisposition to keloids)
UV light
Dermatological practice has highlighted critical issues such as the effects of UV exposure, duration and intensity, leading to:
photoaging, pigmentation disorders, wrinkling, telangiectasia, solar keratosis, dull skin tone, sagginess, and loss of skin elasticity.
Historical summary
Chemical peeling has its roots stretching back to ancient times where women utilised natural substances for skin care.
In ancient Egypt, for instance, women bathed in sour milk to smooth their skin, making use of lactic acid unknowingly.
In subsequent centuries, varied ingredients like mustard, sulphur, and limestone were used for skin whitening, while in Turkey fire was used in an attempt to peel the skin.
The therapeutic benefits of herbs have been acknowledged for millennia, underpinning the longstanding tradition of natural cosmetics.
Influential women throughout history, including the mythical Queen of Sheba, crafted beauty recipes like her favorite almond milk mask that are still in use today.
Women created scrubs with sea sand or ground nut, and fashioned enzymatic peelings utilizing enzymes from fruits like bananas, papayas, and cucumbers.
Introduction to skin healing and HOW peels work ?
When your skin is damaged, it activates a natural healing process.
This process works to repair and restore your skin, breaking down damaged structures and replacing them with healthy, functional ones.
Interestingly, certain controlled damage, like the kind from superficial, medium, or deep chemical peels, is a standard treatment in aesthetic medicine.
By triggering these healing mechanisms, we can enhance both the clinical health and improve aesthetic appearance of the skin.
Superficial peels
i.e: Glycolic, Mandelic, Lactic acid
Superficial peels work by stimulating the basal keratinocytes. These cells increase their activity, producing proteins, lipids, and structures that form the protective barrier of your skin. Essentially, the process helps to rebuild a smooth, compact outer layer, improving the skin’s health and appearance.
Medium and Deep peels
i.e: TCA & phenol
These acids penetrate deeper, targeting both the epidermis and dermis.
While the healing process takes longer, the results are more dramatic - offering dermal rejuvenation and improved elasticity as collagen production ramps up. However, patience is key!
Key Takeaways for Patients
What Are the Benefits of Medium - Deep Peel ?
The goal of these treatments is not only to repair damaged skin but also to improve its overall appearance through smoother texture, firmer structure, and a healthier-looking glow. With proper aftercare, you can enjoy rejuvenated, youthful results.
What About Risks?
Side effects are typically minimal but must be addressed on a case-by-case basis. Your skin type, the area being treated, and the depth of the peel all play a role in managing the risk of pigmentation changes, scarring, or prolonged healing in rare cases.
What Should I Expect Post-Treatment?
- After a superficial peel, the upper layer will regenerate quickly, often within 1 - 2 days.
- For deeper treatments (TCA) you’ll notice improvements within 7 - 10 days, but full effects (especially improved collagen production) take a bit longer.
