peel is most commonly performed for cosmetic reasons: To enhance
your appearance and your self confidence. Chemical peel may
also remove pre-cancerous skin growths, soften acne facial
scars and even control acne. In certain cases, health insurance
may cover the peel procedure. Be sure to check your policy
and contact your insurance company before the procedure is
Monteiro about anything you don't understand.
If you are considering
a chemical peel...
Chemical peel uses a chemical
solution to improve and smooth the texture of the facial
skin by removing its damaged outer layers. It is helpful
for those individuals with facial blemishes, wrinkles
and uneven skin pigmentation. Phenol, trichloroacetic
acid (TCA) and alphahydroxy acids (AHAs) are used for
this purpose. The precise formula used may be adjusted
to meet each patient's needs. Although chemical peel
may be performed in conjunction with a facelift, it is
not a substitute for such surgery, nor will it prevent
or slow the aging process. Some
patients choose to have a chemical peel in
conjunction with other procedures such as a forehead lift, eyelid
surgery, or a facelift.
Types of Peels
Alphahydroxy acids (AHAs), such as glycolic, lactic,
or fruit acids are the mildest of the peel formulas and produce
light peels. These types of peels can provide smoother,
brighter-looking skin for people who can't spare the time to
recover from a phenol or TCA peel. AHA peels may be used to treat
fine wrinkling, areas of dryness, uneven pigmentation and acne.
Various concentrations of an AHA may be applied weekly or at
longer intervals to obtain the best result. Dr. Monteiro will
make this decision during your consultation and as the treatment
proceeds. An alphahydroxy acid, such as glycolic acid, can also
be mixed with a facial wash or cream in lesser concentrations
as part of a daily skin-care regimen to improve the skin's texture.
Trichloroacetic acid (TCA) can be used in many concentrations,
but it is most commonly used for medium-depth peeling. Fine surface wrinkles,
superficial blemishes and pigment problems are commonly treated with
TCA. The results of TCA peel are usually less dramatic than and not as
long-lasting as those of a phenol peel. In fact, more than one TCA peel
may be needed to achieve the desired result. The recovery from a TCA
peel is usually shorter than with a phenol peel.
Phenol is the strongest of the chemical solutions and produces
a deep peel. It is used mainly to treat patients with coarse facial wrinkles,
areas of blotchy or damaged skin caused by sun exposure, or pre-cancerous
growths. Since phenol sometimes lightens the treated areas, your skin
pigmentation may be a determining factor as to whether or not this is
an appropriate treatment for you. Phenol is primarily used on the face;
scarring may result if it's applied to the neck or other body areas.
formulas at a glance: Alphahydroxy
rough, dry skin
texture of sun-damaged skin Aids in control of acne
be mixed with bleaching agent to correct pigment problems
be used as TCA pre-treatment
series of peels may be needed
with most peel treatments, sunblock use is recommended
formulas at a glance: Trichloroacetic
out fine surface wrinkles
be used on neck or other body areas
require pre-treatment with Retin-A or AHA creams
takes only 10-15 minutes
for darker-skinned patients
depth can be adjusted
treatment may be needed to maintain results
must be used for several months
is usually quick, much quicker than with a phenol peel
formulas at a glance: Phenol
blotches caused by: sun exposure, birth-control pills, aging
out coarse wrinkles
on the face only
recommended for dark-skinned individuals
may pose risk for patients with heart problems
treatment may take one hour or more
may be slow - Complete healing may take several months
permanently remove facial freckles
protection, including sunblock, must always be used
are dramatic and long-lasting
skin lightening and lines of demarcation may occur
peel is especially useful for the fine wrinkles on cheeks, forehead,
and around the eyes, and the vertical wrinkles around the mouth.
All chemical peels carry some uncertainty and risk.
peel is normally a safe procedure when it is performed by a qualified, experienced
plastic surgeon. However, some unpredictability and risks such as infection and
scarring, while infrequent, are possible.
Planning your chemical peel
some states, no medical degree is required to perform a chemical peel -
even the strongest phenol peels. Many states have laws that permit non-physicians
to administer certain peel solutions, but regulate the strengths which
they are permitted to apply. You should be warned that phenol and TCA peels
have been offered by inadequately trained practitioners claiming "miracle
techniques" to rejuvenate the skin.
It is very important that you find a physician who has adequate training and
experience in skin resurfacing. Dr.
offer you a choice of peel techniques or suggest a combination of peels to obtain
the best result for you.
During your initial consultation, it is important that you discuss your expectations
with Dr. Monteiro. Don't hesitate to ask any questions or express any concerns
that you may have. Expect your plastic surgeon to explain the planned procedure
in detail, including its risks and benefits, the recovery period and the costs.
