Chemical peeling is a way of rejuvenating facial skin (sometimes arms and chest) by applying a chemical that essentially destroys the top layers of the skin. When the skin heals it does so by reforming collagen that is thicker, better vascularized, and more youthful. It is most effective in treating sun damaged skin. It effectively eliminates or reduces age spots and skin discoloration. It also helps with fine wrinkles as well as improving skin texture. Chemical peeling is very effective in recapturing the healthy, glowing texture seen in youthful skin.

The most common chemical used for peeling by Dr. Cruise is trichloroacetic acid or TCA. TCA is the most common chemical used for peeling because it combines safety with effectiveness better than other agents. There are other chemicals such as the phenol and fruit acids, but they do not have the same combination of effectiveness and safety as TCA. They are, however, useful for certain skin problems.

Chemical peeling is particularly useful within the armamentarium of rejuvenation because it is very effective, does not need general anesthesia, and is relatively low-cost. Effectively, a chemical peel causes a controlled burn. Dr. Cruise can predict the depth of the burn so that it goes down to a certain depth within the skin but no further. The skin heals with collagen that is more abundant and youthful. Obviously, you need to make sure that whomever is performing this procedure has the proper credentials and is well-trained because too deep of an burn can result in serious scarring.

Normally, the entire face is peeled at once. This includes the eyelids, forehead, and onto the neck. The procedure is performed within ICRS's surgical suite under local anesthesia. Some plastic surgeons and dermatologists perform peels with no anesthesia at all. While this is acceptable, Dr. Cruise prefers to be as painless as possible. After the peel, the skin of your face becomes leathery and appears burned until the skin peels off uncovering the new skin below. This takes about 7 to 10 days.

After your skin has peeled, your face is pink for 1 to 2 months depending on the depth of the peel. It is important that you stay out of the sun for at least 6 months. Exposure to sun may cause hyper-pigmentation and/or irritation of the face.

Chemical peeling is extremely useful both in facial rejuvenation and as part of an anti-aging protocol that can be repeated every 4 years after the age of 30.

Benefits

Chemical Peeling has many benefits. Outlined below are the most notable.

• Very effective at removing age spots and skin discoloration.
• Treats fine wrinkles and skin irregularities.
• Improves texture of skin creating a more youthful, glowing skin.
• Improves skin texture and some scarring in patients with acne scars.
• Can be used on hands, arms, chest, and shoulders.
• Is relatively inexpensive.
• Can be done as an office procedure under local anesthesia.
• Depth of peel can be controlled to obtain the desired results.
• The most superficial of peels can be done as a lunchtime peel.

Are you a good candidate?

People who could benefit most from chemical peeling are those with sun damaged skin. If you feel that your skin would be improved by any of the reasons mentioned above in the benefits section then you are a good candidate.

People who have been on Accutane within the last 2 years should not have chemical peeling as this drug prevents adequate peeling after the peel. Patients with a history of herpes should notify the plastic surgeon so that proper prevention is instituted. Herpes reactivation can occur after a peel.

Another consideration for those thinking of chemical peeling is that it is important to stay out of intense sun exposure for at least 6 months. Ultra-violet rays can cause undesirable darkening or redness of post peel patients. Your doctor will discuss ways to avoid sun exposure. He will also go over a simple, effective skin care program that he follows. This program includes daily glycolic acid moisturizers and Retin-A as a minimum.

Possible complications

The risks of chemical peeling in the hands of a competent plastic surgeon are very low and satisfaction is extremely high. The most significant complication is scarring. This is avoided by proper skin pretreatment as well as controlling the depth of the peel. Experienced plastic surgeons have the capability to adjust the depth of peel precisely depending on skin type and patient wishes. Another complication unique to chemical peeling is hyper or hypo-pigmentation. This can occur if early sun exposure occurs or if the peel is too deep for a particular skin type. Other possible complications are prolonged redness and whiteheads. Whiteheads, otherwise know as milia, are not uncommon as the sebaceous glands become blocked by the newly formed skin. They go away and are not usually a problem.

A particular concern is the patient with a history of facial herpes. A chemical peel may cause a reactivation of the herpes. Your doctor will address this mostly likely by prescribing the medication, Valtrex which is quite effective.

Do's and Don'ts prior to Chemical Peeling

• Medications. Certain medications thin your blood and should not be taken within 3 weeks of surgery. The most notable is aspirin and aspirin containing products. Vitamin E and many herbal products also thin the blood and should not be used within 3 weeks of surgery. Your plastic surgeon will go over this more thoroughly prior to the procedure. It is critical to inform Dr. Cruise if you have used the drug ACCUTANE within the last two years. This drug prevents the skin from healing after a peel and can lead to serious wound healing problems.

• Washing. It is a good idea to wash the area to be peeled thoroughly the morning of the peel. Do not apply makeup. Style your hair so that it stays back and out of the way.

• State of mind. Remember, this should be a happy and exciting time. A certain amount of nervousness is normal but you should not be overly concerned. Excessive worrying can actually be detrimental and you should discuss this with your doctor prior to surgery so that something can be prescribed to make sure you remain calm.

• Skin Care Protocol. It is very important to follow exactly the pre-peel protocol consisting of Retin-A, glycolic acid, and Valtrex as outlined by your doctor.

Anesthesia

Normally,most doctors will perform a complete facial sensory block using local anesthesia. This provides excellent anesthesia without the side effects of general anesthesia.

After the procedure

The procedure itself will take about 1 hour.

• Immediately. Right after the peel the local anesthesia will provide excellent pain management. You will go home within one hour of finishing the procedure. Keep in mind, however, that your face will not look presentable to the general public for approximately 1 week. Keep your head elevated to reduce swelling. It is important that someone else drives you and that you wear a hat to protect your face from sunlight. An antibiotic cream will be applied to the peeled area. It is important that you keep reapplying this so that the skin does not dry out. A very thin layer is all that is necessary.

• First 48 hours. You can shower, eat, and do just about whatever you want as long as you keep your head elevated and away from sunlight and dirt. Keep reapplying a thin layer of the antibiotic cream as necessary.

• First week. At about 7 to 14 days your skin will peel off revealing the new skin underneath. Your face will be pink for at least 6 weeks with the first 2 weeks being more red than pink. This can be adjusted depending on how deep of a peel you desire.

• Beyond. It is important to wear sunscreen and/or a hat for at least the first six months and preferably the rest of your life. After a chemical peel your skin becomes much more sensitive to sunlight and may easily become hyper pigmented or irritated.

Recovery time

Surprisingly, you will feel much better than you look after a Chemical Peel. If you work at home you could easily return to work the next day. Most people, however, are self-conscious until their skin peels and their new skin is revealed. This takes about 7 to 14 days. This is when most people return to work.