Chemical Peel

Skin is a dynamic, growing organ. Every day cells divide at the basal layer of the epidermis and begin their journey upward to the uppermost layer, the stratum cornea. As new cells continue to grow, old cells from the stratum cornea slough off. This exfoliation of cells from the stratum cornea is a normal daily event.

Chemical peeling is basically an accelerated form of exfoliation induced by the use of a chemical agent. Very light peeling agents induce a faster sloughing of the cells in the stratum cornea, whereas deeper peeling agents create necrosis and inflammation in the epidermis, papillary dermis, or reticular dermis.

Chemical peeling creates changes in the skin through three mechanisms:
Stimulation of the epidermal growth through removal of the stratum cornea. Even very light peels that do not create necrosis of the "living epidermis" can induce the epidermis to thicken.
Destruction of specific layers of damaged skin. By destroying the layers and replacing them with more "normalized" tissue, a better cosmetic result is achieved. This is especially true in the treatment of pigmentation abnormalities and actinic keratoses.
Introduction of inflammatory reaction deeper in the tissue than the necrosis induced by the peeling agent. Activation of the mediators of inflammation is able to induce production of new collagen and ground substance in the dermis. Epidermal wounds are capable of inducing deposition of collagen and glycosaminoglycans in the dermis.

Because deeper peels involve a greater risk of complication and a longer period of recovery, or downtime, the goal is to create as little necrosis as possible while inducing as much new tissue formation as possible. This is the concept behind repetitive superficial and medium depth peels. They have low risk, but they create cumulative benefits that far exceed the results of on lighter peel.

Levels of Peels

Very superficial (exfoliation): These peels thin or remove the stratum corneum and do not create a wound below the stratum granulosum.

Superficial (epidermal): These peels create necrosis of part of all of the epidermis, anywhere from the stratum granulosum to the basal cell layer.

Medium (papillary dermal): These peels create necrosis of the epidermis and part or all of the papillary dermis.

Deep (reticular dermal): These peels create necrosis of the epidermis and papillary dermis, which extends into the reticular dermis.

Classification of Peeling Agents

Very Superficial: Glycolic acid 30% to 50% applied briefly (1 to 2 minutes)
Jessner's solution applied in 1 to 3 coats
Low-concentration resorcinol 20% to 30% applied briefly (5 to 10 minutes)

Superficial: Glycolic acid 50% to 70% applied for a variable time (2 to 20 minutes)
Jessner's solution applied in 4 to 10 coats
Resorcinol 40% to 50% applied for 30 to 60 minutes.
TCA 10% to 30%

Medium Depth: Glycolic acid 70% applied for a variable time (3 to 30 minutes)
TCA 35% to 50%
Augmented TCA (Jessner's solution plus TCA 35%, glycolic acid 70% plus TCA 35%)

Deep: Phenol 88%
Baker Gordon Phenol Formula

Complications of a Chemical Peel

Some of the reported complications from getting a chemical peel are:
Premature Peeling
Infection
Postinflammatory Infection
Hypopigmentation
Allergic Reactions
Scabbing
Scarring
Ecchymoses
Acneform Eruptions
Tears Dripping Onto the Neck

The cost of a chemical peel is determined by depth, location, and type.