Chemical Peels and Skin Resurfacing
There is a lot of confusion about how to rejuvenate the skin. Do you use a laser, dermabrasion or chemical peel? What should you expect from skin resurfacing?
The first step toward answering these questions is to understand how the skin ages and how we can effectively restore its appearance.
Skin aging: the factors
Intrinsic factors are related to your skin biology. This includes your genes, your diet, stress, and other biochemical and molecular interactions (e.g. oxidative reactions etc). For example, changes in hormone levels during menopause, result in a reduction in skin thickness and elasticity. Although you cannot do anything about your genetics, you do have a role in managing your diet, rest and stress levels.
Extrinsic factors are related to things that you expose yourself to that may have a negative impact on the skin. The two biggest negative extrinsic factors are sun exposure and smoking. Nothing accelerates the aging of the skin more than these factors. They accelerate the oxidative reactions, which age the skin on a molecular level. The result in a process termed elastosis, in which the organization of the collagen and elastin fibers in the skin is lost. Elastosis results in loss of the tight elastic recoil of the skin and the acceleration of fine lines and wrinkles. Further, darkening of the skin, discoloration, broken capillaries are the manifestations of sun damage.
What can you do to slow the process of skin aging?
Simple interventions such as eating a healthy diet high in anti-oxidants, maintaining a regular exercise program, drinking plenty of water, and trying your best to minimize stress are important lifestyle changes that can have big long-term implications on skin health.
Avoiding smoking and good sun protection/avoidance are obviously important lifestyle modifications, as well. In addition to the anti-aging benefits, sun protection/avoidance needs to be especially emphasized as an important means of reducing skin cancer risk.
Other extrinsic factors are related to what you can do to actually help your skin. In addition to good basic skin care and regular aesthetician services, there comes a time when you may need to actually reverse some of the changes that have resulted from years of sun exposure.
So what Treatments are available to resurface the skin?
There are 3 basic categories or methods of skin resurfacing. They all have the same end point in common- remove the upper surface of the skin and allow a new layer to resurface. The primary difference is the method used to achieve this goal.
The three categories are:
1) Mechanical- this is dermabrasion or microdermabrasion. This involves using a crystals (microdermabrasion) or a spinning wire brush (dermabrasion) to remove the upper skin layers. This is analogous to sanding down the skin (gently, of course).
2) Laser- this involves heat generated from the laser. A laser is used to essentially evaporate the upper skin layers. Common lasers for this are the CO2 and Erbium:YAG laser.
3) Chemical Peel- this involves using a chemical that dissolves the skin layers.
Why we like the chemical peel and when is it used.
In our practice we use to revitalize the skin by improving texture, evening discoloration, and enhancing skin clarity/radiance. It is also effective at softening fine lines and wrinkles. We offer it to many patients who are undergoing a procedure such as a facelift or fat transfer, as it complements the surgical results without extending the downtime. Otherwise, the light chemical peels can be used when an individual cannot afford the downtime it takes to recover from a medium or deep chemical peel (see below).
The chemical peel offers the right balance between reliability, consistency, efficacy, and cost, risk, and recovery.
Understanding the chemical peel.
There are a wide variety (TCA, alpha hydroxy acids, glycolic acid, phenol, etc) of chemical peels, each with their own specific attributes. Broadly, their depth of skin penetration categorizes chemical peels. The categories are Superficial, Medium, and Deep Chemical Peels. The choice of which peel to use is based on how sun damaged or aged the skin is and how much downtime you can afford to take.
Light Chemical Peels: Many types of peels fall under this category. The light or superficial peels treat the upper layers (epithelium) and will improve pigment and fine lines. These are generally used in series of 4-6 treatments. Our preferred peels are the Jessners/ 15% TCA and the line of PCA peels. The advantage of these peels is that there is essentially no downtime and the cumulative effect of the peel series is very good.
Medium Chemical Peels: For individuals with more significant sun damage, discoloration and surface wrinkles, a medium depth chemical peel is the best option. Also for individuals who are under going a procedure, such as a facelift, blepharoplasty, or fat transfer, this peel level can be very complementary. This peel usually consists of a Jessners pre-peel combined with a 25-35% TCA peel. The peel is very effective and is the most popular type of resurfacing among experienced surgeons. The treatment takes 7-10 days to recover.
Examples of Medium Depth Jessners/35% TCA
Deep Chemical Peels: For individuals with course wrinkles and severe sun damage would be candidates for a deep chemical peel. This consists of Phenol, Bakers-Gordon Peel, and Stone Peel. These peels can have extremely impressive results however the down-time is closer to 2-3 weeks with additional time required for resolution of redness. These are highly technical peels and only a very small number of surgeons and dermatologist perform this type of peel.
In summary, chemical peels are used to improve skin texture, tone, fine lines and wrinkles and overall discolorations. They provide a consistent and cost effective way of rejuvenating the skin. The advantage of this form of resurfacing is that it can be used on individuals with any skin type and color. We often will pre-treat patients with darker skin types with retin-A and hydroquinone for several weeks prior to peeling to avoid hyperpigmenation after the treatment. Hyperpigmentation is the most common complication of the peels, however, fortunately this is a temporary condition that is easily treated.
The end result is that the skin looks more vibrant, fresh and healthy.
Dr. Karam voted
"2010 Best Cosmetic Surgeon"
Ranch and Coast Magazine
Readers Choice Award
Contact Dr. Karam