Chemical peel uses a chemical solution to improve and smooth the texture of the facial skin by removing its damaged outer layers. It is helpful for those individuals with facial blemishes, wrinkles and uneven skin pigmentation. Phenol, trichloroacetic acid (TCA) and alphahydroxy acids (AHAs) are used for this purpose. The precise formula used may be adjusted to meet each patient's needs. Although chemical peels may be performed in conjunction with a facelift, it is not a substitute for such surgery, nor will it prevent or slow the aging process. This information provides basic information about certain types of chemical peel treatments and the results you might expect. It won't answer all your questions, since a lot depends on your individual circumstances. Once you and Dr. Freedland have decided on a specific peel program, be sure to ask about any details that you do not understand.

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A chemical peel is most commonly performed for cosmetic reasons -- to enhance your appearance and your self confidence. A chemical peel may also remove pre-cancerous skin growths, soften acne facial scars and even control acne. In certain cases, health insurance may cover the peel procedure. Be sure to check your policy and contact your insurance company before the procedure is performed.

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 a 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.

All chemical peels carry some uncertainty and risk. A chemical peel is normally a safe procedure when it is performed by a qualified, experienced plastic surgeon. However, some unpredictability and risks such as infection and scarring, while infrequent, are possible.

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.

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USES:

• Smooths out fine surface wrinkles
• Removes superficial blemishes
• Corrects pigment problems

CONSIDERATIONS:

• Can be used on neck or other body areas
• May require pre-treatment with Retin-A or AHA creams
• Treatment takes only 10-15 minutes
• Preferred for darker-skinned patients
• Peel depth can be adjusted
• Repeat treatment may be needed to maintain results
• Sunblock must be used for several months
• Healing is usually quick, much quicker than with a phenol peel

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

It is very important that you find a physician who has adequate training and experience in skin resurfacing. Dr. Freedland may offer you a choice of peel techniques or suggest a combination of peels to obtain the best result for you.

During your initial consultation, it is important that you discuss your expectations with Dr. Freedland. Don't hesitate to ask any questions or express any concerns that you may have. Expect Dr. Freedland to explain the planned procedure in detail, including its risks and benefits, the recovery period and the costs. If you have a history of herpes, you should inform your physician prior to the procedure. Remember, chemical peel treatments are usually not covered by medical insurance unless they are performed for medically related problems.

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Dr. Freedland will instruct you on how to prepare for your peel treatment.

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 your skin won'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 you have blotchy skin areas or pigmentation problems. You may have to spend a month or more in the pre-treatment phase before the doctor will schedule your actual peel.

You will need to arrange for someone to drive you home and help you out for a day or two if you are having a deeper TCA peel. You probably won't need any extra assistance if you're having a superficial TCA peel.

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Most chemical peels may be safely performed in a plastic surgeon's office, office-based surgical facility or outpatient surgical center. Dr. Freedland may want you to stay overnight in a facility or hospital if other cosmetic procedures are performed simultaneously.

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Anesthesia isn't required for TCA peels because the chemical solution acts as an anesthetic. However, sedation may be used before and during the procedure to relax you and keep you comfortable.

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TCA peels: Typically, the skin is first thoroughly cleansed. Then, the surgeon will carefully apply the TCA solution. You 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 15 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.

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

A TCA peel may also cause significant swelling, depending on the strength of the peel used.

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With a TCA peel, the moderate discomfort and mild swelling you may experience will subside within the first week. In about a week to ten days, your new skin will be apparent and you should be healed sufficiently to return to your normal activities. It is best to avoid sun exposure unless you are adequately protected.

About two weeks after treatment, you may return to work and resume some of your normal activities. Your skin will be healed enough for you to wear makeup (for makeup tips, ask Dr. Freedland for the ASPS brochure on camouflage cosmetics).

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Improvements from AHA peels may be very subtle at first. You may detect a healthier glow to your skin. With continued treatments, you will notice a general improvement in the texture of your skin.

The results of a TCA peel are usually not as long-lasting as those of phenol peel. However, your skin will be noticeably smoother and fresher-looking.

If you're planning a phenol peel, you can expect dramatic improvement in the surface of your skin - fewer fine wrinkles, fewer blemishes and more even-toned skin. Your results will be long-lasting, although not immune to the effects of aging and sun exposure.

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