What Do Peels Contain?
Peel solutions most typically contain either alpha hydroxy acids (an AHA such as glycolic acid), beta hydroxy acid (salicylic acid, also known as BHA), tricholoracetic acid (TCA), or phenol as the exfoliating agent. Each of these are categorized by the concentration and the resulting depth of the peel on the skin which can range from superficial (also known as micro or light peels) to medium or deep peels. Results are closely linked to the depth of peel performed. Superficial peels (typically those using low concentrations of AHA or BHA) offer far less dramatic improvement than medium or deep peels (usually TCA or phenol-based) do. Overall, you can expect minor to major improvement in fine lines and wrinkles, skin discolorations, skin texture, rebuilding of collagen, removal of blackheads, and a temporary reduction in excessive oil production (Sources: Cutis, February 2003, pages 18-24; eMedicine Journal, February 14, 2002, volume 3, number 2; Facial and Plastic Surgery, November 2001, pages 253-262; and Dermatologic Clinics, July 2001, pages 413-425).
What Can a Peel Do…and Not Do?
With any peel it is important to know what’s possible so you can keep your expectations realistic and spare yourself disappointment. Chemical peels in any form cannot remove or reduce the appearance of blood vessels on the skin, they cannot change the appearance of enlarged pores, they do not have an effect on keloidal (raised) scarring, they do not work as a face-lift, and they have limited benefit for improving skin discoloration for those with darker skin color. They can make skin smoother, help fade brown spots and an uneven skin tone from sun damage, and generally make skin’s surface look fresher and younger. Having peels done on a regular basis (say, every 6-8 weeks) will lead to collagen stimulation that improves the appearance of wrinkles.
There are definite drawbacks to consider with peels, but this is largely dependent on the type and depth of peel. Superficial peels have few associated risks but also offer less noticeable results. Some redness, swelling, and increased skin sensitivity can occur with superficial peels. You may also experience a period of intense flaking as the old, damaged skin is replaced by fresh, smooth new skin.
When significant results are desired, complications increase proportionately. Medium and deep peel complications can include scarring, infection, temporary or permanent changes in skin color (this is especially true for deeper peels), and cold sore breakouts for those with a history of cold sores. (Sources: Dermatologic Clinics, July 2001, pages 427-438.) For these reasons, many cosmetic dermatologists are forgoing deeper peels in favor of what can be accomplished more safely with light-emitting and laser devices.
Chemical peels are performed by the application of the specific solution that actually dissolves the skin’s top layers, either over the entire face or on specific areas. Often, several shallow to medium-depth peels can achieve similar results to one deep-peel treatment, with less post-procedure risk and a shorter recovery time. Talk to your dermatologist about this option and see if it may be the best approach to take.
Alpha hydroxy acid (AHA) peels use glycolic acid as the peeling ingredient and these are considered superficial to medium peels depending on the concentration utilized. Typically the concentrations range from 30% to 70%. AHA peels are effective in improving skin texture, causing some collagen and elastin rebuilding, minimally reducing the appearance of acne scarring, and reducing the appearance of skin discolorations. Repeated treatments are necessary for all concentrations to maintain results. (Sources: Dermatologic Surgery, June 2002, pages 475-479; Plastic and Reconstructive Surgery, January 2001, pages 222-228; American Journal of Clinical Dermatology, March-April 2000, pages 81–88 and September-October 2000, pages 261-268; and International Journal of Dermatology, October 2000, pages 789-794).
Important Note: AHA peels are not medical procedures and as a result are not regulated by the FDA. A physician usually performs higher-concentration peels (more than 30%), but this is not always the case. Lower-concentration peels (20% to 30%), often performed by aestheticians, require repeated treatments to achieve and maintain the results seen immediately after the peel is performed.
After any peel, the practitioner should apply a broad-spectrum sunscreen (preferably one whose only active ingredients are titanium dioxide or zinc oxide) to your skin. Skin will be sun-sensitive for a few weeks after the peel, and it makes sense to use sun protection to protect the investment you just made. Don’t bother with peels if you insist on getting a tan, either from the sun or from a tanning bed. A reputable, ethical dermatologist would never offer a peel to someone who is visibly tan or cannot commit to daily sun protection.
Beta hydroxy acid (BHA) or salicylic acid peels are not as popular as AHA peels, yet they can be equally effective and have specific advantages for some skin types. A salicylic acid solution can work in a way that is similar to a glycolic acid peel, but irritation may be reduced. Salicylic acid is a compound closely related to aspirin (acetylsalicylic acid), and it retains its aspirin-like anti-inflammatory properties. A deep BHA peel can be superior for many skin types because the irritation and inflammation are kept to a minimum due to the analgesic action of the BHA compound. Salicylic acid is also lipid soluble; therefore, it is a good peeling agent for blemish-prone skin with blackheads. The most common concentrations used today are 20% to 30% (Sources: Dermatologic Surgery, December 2003, page 1196 and March 1998, pages 325–328; and Cosmetic Dermatology, October 2000, pages 51-57).
