Peels and Facials

Natural fruit acids are applied to the skin which remove damaged cells, resurfacing the skin.

Treatment Details:

The application of one or more natural fruit acids to the skin which removes damaged cells, resurfacing the skin
The three principal types of peels are alpha-hydroxy acid peels, trichloracetic acid peels, and the phenol croton oil peel

A peel removes several layers of sun-damaged skin cells, leaving fresh skin which has a more even surface and colour. It may stimulate new collagen to be formed improving the skin texture. Peels may result in superficial, moderate depth or deep skin injury

Chemical peels are most often used on the face, but they are sometimes applied to other sites such as the hands.
A peel may be used to treat damage caused by exposure to the sun (photoaging) including actinic keratosis, to remove pigmentation such as freckles and melasma, to reduce fine lines and wrinkles, and to improve acne.
They are most often used in patients with fair skin, Fitzpatrick skin types I to III.
Patients with Fitzpatrick skin types IV to VI have an increased risk of pigmentation, hypertrophic, and keloid scarring, and chemical peels must be performed cautiously with full patient informed consent.
Peels can be repeated as necessary; some people have superficial peels every few weeks. It is wise to wait for 3 to 6 months before repeating a moderate depth peel

Superficial peel

Superficial peels use glycolic acid, salicylic acid, and Jessner solution and are well tolerated — the ‘lunchtime’ peel. They remove thin lesions on the skin surface, reducing pigment and surface dryness. The result of the first peel may be disappointing, but after repeated peels, significant improvement is usually evident. A nurse or aesthetician (beauty therapist) may perform superficial peels.

Medium depth peel

Trichloracetic acid (TCA) is the most common chemical used for a medium depth peel. The results depend on its concentration, usually 20–35%. The treatment is painful and treated areas are swollen, red, and crusted for the next week or so. It can lead to an impressive improvement in skin texture with a reduction in blotchy pigmentation, freckling, and actinic keratosis (dry sunspots). Although fine wrinkles and some acne scars are less obvious, the TCA peel has no effect on deep furrows. A dermatologist or plastic surgeon usually performs moderate to deeper peels.

Deep peel

Phenol results in deep skin injury. It is rarely used for facial peels nowadays because of the risk of scarring and because of its toxicity. Absorption of phenol through the skin results in potentially fatal heart rhythm disturbances and nerve damage. However, it is very effective at improving both surface wrinkles and deep furrows. After a phenol peel, the treated skin is pale and smooth but it may be waxy and ‘mask-like’.

The performance of a peel requires a thorough knowledge of aesthetics including any medical or surgical treatment for skin aging
Pre-treatment creams are applied to the face at night for several weeks prior to the peel. By exfoliating the skin and reducing pigmentation themselves, they improve the results seen from the peel. They may also reduce the time needed for healing. The creams usually include one or more of the following:
- Tretinoin
- Alpha hydroxy acid e.g. glycolic or lactic acid
- Hydroquinone for tanned or dark-skinned patients or those with melasma
- Broad-spectrum SPF 50+ sunscreen should be used during the day.

Superficial peels are a minor procedure and no special arrangements are needed. But you may need painkillers, sedation, local anesthetic or even a general anesthetic for deeper peels
First, the face is thoroughly washed to remove surface oil. The peeling agent is then applied for several minutes. It stings – how badly and for how long depends on the chemical, its concentration, whether you’ve had pre-treatment with aspirin, and individual factors. A fan can help. The peel is then neutralized, and the burning sensation lessens
Individual treatments may include peels with several agents on the same occasion, with the aim of improving results and reducing risks
Antibiotics and oral antiviral agents may be recommended after deeper peels

Superficial peels result in mild facial redness and occasional swelling which usually resolve within 48 hours. The peeling is similar to a sunburn. Most people can continue their normal activities. Make-up can be applied a few hours after the procedure
Moderate depth peels result in intense inflammation and swelling, which resolve within a week. The peeling is more marked. Mild redness can persist for several weeks. Most people take a week off from work after a moderate depth peel

Keep treated areas cool (use a water spray)
Do not pick! Picking delays healing and causes scarring
Moisturise – use light preparations after a superficial peel, thicker moisturizers after a deeper peel
Protect from the sun
If advised to do so, continue to use tretinoin, glycolic acid, and/or hydroquinone at night long-term