Chemical Peels
These take many forms from very mild to very aggressive and are the time-honored treatment of most kinds of skin problems. Peels specifically and predictably can improve skin wrinkles, texture, pigmentation and some degree of looseness. They are customized to your anatomy, lifestyle, and what you have and what you want done. The basic feature is how deep your skin problems are, and how deep you need to peel, and do you want to do this in one treatment at or in several partial treatments.
On the low end of the spectrum are enzyme and herbal peels that can cause minor exfoliation and be performed by patients at home and almost on a daily basis. Next, light (superficial) epidermal peeling can be provided by glycolic peels or a slightly deeper peel in the form of Jessner's solution.
Glycolic peels contain medical concentrations of glycolic that are administered in the office and need to be presented as a program with frequent intervals in the beginning, increasing the duration and concentration of glycolic as tolerated with each visit until a stable endpoint of improvement is obtained at which time maintenance is begun. These are comfortable and heal quickly so there is very little downtime. I have seen nice improvement in fine wrinkle lines, texture, and coloration and even softening of medium depth wrinkle lines with this program.
The next level of peel offered in my office is the medium depth peel. The most popular product is low concentrations (15-30%) TCA (tri chloro acetic acid). There are many great indications for its usage. It is an excellent "refresher" minimal downtime peel that can be frequently safely repeated for cumulative benefits. I also like to offer it for use in the nonfacial areas such as the chest, hands, and arms. I also use this to feather the edges of demarcation along and into the neck when I use deeper (laser or phenol peel) treatments to the face. I suggest this as a "jump-start" to the patients on the bleaching program in which cases it works extremely well. It is an excellent stand-alone treatment for such things as the fine wrinkles of lower eyelids.
A popular product I use is the Obagi Blue Peel that compliments nicely their bleaching program. A methylene blue dye added to the TCA solution makes the application and endpoint of the peel much easier to identify and control. I offer this as the "weekend peel", performed on a Thursday, back to work on Friday, peel on Saturday and Sunday and mostly done by Monday or Tuesday. It looks like a deep brown sunburn that comes off like a "snake-skin". It further increases the amount of improvement in pigmentation and softening wrinkle lines. I offer this also as part of a program and caution patients that a one-time isolated treatment is simply not enough.
The final and highest level of peel is the phenol peel. It is roughly the equivalent of a laser resurfacing procedure. It is performed in the outpatient surgery setting and can be painful. Many doctors continue to prefer and offer phenol peels over laser. It seems to be more effective for coarse deep wrinkles. Hypopigmentation is still an unavoidable byproduct of phenol peels. Peels work. There are many to choose from and they can be customized to complement your skin care program, lifestyle, and goals.