12 Jun Facial Chemical Peels
Our last discussion was about Body Peels. Let’s change the focus and talk “face to face”. Chemical Peels are a series of applications of acids or enzymes applied to the skin to remove layers of the Stratum corneum and encourage the remaining layers of the skin to refresh and remodel. This will amp up the production of collagen and elastin which contributes to a smoother, more wrinkle-free appearance. The production of collagen begins a downward production spiral about the age of 20.1 We lose about 1% per year and since collagen acts as a scaffolding, the structural support of the face diminishes. By the time we reach our 40’s, 50’s and 60’s, the visible deficit cannot be denied. We have taken a MedAesthetics seminar to use Botulinum toxin A to reduce the dynamic wrinkles and dermal fillers to substitute the structural support to reduce the static wrinkles and restore volume. Another tool is to improve the appearance of the skin. We will embark on a series of articles to add tools to our belt and help our clients become the best they can be and increase your confidence in helping them achieve their goal.
Categorizing the Skin
Some of the inf
ormation will be a repeat of what we discussed in body peels. For chemical peels of the face, we need to look at two important scales which help us decide the most effective peel and
very importantly, the s
afest peel we should consider for their skin type. The skin is categorized based on its reaction to sun exposure and the level of wrinkling present. The rating scale by Dr. Thomas Fitzpatrick groups fair and light skin up to darkly-pigmented brown skin. This division is based on the client’s reaction to sun exposure—burning vs tanning. The lighter skin tolerates stronger acids and the darker skin reacts with more adverse effects thereby requiring weaker acids. The second scale is the Glogau Scale. Dr. Richard Glogau categorized skin aging by how UV skin exposure
changes our skin and wrinkling. Chemical peels in Skin Types I through IV are based on need and level of improvement desired. The presence of acne scarring may also play a role in the depth and type of peel.
Types of Chemical Peels
Classic options for peels are acids but enzymes, like pumpkin, are also popular. Peels are divided into the level of the skin that the peeling agent descends. These layers are superficial, medium and deep. Some peels can bridge groups depending on how many coats of the chemical are applied. Superficial peeling agents are Alpha Hydroxy Acids (AHA) like Glycolic Acid from sugar cane, Lactic acid from sour milk, Citric acids from fruits and Malic acid from apples. Beta Hydroxy Acids (BHA) like Salicylic acid from willow tree bark are popular and effective but contraindicated in allergies to aspirin. We need to establish if the “allergy” is gastrointestinal irritation or a true allergy or anaphylaxis. Trichloroacetic acid is an analogue to vinegar and it can go deeper into the skin layers if the percentage in the peel is higher. Retinoic acid is a Vitamin A product and present in Retin A™ and many OTC creams and lotions to improve skin texture. Retinols play a key role in turnover in skin cells and studies show that it may prevent and cause regression in actinic keratoses and non-melanoma skin cancers. 3,4 The deepest-descending agent is Phenol, an aromatic alcohol acting as a weak acid. Resorcinol is a substituted Phenol and popular in combination peels in low concentration. Deep peels are relegated to procedure rooms with sedation and cardiac monitoring. Superficial through medium level peels are safe for office-based and some concierge practices. In our Chemical Peel Class, we discuss the different acids in more depth and start participants with a customized superficial to medium depth peel based on the client’s skin characteristics and needs.
Written by: Dr. Christy Bennett
- Schuster, et al. The influence of age and sex on skin thickness, skin collagen and density. Br J Dermatol. 1975; 93: 639-43
- Women’s’ picture courtesy © WujinSHike.com 2017. All Rights Reserved.
- Skin Cancer Prevention Strategies: Tried, True and New. RL Moy, S. Famini. Skin Cancer Foundation.
- Retinoids for prevention and treatment of AK’s. Ianez, et al. An Bras Dermatol. 2013, 88 (4):585-593
- Diagram: Edited/iStockphoto-ttsz. Used with permission.