Chemical peels

A chemical peel is an acid solution applied to the skin for a controlled time and then removed or neutralized, so the outer layers shed in a controlled way. Superficial peels act on the outermost layers; medium-depth peels act further down and need a longer recovery. The practitioner chooses the peel and sets the recovery plan.

The protocol is the treating professional's clinical decision.

What it is

Peels are grouped by how far down the acid acts. Superficial peels commonly use alpha hydroxy acids such as glycolic, lactic or mandelic acid, or the beta hydroxy acid salicylic acid. Medium-depth peels classically use trichloroacetic acid, alone or after a superficial agent. Deep peels are a physician procedure and outside the scope of this page.

The ingredient background is in the library: alpha hydroxy acids and salicylic acid. Practitioners use peels for the look of uneven tone, dullness and surface texture. This page sits within the professional treatments section.

Who performs it

A licensed professional performs it, and which professionals may perform which depth of peel is set by each jurisdiction's scope of practice rules.

What the skin goes through

The acid loosens the bonds that hold surface cells together, and the treated layers shed over the following days. A superficial peel may leave the skin looking flushed and feeling tight, with fine flaking or none that is visible. A medium-depth peel darkens and tightens the surface before it peels away in larger pieces.

The more a peel removes, the longer the recovery and the greater the risks. Published reviews list prolonged redness, changes in pigment, reactivation of cold sores and, less often, scarring. Pigment change is a particular consideration for darker skin tones, which is one reason the choice of acid and strength belongs to the practitioner. Laser resurfacing reaches similar goals by a different route: see laser resurfacing.

Recovery

The practitioner who performed the peel describes the expected course for your skin, and that description is the reference. Typical aftercare means cool water, no picking or pulling at flaking skin, no heat, no exfoliation, no actives and strict sun avoidance until the practitioner lifts each restriction.

Pain or redness that increases instead of settling, blisters, crusting, discharge or fever is a reason to call the practitioner the same day. A patch test before a peel is common practice; the background is on patch testing and allergens.

Questions to ask your practitioner

• Which acid and which strength are you planning, and why for my skin?
• Do you need a patch test first, and when will you read it?
• I use these products at home, including anything prescribed. What stops, and when?
• What is the pigment risk for my skin tone, and how do you manage it?
• I get cold sores. Does that change the plan?
• What will my skin look like each day this week, and what would be outside that?
• On what date can I restart my acids and retinoids?

Caring for skin once it is intact

Once skin is intact, keep the routine short and free of actives until the restart date:

• Cleanse gently. Comfort Cleansing Milk with cool to lukewarm water.
• Hydrate. One 1.5 ml application from a sealed vial of Hyaluronic Skin Repair NanoSerum on damp skin.
• Moisturize. AquaCell Moisturizer by day, and Barrier Repair Cream at night where the skin feels tight.
• Protect. Daily broad-spectrum sun protection from any brand. Vegalab does not sell an SPF product.

Leave-on acid products are actives and wait for the practitioner's date. Why acids and sun exposure are linked: acids and sun sensitivity.

Related professional protocols

• Professional resurfacing peel: the treatment-room peel protocol, with its patch-test rule and full contraindication list.
• Gentle resurfacing for reactive skin: the alternative when skin is too reactive for an acid peel.
• Post-treatment calming: comfort care on intact skin, with clearance from the performing professional.
• At-home maintenance after a professional treatment: the written week after the appointment.

Gentler surface options: microdermabrasion and hydradermabrasion and dermaplaning.

References

The studies below describe the procedure.

• Soleymani T, Lanoue J, Rahman Z. A practical approach to chemical peels: a review of fundamentals and step-by-step algorithmic protocol for treatment. Journal of Clinical and Aesthetic Dermatology, 2018;11(8):21-28.