BHA peels are also the preferred option for those with sensitive skin, including skin affected by rosacea. Note that some people with rosacea cannot tolerate salicylic acid. If you have rosacea, consider experimenting with a skin-care product that contains salicylic acid before considering a BHA peel.
Trichloroacetic acid (TCA) peels (sometimes called Blue Peel) in concentrations up to 50% are superficial to medium peels and have been around for years with a history of being effective and safe (Source: Dermatologic Clinics, July 2001, pages 413–425). This type of peel can be used for peeling the face, neck, hands, and other areas of the body. It has less bleaching effect than phenol (see below) and is excellent for “spot” peeling of specific areas. TCA peels are best for fine lines but are minimally effective on deeper wrinkling (Sources: Dermatologic Surgery, February 2004, pages 179-188; eMedicine Journal, December 5, 2001, volume 2, number 12; and Plastic and Reconstructive Surgery, January 2001, pages 222-228).
Jessner’s peel is a medium-depth peel containing 14% salicylic acid, 14% lactic acid, and 14% resorcinol. Though considered effective and easy to use, there is little research on this method. We do know this peel becomes stronger as more layers are applied. The amount of resorcinol in this peel makes it more irritating than AHA or BHA peels, and it is generally not recommended for those with dark skin tones due to the risk of resorcinol causing post-inflammatory hyperpigmentation (Source: Cosmetic Dermatology, Second Edition, Baumann, Leslie, MD, 2009, pages 154).
Phenol is sometimes, though rarely, used for full-face peeling when sun damage or wrinkling is severe. It can also be used to treat limited areas of the face, such as deep wrinkles around the mouth, but it may permanently bleach the skin, leaving a line of demarcation between the treated and untreated areas that must be covered with makeup. “Although phenol produces the most remarkable resolution of actinic damage and wrinkling among the various [chemical peels]… it also possesses some of the more significant [serious side effects]. Many have abandoned phenol in favor of other agents or laser resurfacing… . Hypopigmentation may occur in all skin types, noticeably lightening patients with darker skin and making lighter-skinned patients appear waxy or pale. A clear line of demarcation may be present between treated and untreated skin” (Source: eMedicine Journal, July 20, 2001, volume 2, number 7).
Buffered phenol offers yet another option for severely sun-damaged skin. One such formula uses olive oil, among other ingredients, to diminish the strength of the phenol solution. Another, slightly milder formula uses glycerin. A buffered phenol peel may be more comfortable for patients, and the skin heals faster than with a standard phenol peel, but it is still a risky procedure that can depigment the skin(Source: http://surgery.org/press/news-release.php?iid=109§ion=news-consumer). On balance, we recommend forgoing phenol peels in favor of laser treatments such as Fraxel.
What About At-Home Peels?
Many women ask us about the number of peels sold online for use at home. These peels often advertise having high concentrations of AHAs or BHA and some contain other peeling agents along with these popular standbys. We cannot stress enough how potentially dangerous these peels can be. If they’re as effective as claimed or if they really contain the amount of acid(s) advertised and the pH is within range for them to work, you could be setting your skin up for some serious damage. In the wrong hands or used incorrectly or too often, at-home peels can cause burns, extremely sensitive skin, discolorations (from loss of pigment), and persistently dry, flaky skin that doesn’t respond to even very rich moisturizers. If you decide to ignore our warnings and try this anyway, proceed with caution.
The other issue with at-home peels is that despite the impressive claims in terms of amount of acid they contain, the pH may be buffered beyond the range needed for efficacy. So yes, the peel you’re considering contains 50% glycolic acid, but because the pH when mixed is above 4, you’re not going to see much in the way of results. The good news? A higher pH like this means the peel poses less risk of causing excess irritation.
The Final Decision
Whether to have a peel and what type to get depends on the condition of your skin, your skin type, and keeping your expectations realistic. Most important is for you to know that a peel isn’t an anti-aging cure-all. For example, peels cannot help with sagging skin and they don’t replace the results possible from cosmetic corrective procedures such as Botox or any of the numerous dermal fillers. Peels are helpful for improving skin tone, texture, and for some cases of hyperpigmentation (brown spots) but for best results, they must be accompanied by daily use of a well-formulated sunscreen rated SPF 25 or greater along with a brilliant anti-aging skin-care routine. Now that’s a beautiful combination proven to help you look younger, longer!