Chemical peels involve applying a solution to skin to improve its appearance by removing the outer layer of skin or exfoliating the skin. This process can eliminate fine lines under the eyes and around the mouth, give skin a more even color tone and reduce the appearance of wrinkles and scars. Skin on the face, neck, chest, hands, arms and legs may be treated with this process.

Chemical peels are usually performed in a dermatologist’s office on an outpatient basis. During the peel, a solution is applied to the area of the skin being treated. As the chemical begins to work, it can cause superficial exfoliation or possible blistering of the skin, depending on the strength and type of chemical peel. This allows new layers of skin to appear after healing is complete. The new skin is typically smoother than the old skin, and may have a more even tone. Chemical peels may also be mixed with skin bleaching agents to correct uneven pigmentation.

Depending on the severity of the skin condition to be treated, chemical peels may be superficial, medium or deep. In general, the deeper the peel, the more discomfort the patient will experience and the longer the recovery time. However, the deeper peels usually lead to a much more improved result in a much shorter period of time. However, the deeper peels can be used to correct deeper wrinkles, freckles and pigment problems, and remove pre-cancerous growths, whereas the mild peels generally only smooth rough, dry skin.

Potential risks associated with chemical peels may include a temporary or permanent change in skin color, redness and scarring (in rare instances).

Chemical peels are a technique in which a solution is applied to skin that causes causes a layer of skin to separate and peel off. This allows new skin to regenerate, resulting in a more youthful, less wrinkled appearance. The new skin is typically smoother than the old skin and may have a more even color tone. Chemical peels can also be used in conjunction with skin lightening agents to correct pigment problems.

Depending on the severity of the skin condition to be treated, chemical peels may be superficial, medium or deep. In general, the deeper the peel, the greater the potential discomfort and the longer the recovery time.

Chemical peels have been performed safely for decades. Results may be enhanced by combining chemical peels with other techniques, such as laser resurfacing, botulinum injections (Botox), skin fillers or facelift. Chemical peels work best for fair-skinned and light-haired patients, but some types of peels may also work for those with darker skin. Patients should discuss their options with a physician before deciding which approach is best for them.

Fine lines under the eyes and around the mouth are among the most common conditions treated with chemical peels. Other areas that are treated include the rest of the face, as well as the neck, chest, hands, arms and legs. Skin problems that may be treated with chemical peels include:

• Wrinkles caused by sun damage, aging and hereditary factors
  
• Mild scarring
  
• Certain types of acne
  
• Precancerous skin growths
  
• Pigmentation, including sun spots, liver spots or freckles
  
• Blotchiness associated with the use of birth control pills
  
• Skin that has become dull in texture and color
  
• Scaly skin patches
  
• Actinic keratoses

Skin problems that do not respond as well to chemical peels include sags, bulges and more severe wrinkles. These problems are due aging, with loss of elasticity in the skin, and are better treated by other procedures such as facelifts, browlifts and laser or other light-based therapies. Chemical peels also cannot remove deeper scars, which can be treated using procedures such as dermabrasion, scar excision or soft tissue fillers (e.g., collagen implants).

Chemical peels cannot eliminate broken blood vessels on the face. However, they may improve the appearance of this condition. It is also important to note that chemical peels do not prevent or slow the natural aging process of the skin. They mainly help to rejuvenate and refresh the skin.

There are three main types of chemical peels: superficial, medium and deep. The type of skin condition to be treated will determine which of the peels will be used.

• Superficial peels. Most often performed using alpha hydroxyacids (AHAs), which are naturally occurring acids found in fruits and other foods. They are effective in treating dry skin, acne and fine facial wrinkles. They can also decrease pore size and improve skin texture. Superficial peels are typically performed as a series of six to eight peels, with each peel taking place two or three weeks apart. Superficial peels are cosmetic procedures. The peeling agent can also be mixed with skin lighteners to improve the skin tone.
  
  
• Medium peels. Most often performed using trichloroacetic acid (TCA), sometimes in combination with other chemicals. They have the same benefits as superficial peels, but their deeper level of penetration also allows them to help remove larger wrinkles and precancerous skin lesions. Medium peels cause more discomfort and greater reddening of the skin than superficial peels, and patients must stay out of the sun for a period of about seven days, after which sunblock use might be recommended for several months. Medium peels are performed once every couple of years.
  
  
• Deep peels. Stronger solutions, such as phenol, are used in this type of chemical peel, which can improve deeper wrinkles, correct blotches, remove pre-cancerous lesions and in some cases may be as effective as a facelift. Deep peels can be performed only on the face because they may cause scarring when used in other areas. This type of peel has an extended recovery time of as long as two months. In addition, deep peels may pose risks for patients with heart problems. Deep peels are performed less frequently now that physicians have the option of laser resurfacing, which uses a light beam to change the texture and appearance of the skin, achieving some of the same results as deep chemical peels with fewer complications.

