Chemical Peel

CHEMICAL PEEL
DR BAIHAQI
 ANATOMY & PHYSIOLOGY OF SKIN
 CHEMICAL PEEL
 INDICATION
 TYPE OF CHEMICAL PEEL
 STEP BY STEP PROCEDURE
CONTENT
ANATOMY & PHYSIOLOGY
 Throughout your life, your skin will change constantly, for better or worse. In
regenerate itself
fact, your skin will
approximately every 27 days.
SKIN REGENERATION
CHEMICAL PEEL?
 Method of skin resurfacing - By controlled keratolytic activity.

 Accelerating Exfoliation - By using irritant chemicals.
 The pH of the skin (the measurement of its acidity) is 5.5 which is slightly ACID, so that anything that
is applied to the skin deviating from the pH of 5.5 will tend to cause some irritation & “burn” the skin
 The BURNING of the Skin → Healing Process
(The benefits are obtained in the process of healing
 Synonyms:
 Chemical resurfacing
 Chemexfoliation
 SUPERFICIAL
 VERY LIGHT PEEL
 LIGHT PEEL
 MEDIUM-DEPTH
 DEEP
CLASSIFICATION OF CHEMICAL PEEL

 VERY LIGHT PEEL : Injury is limited to the st. corneum and only creates exfoliation
 • AHAs
 • 10-15% TCA
 • Tretinoin
 • Salicylic acid
 Light Peels : Injury to the entire epidermis down to the basal layer , stimulating
regeneration of fresh new epithelium
 • 70% glycolic acid
 • Jessner’s solution (resorcinol + salicylic acid + lactic acid +ethanol)
 • 20-30% TCA.
SUPERFICIAL PEEL
 Because of their superficial action, superficial peels can be used in nearly all skin types.
 After a superficial peel, epidermal regeneration can be expected within 3 to 5 days, and desquamation is usually well
accepted.
 Superficial peels exert their actions by decreasing corneocyte adhesion and increasing dermalcollagen.
 These peels are a good method for rejuvenating the epidermis and upper dermal layers of skin.
INDICATIONS:
 used to enhance treatment for a variety of conditions, including
 Acne
 Melasma
 Dyschromias
 Photodamage
 Actinic keratoses.
 ROSACEA
MEDIUM-DEPTH PEELS
 Injury through the entire epidermis and papillary dermis.

 First days:
 Epidermal necrosis + papillary dermal edema + lymphocytic infiltration
 Next 3 months:
 Increased collagen production
 AGENTS:
 35% TCA
 Jessner’s + 35% TCA
 70% glycolic acid + 35% TCA
MEDIUM DEPTH PEEL
• The healing process is longer, with full epithelialization occurring in
about one week.
• Sun protection after a medium-depth peel is recommended for several
weeks.
• Because of the risk of prolonged hyperpigmentation, medium-depth peels
should be conducted with caution in patients with dark skin.
INDICATIONS:
 dyschromia, multiple solar keratoses, superficial scars and pigmentary disorders
 Injury through the papillary dermis , into the upper- reticular dermis and may
extend to mid –reticular dermis
 AGENTS
 TCA > 50% (scarring)
 Phenol containing preparation
INDICATIONS - severe photoaging, deep wrinkles, or scars
DEEP PEELS
 Deep peels cause rapid denaturization of surface keratin and other proteins in the dermis
and outer dermis and penetrate the reticular dermis, so deep peel maximizes the
regeneration of new collagen.
 Epithelialization occurs in 5 to 10 days, but deep peels require significant healing time
usually two months or more and sun protection must always be used.
 Phenol is rapidly absorbed into the circulation, potentiating cardiotoxicity in the form of
arrhythmias.
 Therefore, special care, such as cardiopulmonary monitoring and intravenous hydration,
must be provided to address this concern.
 Due to the increased risk of prolonged or permanent pigmentary changes, deep peels are
not recommended for most darkskinned individuals.
DEEP PEEL
 Effective with fewer side effects
 Preventing the HOT SPOTS that can cause dyschromias and scarring seen
with higher conc. of TCA
 Starting with glycolic 70% or Jessner’s solution before 35%TCA
*weakens the epidermal barrier
*allows deeper, more uniform penetration of 35%TCA
* Level of penetration is better controlled*
COMBINATION PEELS
1. Glycolic acid (AHA)
2. Salicylic Acid (BHA)
3. Lactic Acid
4. Jessner’s Peel ( A Combination of Salicylic acid, resorcinol
and lactic acid mixed in alcohol)
5. Resorcinol
6. TCA (Trichloracetic Acid)
7. Miami peel
8. Baker’s Phenol
AGENTS:
 AHAs are naturally occuring ingredients in sugarcane, milk & fruits, e.g.
 Glycolic acid
 Lactic acid
 Citric acid
 Malic acid peel
 Tartaric acid
These acids are known as exfoliating agents as they only penetrate the epidermis (the outermost
layer of the skin). It can be done every 3-4 weeks & applied in multiple sessions to achieve the
desired results
AHA
Salicylic acid (SA) is a BHA; used alone or in Jessner's solution
• BHA has a stronger comedolytic effect than AHA
• Comedonal acne ; lipophylic & concentrates in pilosebaceous unit and exfoliates the pores
• BHA needs no neutralization
White ppt appears once peel is complete ( 2 min.)