If you have a history of cold sores (herpes), you should inform Dr. Monteiro
prior to the procedure. Remember, chemical peel treatments are usually not covered
by medical insurance unless they are performed for medically related problems.
Preparing for your chemical peel
instruct you on how to prepare for your peel treatment.
Sometimes Retin A - a prescription
medication derived from Vitamin A - is used to pre-treat the skin. This thins
out the skin's surface layer, allowing the TCA solution to penetrate more deeply
and evenly. If your skin won't tolerate Retin-A pre-treatment, an AHA cream may
be used instead. Hydroquinone, a bleaching agent, is sometimes used in conjunction
with Retin-A or AHA pre-treatment, especially if you have blotchy skin areas
or pigmentation problems. You may have to spend a month or more in the pre-treatment
phase before Dr. Monteiro will schedule your actual peel.
You will need to arrange for someone to drive
you home and help you out for a day or two if you are having
a phenol or deeper TCA peel. You probably won't need any extra assistance
if you're having an AHA peel or superficial TCA peel.
Where your peel be performed?
chemical peels may be safely performed in Dr. Monteiro's office or outpatient
surgical center. The doctor may want you to stay overnight in a facility
or hospital if other cosmetic procedures are performed simultaneously.
Types of Anesthesia
Anesthesia isn't required for phenol or TCA peels because the chemical solution
acts as an anesthetic. However, sedation may be used before and during the procedure
to relax you and keep you comfortable.
No anesthesia is needed for AHA peels since they cause only a slight stinging
sensation during application. Dr.
answer any questions you may have concerning sedation during a chemical peel.
Monteiro will apply the AHA solution to your cleansed facial skin,
a process that usually takes no more than 10 minutes. No "after-peel" ointment
or covering is required. Depending on the strength of the peel, periodic
treatmentsmay be necessary until the desired effects are achieved.
For some patients, the application of an AHA-based face wash or cream once
or twice a day at home will be sufficient to accomplish the desired goal. Dr.
Monteiro may add Retin-A or a bleaching agent to your at-home treatment schedule.
After several weeks of at-home use, Dr.
examine your skin to determine if your regimen needs adjustment.
Phenol and TCA peels: Typically,
the skin is first thoroughly cleansed. Then, the doctor will carefully
apply the phenol or TCA solution. You may feel a stinging sensation
as the peel solution is applied, but this feeling will quickly pass.
A full-face TCA peel usually takes no more than 15 minutes. Two or
more TCA peels may be needed to obtain the desired result, and those
may be spaced out over several months. Mild TCA peels may be repeated
as often as every month.
If phenol solution has been used, your plastic surgeon may coat the treated
area with petroleum jelly or a waterproof adhesive tape. With lighter peels,
no covering is necessary. A full-face phenol peel generally takes one or two
hours to perform, while a phenol peel to a smaller facial region (perhaps the
skin above the upper lip) may take only 10 or 15 minutes. A single treatment
chemical solution can be applied to the entire face, or to
a specific area -
for example, around the mouth. Sometimes a peel is done in conjunction with a
At the end of a phenol peel, a thick layer of petroleum jelly
may be applied to the treated area
After your procedure
an AHA peel, it is common to experience some temporary flaking or scaling,
redness and dryness of the skin. However, these conditions will disappear
as the skin adjusts to treatment.
A TCA peel may also cause significant swelling, depending on the strength of
the peel used.
After a phenol or TCA peel, Dr. Monteiro may prescribe a mild pain medication
to relieve any tingling or throbbing you may feel. If tape was used to cover
your face, it will be removed after a day or two. A crust or scab will form on
the treated area. To help your face heal properly, it is essential that you follow
Dr. Monteiro's specific post-operative instructions.
If you've had a phenol peel, your face may become quite swollen. Your eyes may
even be swollen shut temporarily. You will need someone to help care for you
for a day or two. You may also be limited to a liquid diet and advised not to
talk very much during the first few days of recovery.
back to normal...!
healing, the skin is lighter in color, tighter, smoother, and
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 Dr. Monteiro to recommend a sunblock with adequate
UVA and UVB protection and use it every day.
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.
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.
About two weeks after treatment, you may return to work and resume some of your
normal activities. Your skin will be healed enough for you to wear makeup. (For
makeup tips, ask your plastic surgeon for the ASPS brochure on camouflage cosmetics.)
Improvements from AHA peels may be very subtle at first. You may detect a healthier
glow to your skin. With continued treatments, you will notice a general improvement
in the texture of your skin.
The results of a TCA peel are usually not as long-lasting as those of phenol
peel. However, your skin will be noticeably smoother and fresher-looking.
If you're planning a phenol peel, you can expect dramatic improvement in the
surface of your skin - fewer fine wrinkles, fewer blemishes and more even-toned
skin. Your results will be long-lasting, although not immune to the effects of
aging and sun exposure.