Chemical Peel

Chemical peel is no substitute for a facelift, although it can be performed in conjunction with a facelift. Furthermore, chemical peel will not prevent or slow the aging process.


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The best candidates are those with fair, thin skin that has a tendency towards fine wrinkling or scarring on the face. Deeper chemical peels are usually not recommended for highly pigmented skin, such as Asian, black and Mediterranean, or oily complexions.


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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.

In some countries, no medical degree is required to perform a chemical peel - even the strongest phenol peels. Many countries have laws that permit non-physicians to administer certain peel solutions, but regulate the strengths which they are permitted to apply. The patient should be warned that phenol and TCA peels have been offered by inadequately trained practitioners claiming "miracletechniques" to rejuvenate the skin.

During the initial consultation, the patient should discuss his or her expectations with the surgeon. The surgeon should explain the procedure in detaild, including the risks and benefits, the recovery period and the costs. If the patient has a history of herpes, he or she should inform the doctor about this.

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 the patient's skin doesn'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 the patient has blotchy skin areas or pigmentation problems. The patient may have to spend a month or more in the pre-treatment phase before the doctor will schedule the actual peel.

The patient should arrange for someone to drive him or her home and help out for a day or two if the patient is having a phenol or deeper TCA peel. Extra assistance won't be necessary if the patient is having an AHA peel or superficial TCA peel.

Chemical peels are usually performed on an outpatient basis. Sometimes the surgeon may want the patient to stay overnight in a facility or hospital if other cosmetic procedures are performed simultaneously.

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 the patient and keep him or her comfortable. No anesthesia is needed for AHA peels since they cause only a slight stinging sensation during application.

When the patient is having a AHA peel, the doctor will apply the AHA solution to the cleansed facial skin, a process that usually takes no more than ten 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.

A Phenol or TCA peel requires the skin to be thoroughly cleansed first. Then, the surgeon will carefully apply the phenol or TCA solution. The patient 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 fifteen 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, the 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, like the skin above the upper lip, may take only ten or fifteen minutes. A single treatment usually suffices.

After 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.

After a phenol or TCA peel, the doctor may prescribe a mild pain medication to relieve any tingling or throbbing the patient may feel. If tape was used to cover the face, it will be removed after a day or two. A crust or scab will form on the treated area. To help the face heal properly, it is essential that you follow your doctor's specific post-operative instructions.

A TCA peel may also cause significant swelling, depending on the strength of the peel used. If the patient's had a phenol peel, the face may become quite swollen. The patient's eyes may even be swollen shut temporarily. The patient will need someone to help care for him or her for a day or two. It may also be necessary to follow a liquid diet and not to talk very much during the first few days of recovery.

With an AHA peel, the temporary redness, flaking and dryness that can be experienced will not prevent the patient from working or engaging in normal activities. A fresher and improved skin texture will result with continued AHA treatments. Remember, protecting the skin from the sun is also important following these mild acid peels. The patient should ask the doctor 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 the patient may experience will subside within the first week. In about a week to ten days, the new skin will be apparent and he or she should be healed sufficiently to return to his or hers normal activities. It is best to avoid sun exposure unless adequately protected.

With a phenol peel, new skin will begin to form in about seven to ten days. The 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 the patient uses a sunblock or blotchy, irregular skin coloring may result.


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AHA peels may cause stinging, redness, irritation and crusting. However, as the skin adjusts to the treatment regimen, these problems will subside.

With a TCA peel, your healed skin will be able to produce pigment as always; the peel will not bleach the skin. However, TCA-peel patients are advised to avoid sun exposure for several months after treatment to protect the newly formed layers of skin. Even though TCA is milder than phenol, it may also produce some unintended color changes in the skin.

With a phenol peel, the new skin frequently loses its ability to make pigment. This means that not only will the skin be lighter in color, but the patient will always have to protect it from the sun. Phenol may pose a special risk for patients with a history of heart disease. It's important that the surgeon is aware of any heart problems.

It is also possible that phenol will cause some undesired cosmetic results, such as uneven pigment changes. Certain modified phenol peels are gentler and may be preferred in some circumstances.

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