When we think of skin rejuvenation, there are so many new and high tech choices available that chemical peels are often overlooked. However, they can be a practical, cost-effective option to improve skin texture, mottled pigmentation, and uneven tone.
I am often asked what is the difference between a chemical peel and a laser peel. A chemical peel uses a chemical solution to nonspecifically damage layers of the skin to a desired depth (depending on the strength of the peel). As this heals, the response stimulates skin turnover and some degree of collagen growth. Resurfacing lasers use light energy to peel away very precise layers of skin. Not only does the healing response stimulate skin renewal, but the additional benefit of thermal heating causes some degree of skin tightening plus a greater amount of new collagen growth. Laser peels are not necessarily better than chemical peels, it depends on what laser you are using, the setting of the laser, and what you are trying to treat.
Two of the most popular peeling agents are TCA (Trichloracetic Acid) and Glycolic Acid. TCA peels are my personal favorite because they are so versatile and in my opinion give more noticeable results. However, many patients prefer Glycolic peels because they can pretty much continue their normal routine with limited downtime.
A medium depth TCA peel will have 4-5 days of heavy peeling and you will want to plan your schedule accordingly. A superficial Glycolic Acid peel is better suited for patients who cannot tolerate downtime, have very sensitive skin, or have skin of color. With these peels, you may be pink or red for a day and may not necessarily have actual “peeling” of the skin. Because of their gentle nature, these types of peels will have to be done in a series of 6 treatments for best results. Heavier Glycolic peels are still considered fairly superficial, but will cause somewhat more redness and peeling.
The ideal patient for a chemical peel is someone with brown, blotchy freckling on the face or chest, melasma, or fine textural complaints. Chemical peels can also help clear residual color left on the skin after acne breakouts. Those who have deeper lines or wrinkles and true acne scars should consider laser treatment.
The one exception to this is that some patients with ice pick scars can do quite well using what is called the CROSS technique, where 100% pure TCA is placed in the divot of the scar with a fine tipped toothpick. The goal is to stimulate excessive granulation tissue (which is basically collagen) to fill up just that tiny hole. It can take 1 to 6 treatments and usually this technique is done before laser resurfacing in a select subset of patients. It is not recommended for patients with dark skin types.
Whatever approach is used for skin rejuvenation, fillers and Botox should be discussed as part of the treatment armamentarium since chemical peels do not have an effect on volume loss due to normal aging or muscle relaxation. Combination therapy leads to the highest degrees of patient satisfaction when performed appropriately, however not everyone needs all three approaches.