This is not Frosting
• White ppt of SA is a guard so that inadequately treated areas can be easily identified and retreated
BHA
 • Combination of keratolytic ingredients
 (resorcinol + salicylic acid + lactic acid + ethanol)
 • Inflammatory & comedonal acne (resorcinol)
 • Rosacea (SA)
 • Intense keratolytic activity induces loss of
 corneocyte cohesion within the st. corneum
 • Can be used with other peels because it does
 not need neutralization
JESSNER’S SOLUTION
• Different concentrations: 10-35%
• 10-15% TCA: intra epidermal superficial peel; Improves fine wrinkles and dyschromias to give smooth
healthy appearance
• 30-35% TCA: papillary dermis, medium depth peel. Produce epidermal & dermal necrosis withoutsystemic
effects
• Be cautious with dark skin.
• Not light or heat-sensitive, no need for neutralization
• The clinical end point of tx. is frosting due to denaturation of proteins. Frosting appears within 7sec up to
20minaccording to the conc. used.
 Healing time within a week if used alone , 10 days if used in combination
TRICHLOROACETIC ACID PEELS

 Baker’s Formula
 Pure undiluted 88% phenol + croton oil + septisol liquid soap + water
DEEP
 It is difficult to classify the depth of a chemical peel
 because it depends on a variety of variables such as
 1. Type of Peeling agent
 2. Concentration of the peeling agent
 3. Layers of the agent applied
 4. Applications technique
 5. Patient’s skin type
 6. Location of the peel
VARIABLES DETERMINING DEPTH OF

A PEEL
 PATIENT SELECTIONS
 CONSENT FORM
 PRE-TREATMENT
 PREPARATION
 PEEL
 POST TREATMENT CARE
STEP BT STEPS
This is the most important step in a successful chemical peel
program in order to have the correct candidate for the
procedure & the choice of peeling agent should correspond
with the treating conditions.
1. Initial consultation
2. Skin care history
3. Medications
4. Conditions to correct
5. Patients’ lifestyle
6. Formulate a skin care treatment plan
7. Follow up
PATIENT SELECTIONS
 Tretinoin improves skin texture and reduces fine Wrinkling and mottled hyperpigmentation.
 Topical tretinoin pretreatment accelerates wound healing after medium-depth and deep-depth chemical
peels.
 The American Academy of Dermatology (AAD) Guide lines Outcomes Committee
developed‘Guidelines of Care for Chemical Peeling’ in an effort to enhance quality of care for patients
having cosmetic procedures.
 This AAD committee recommended tretinoin pretreatment as preparation for skin that is undergoing
chemical peeling.
 The committee also recommended postoperative tretinoin to enhance wound healing and to maintain
results.
PRE-TREATMENT – TO PRIME SKIN

−Photo-protective measures (at mornings)
−Tretinoin (at night)
−Bleaching agents hydroquinone (at night)
−Antivirals acyclovir 400mg 3x daily for 2 weeks (medium or deep peel only
ROUTINE -1 MONTH BEFORE