Patients who have a skin problem should consult with a dermatologist about whether or not a chemical peel is the best option for treating their condition. It is important to search for a qualified physician who has experience performing the procedure. Qualified physicians will be able to choose the proper peeling agent based on the patient's skin type and condition. In some states, a medical degree is not required to perform a chemical peel.

Patients considering a chemical peel should also inform their dermatologist if they have a history of keloids (red, raised formations of fibrous scar tissue), unusual scarring, extensive x-rays or radiation to the face, or recurring cold sores.

Prior to the procedure, patients should follow any preparatory steps suggested by their physician. Patients may be asked to stop using certain medications or to prepare the skin for the procedure by applying certain preconditioning creams. Patients may also be advised to apply sunscreen with a sun protection factor (SPF) of 30 or higher during the days leading up to the procedure.

Chemical peels are usually performed in a dermatologist’s office on an outpatient basis. The patient’s skin is cleansed with an agent that removes excess oils, and the eyes and hair are covered to protect them from the chemical solution. Depending on the type of peel being performed – superficial, medium or deep – the solution itself is made up of a substance or combination of substances that may include glycolic acid, trichloroacetic acid (TCA), salicylic acid, lactic acid and phenol, or carbolic acid.

The solution is applied to the area of skin to be treated. A frosting of the skin may occur as the protein in the skin is coagulated when the acid is applied. This can last for several minutes.

Patients may feel a warm to hot sensation that lasts for five to 10 minutes and is followed by a stinging sensation. As the chemical begins to work on the skin, it produces a separation as the top layers of skin peel off and allow the new skin to appear. Some of the chemicals used must be rinsed with water after use. Other chemicals, such as salicylic acid and TCA, do not need rinsing.

Patients who have deeper peels will probably experience a greater level of discomfort due to the stronger chemical mix used in this type of procedure. Medications are available to help reduce the level of discomfort that patients feel. Emollients may also be applied to heal the skin quicker.

Recovery after a peel is dependent on which kind of peel was used. The use of sunblock is always recommended after any peel. After a series of mild chemical peels, there may be redness and a mild stinging sensation, similar to a sunburn. Patients who have undergone a medium peel or series or peels will experience greater skin discomfort that may include more scabbing, stinging and swelling. The use of sunblock is usually recommended for several months after the peel. Recovery after a deep phenol peel will take the longest and involve the greatest discomfort. These peels permanently bleach the skin, so lifetime sunblock use is mandatory. In addition, the procedure will likely be followed with a period of pronounced swelling, blistering and scabbing. In some cases, the patient's eyes might even swell shut temporarily, and surgical tape may be used to cover the new skin. Bandages are usually removed after several days. Patients should resist the urge to pick at any scabs, to reduce the risk of scarring.

Sun exposure is an important issue after any chemical peel. After mild peels, sunscreen and sunblock use is recommended, while after a medium peel, sunblock might be required for a period of months. These kinds of peels don't actually bleach the skin, however, and after healing is complete, melanin production will begin again and help protect against UV radiation. Deep phenol peels, however, bleach the skin permanently, which requires lifetime use of sunblock. Physicians might decline a phenol peel to patients who are unlikely to follow through with sunblock use.

In some cases, patients may develop a temporary or permanent color change in their skin. Factors that may increase this risk include use of birth control pills, pregnancy or a family history of brownish discoloration on the face. Some patients also experience persistent redness of the skin that may last for months.

Patients can lower their risk for developing abnormal skin color by adhering to their physician's instructions on follow-up care and resisting the urge to pick at the scabs that develop following the procedure.

In rare cases, chemical peels can cause scarring, which can usually be treated successfully. It is important to use lesser strength peels on non-facial areas, as they are more apt to scar. Patients with a history of fever or blisters from cold sores due to herpes simplex infection may be at risk for reactivation of these outbreaks following a chemical peel.

Individuals who undergo chemical peels also risk infection. Antibiotics or antiviral medications may be used to treat infections that develop following a chemical peel.

Deep peels may pose risks for patients with heart problems. As a result, they are often performed under anesthesia with heart monitoring.

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to chemical peels:

1. Are chemical peels a good option for treating my skin condition?
   
   
2. Which type of chemical peel would you recommend for me? 
   
   
3. Do you have experience performing chemical peels? If so, how many have you performed?
   
   
4. Will I feel any pain or discomfort during the procedure? What about after? 
   
   
5. How many chemical peels will I require to get the desired results?
   
   
6. How long will each session last?
   
   
7. How long will it take me to recover?
   
   
8. What complications may I develop?
   
   
9. Will I have to restrict my activities following the chemical peel?
   
   
10. Will I have to avoid the sun following the procedure? If so, for how long?