Chemical Peeling

22 Chemical Peeling

A chemical peel involves the careful application of a scientifically formulated solution to the skin, which later causes the top layer to separate and shed (as would a blister) (Fig. 22.1). The shedding skin takes with it the sun-damaged and wrinkled layers. Swelling of the peeled area may be pronounced for the first few days but subsides dramatically after 5 to 7 days.

Level II and III peels heal as would a sunburn or a blister, in that the top layer of skin is shed or “peels off” over a 4- to 5-day period, revealing the early signs of a fresh new deep pink layer underneath.

Depending on the level of the peel, mineral powder makeup may be used approximately 3 weeks after the application of the peeling solution; therefore, most patients may return to work or go out socially at this time. When instructions and precautions are heeded by the patient, the redness of the skin slowly subsides over the ensuing 6 to 8 weeks, but it can ordinarily be camouflaged by makeup during this time. However, in patients who fail to follow directions, it may take months before deep pink or reddish discoloration subsides. In every case, I have been able to eventually get to the root of the problem. Fact is, many patients are reluctant to admit that they used products or engaged in activities advised against.

Limitations and Restrictions

Avoidance of prolonged exposure to sunlight (as in sunbathing, fishing, and golfing) for 3 to 6 months and of skin irritants are fundamental restrictions after peeling. The “new” skin must build up a tolerance to the elements; otherwise, healing is delayed. Patients who fail to adhere to instructions and precautions may develop pigmentation, skin irritations—and in rare cases—scarring.

All patients contemplating level II and level III peels must be willing to accept the posttreatment restrictions required to promote healing.

Patients must also be informed that neither surgery nor resurfacing can correct wrinkles that occur only during facial expressions. Creases around the eyes produced by smiling, the forehead creases that occur with frowning, and the vertical lines in the upper lip that occur with puckering the lips for the most part are due to the contraction of the muscles of facial expression. None of the surgical procedures discussed in this book are able to eliminate the preceding conditions. However, neuromodulators can be helpful in treating these conditions.