➢ During the applications, the eyes have to be protected against the
solution otherwise, damage to the eyes can happen.
➢ This solution is applied with light, gentle strokes onto the skin and
should be layered. A mild stinging sensation may be felt for several
minutes after application and there is no need to worry about.
➢ This discomfort can be relieved by blowing cool air fan over the
treated area, and it will be done for your comfort.
➢ When all the layers are applied and the solution is left on the
treated area for a certain time, normally 4 to 10 minutes
The depth of this peel is determined by the number of layers applied
during a treatment
 2-3 coats produce a light exfoliation that lasts 3-4 days
 4-6 coats produce a moderate exfoliation that lasts 4-7 days
 7+ coats produce heavy shedding that can last up to 10 days.
 The solution will be neutralized and cool water is used to wash the treated
area to make it free from the applied acid.
 If, at any time during the processing period, you feel your skin is reacting
negatively immediately neutralize and rinse skin.
 If needed, a calming mask will be applied over the treated area. This ends
the main procedure of Jessner peel.
➢ Day 1 to 3 – Tight, dry skin with moderate redness and
sensitivity
➢ Day 2 to 5 – Areas of darkened skin (this is the old skin in
preparation to peel)
➢ Day 3 to 7 – Peeling or slight flaking lasting 2 to 5 days
Home Care Products i.e.(moisturizers, soap free cleanser ,
UVA/UVB protective sunblock and anti oxidants to use for
the following 3 – 5 days including soap free cleanser with
moisturizer.
➢ It is important to avoid the use of exfoliating products for
the next 3-5 days. To avoid sun sensitivities it is important to
apply a broad-spectrum sun block daily.
EXPECTED CHANGES OVER THE NEXT 7-14
DAYS INCLUDE:
 Stimulate the deeper dermis level of skin → Cause new
fibroblasts and collagen to develop → puffing out the lines and
wrinkles Caused by aging
 A progressive treatment that will not produce the final result after
one peel
WHAT DOES JESSNER PEEL DO?

➢ The 1 st visual change occurs with a superficial Jessner
peel is faint erythema.
➢ Associated with this, you may see a powdery looking
whitening on the skin surface. This is not frost but one of
the chemicals precipitating on the skin , this can easily be
wiped off With your finger or wet cotton ball (this is level I)
➢ With application of additional coats, the erythema
becomes more pronounced, usually turning brighter red
than pink.
END POINT OF PEEL

 Now you may be able to see some pin point areas of true white frost.
 ❖ At this point the patient may feel moderate burning and stinging.
 ❖ This erythema can persist for up to 15 to 30 minutes if not neutralized with water.
 ❖ This is level II and can go on to red –brown ,like that of severe sun burn for the next 1 to 3
days.
 ❖ The next step level III presents with more pin point frosting ,flaking and exfoliation.
Obviously there is much variation of this in different persons.
 ❖ PEARL : The point note is that that it takes 4 to 6 minutes for the skin reaction to occur.
Any additional coat should not be applied until you have waited that long
END POINT OF PEEL

Post peel, the skin will appear tight and mask like, frequent use of
creamy emollients is mandatory.
❖ Use fragrance free moisturizers without parabans.
❖ If there is persistent stinging and burning , a mild steroid cream or
ointment may be prescribed.
❖ During the healing process do not use scrubs, astringents, toners,
or retinoic acids or AHA products..
❖ They can resume use of any of these 48hours after peel is healed.
POST PEEL CARE

Expect
1. Look and feel tight
2.Look terrible for 7-10 days after medium depth peel
3.During the first two days skin is slightly pink
4.During the third and fourth day skin darkens
5.By day five skin starts peeling in sheets
6.Erythema may last up to two weeks
7.Epidermal hyperpigmentation will darken (melasma)
POST PEEL
• Very superficial peels: once a week.
• Superficial peels: once every 2 weeks.
• Medium depth peels: Once every 3-4 weeks.
Never repeat peeling for patients who have sensitivity
or persistent erythema from a previous peel
RE-PEELING
• Irritant contact dermatitis
• Post inflammatory hyperpigmentation
• Infections
• Scarring
COMPLICATIONS

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approximately every 27 days.

 Method of skin resurfacing - By controlled keratolytic activity.

CLASSIFICATION OF CHEMICAL PEEL

 Injury through the entire epidermis and papillary dermis.

INDICATIONS - severe photoaging, deep wrinkles, or scars

White ppt appears once peel is complete ( 2 min.)

TRICHLOROACETIC ACID PEELS

VARIABLES DETERMINING DEPTH OF

PRE-TREATMENT – TO PRIME SKIN

ROUTINE -1 MONTH BEFORE

WHAT DOES JESSNER PEEL DO?

END POINT OF PEEL

END POINT OF PEEL

POST PEEL CARE

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