Chemical peels can be used to reduce the appearance of uneven pigmentation, acne and other skin problems and can rejuvenate sun-damaged skin, stimulating the growth of new skin cells making your skin appear healthier and younger. They are non-invasive and have few side effects, but are quickly effective, much more so than prolonged use of expensive creams that fail to live up to their claims.

Chemical peels are one of the oldest cosmetic treatments performed, dating back to ancient Egyptian times when, natural acids derived from fruit and milk were applied to the skin in the name of beauty. As knowledge and science have advanced, chemical peels are much more sophisticated and specific to a variety of skin problems, including uneven pigmentation, dull, dry or oily skin, wrinkles, blocked pores and acne.

There are three basic types of chemical peels:

1. Superficial: Acting on the uppermost layer of the epidermis with temporary results.
2. Medium depth: Acting on the uppermost layer of the dermis, often causing a stinging or burning sensation.
3. Deep: Penetrating as far as the basement membrane of the skin and sometimes beyond.

Chemical peels may contain the following ingredients:

• Alpha hydroxyl acids (AHA); glycolic acid 30-50% (from sugar cane), citric acid (from citrus fruits), lactic acid (from sour milk), malic acid (from apples).
• Beta hydroxyl acids (BHA); salicylic Acid (from the bark of the willow tree).
• Trichloroacetic acid (TCA); related to vinegar, may be superficial to deep depending on concentration.
• Phenol; usually in deeper chemical peels.
• Hydrogen peroxide; usually used to increase depth of penetration of other ingredients.
• Kojic acid; a fungal metabolite to help lighten the skin.
• Retinoic acid; vitamin A derivative, used to increase cell turnover.
• Glutathione; a potent anti-oxidant.

Some peels combine different acids in branded formulas and not all peels are the same, as different brands may add ingredients for additional benefits.

The above list is not exhaustive.

AHAs promote exfoliation of the upper most layer of the skin allowing healthier cells to the top and improving the texture and feel of the skin.

Salicylic Acid promotes exfoliation, unclogs blocked pores by breaking down oils, is antibacterial and anti-inflammatory so is particularly appropriate for acne prone skin. Also suitable for back and chest.

TCA, depending on the concentration, penetrates through the top five layers of the epidermis to the upper most layer of the dermis. Unlike superficial peels, you will find your skin becomes dry and tight, it may darken before peeling. The peeling usually begins on day 3 and continues for 2 or 3 days. Suitable for other areas of the body and for darker skin types.

Phenol Peels are the deepest of peels and may only be performed once. Only suitable for the face. Not suitable for darker skin types. Sedatives and anaesthetics may be required and also heart monitoring if the entire face is to be treated, because phenol is toxic to the heart if absorbed in large doses. Dramatic results on lines and wrinkles can be achieved but the risks of either hyper or hypopigmentation, infection and scarring are greater.

There are many other ingredients and certain acids may be modified to enhance their results or safety profiles, so it is important to speak to your practitioner about any peel that you intend to be treated with.

Superficial peels may sting, prickle of feel hot for a brief minute or two, but are not described as painful. Medium depth peels do feel hot, a cool fan helps you manage this unpleasant sensation and it passes within minutes. Deep peels are painful and will require prescribed medications to help manage any pain, during and after the treatment.

• Dull, tired looking skin
• Pigmentation
• Oily or dry skin conditions
• Fine lines and wrinkles
• Acne prone skin
• Open pores
• Deeper peels required for deep wrinkles and skin laxity.

Results will depend upon several factors, including the type of peel, skin preparation and aftercare, whether a single treatment, or a course of treatments. Except for the phenol peel, a course of treatments initially, and then regular maintenance treatment will achieve the best results over a longer period.

Superficial peels – you may be pink, this will settle within hours. Your skin may become a little dry and tight, but you may not be aware of any obvious peeling.

Medium depth peels – you may be pink, your skin will feel tight and dry, it may darken in patches prior to peeling, much like a sunburn peel. The peeling usually begins on day 3 or 4 and may last for 3 or 4 days.

Deep peels – the skin will darken, crust and peel and remains extremely red for about 3 weeks and longer for some individuals. Some people have extreme swelling, especially around the eye area. The skin will be raw whilst healing and a strict aftercare regime will be prescribed by your clinician. Most people will take 14 days off work. Complete healing may take several months.

Your clinician will provide you with appropriate skin preparation prior to peeling treatment and advice on aftercare and treatment regimens/courses recommended for best results. Such advice will vary depending on the peel used.

All treatments carry a degree of risk. All risks and complications will be discussed with you at consultation and prior to any treatment being agreed.

A variety of peels are available for general purchase on the internet. A great deal of knowledge is required in order to assess skin type, identify any contraindications (medical or medicines), diagnose the skin condition, prescribe the appropriate peel for the right skin, to prepare the skin appropriately and to ensure appropriate aftercare in order to minimise risk and ensure good results are achieved safely.

Side effects include, but are not limited to;

• Redness
• Tenderness
• Dryness
• Itching
• Peeling

All the above are expected to be temporary and settle spontaneously, usually within days.

✓ Altered pigmentation – darker pigment patches (usually temporary) – or loss of pigment which may be permanent.

Misuse of peels can cause permanent skin damage, increased and long-term sensitivity, altered pigmentation, infection and scarring.

Your practitioner will take a detailed medical history and an assessment of your skin type, needs and expectations to ensure this is an appropriate treatment for you, and to select the right peel for your skin type and expectations.

Treatment is not recommended if you are suffering from:

• Any skin infection in or near the treatment area or are unwell in any way (even a cold).
• If you have previously experienced allergic reactions to any ingredients in the peel solution.
• If you are taking any medications that may cause photosensitivity.
• If you are pregnant or breastfeeding.
• If you are currently or have recently completed a course of Roaccutane (acne treatment) in the last 6-18 months.

Chemical peels on the face can trigger the cold sore virus. If you are a sufferer, you must advise your clinician in advance of treatment. Vigorous exercise, sun exposure, sun beds, sauna should be avoided for 48 hours, or as advised by your clinician, after treatment. You must wear sunscreen as advised by your clinician.

If, having had treatment, you are at all concerned about symptoms you were not expecting or not happy with, please contact the practitioner for advice. If necessary, an appointment will be made for you to be seen.