Chemical Peels

Chemical peel uses a chemical solution to improve and smooth the texture of your facial skin by removing the damaged outer layers. It can be useful if you have wrinkles, facial blemishes and/or uneven skin pigmentation, such as that caused by sun exposure, a common problem in sunny California. Chemical peel may also remove pre-cancerous skin growths, soften acne facial scars and even control acne. Although a chemical peel can be performed at the same time as a facelift, it is not a substitute for a facelift, and like a facelift, it will not slow or prevent further facial aging. In certain cases, health insurance may cover the peel procedure, so we suggest that you check with your health insurance carrier before you schedule a chemical peel.

Phenol, trichloroacetic acid (TCA) and alphahydroxy acids (AHAs) are chemicals that are used for this purpose. The precise formula is adjusted to meet each patient's needs.

Our practice utilizes Alphahydroxy acids (AHAs), such as glycolic, lactic, or fruit acids which produce light peels for a smoother, brighter-looking skin. AHA peels may be used to treat fine wrinkling, areas of dryness, uneven pigmentation and acne. AHA peels may cause stinging, redness, irritation and crusting. However, as the skin adjusts to the treatment regimen, these problems will subside. Various concentrations of an AHA may be applied weekly or at longer intervals to obtain the best result. Dr. Kapoor will make this decision during your consultation and as the treatment proceeds. An Alphahydroxy acid, such as glycolic acid, can also be mixed with a facial wash or cream in lesser concentrations as part of your daily skin-care regimen to improve your skin's texture.

All chemical peels carry some uncertainty and risk, although they are normally a safe procedure when performed by a qualified, experienced plastic surgeon. However, because each person's skin is unique, some unpredictability and risks such as infection and scarring, while infrequent, are possible.

A TCA peel (trichloroacetic acid) is the most common of the medium-depth peel. Jessner's solution, glycolic acid, salicylic acid, and other agents are also used. With a TCA peel, your healed skin will be able to produce pigment as always; the peel will not bleach the skin. However, TCA-peel patients are advised to avoid sun exposure for several months after treatment to protect the newly formed layers of skin. Even though TCA is milder than phenol, it may also produce some unintended color changes in the skin.

Peel Formulas at a Glance
Alphahydroxy acids (AHAs)
Uses:
. Smooths rough, dry skin
. Improves texture of sun-damaged skin
. Aids in control of acne
. Can be mixed with bleaching agent to correct pigment problems
. Can be used as TCA pre-treatment
Considerations:
. A series of peels may be needed
. As with most peel treatments, sunblock use is recommended

Trichloroacetic acid (TCA)
Uses:
. Smooths out fine surface wrinkles
. Removes superficial blemishes
. Corrects pigment problems
Considerations:
. Can be used on neck or other body areas
. May require pre-treatment with Retin-A or AHA creams
. Treatment takes only 10-15 minutes
. Preferred for darker-skinned patients
. Peel depth can be adjusted
. Repeat treatment may be needed to maintain results
. Sunblock must be used for several months
. Healing is usually quick, much quicker than with a phenol peel

Planning for a Chemical Peel

During your initial consultation, it is important that you discuss your expectations with Dr. Kapoor. Don't hesitate to ask any questions or express any concerns that you may have. Dr. Kapoor will explain the planned procedure in detail, including its risks and benefits, the recovery period and the costs. If you have a history of herpes, you should tell Dr Kapoor prior to the procedure. Remember, chemical peel treatments are usually not covered by medical insurance unless they are performed for medically related problems.

Preparing For Your Chemical Peel
Sometimes Retin A - a prescription medication derived from Vitamin A - is used to pre-treat the skin. This thins out the skin's surface layer, allowing the TCA solution to penetrate more deeply and evenly. If your skin won't tolerate Retin-A pre-treatment, an AHA cream may be used instead. Hydroquinone, a bleaching agent, is sometimes used in conjunction with Retin-A or AHA pre-treatment, especially if you have blotchy skin areas or pigmentation problems. You may have to spend a month or more in the pre-treatment phase before Dr. Kapoor can schedule your peel.

You will need to arrange for someone to drive you home and help you out for a day or two if you are having a deeper TCA peel. You probably won't need any extra assistance if you're having an AHA peel or superficial TCA peel.

Where Your Peel Will Be Performed
Your chemical peel may be safely performed in our office.

Types of Anesthesia
No anesthesia is needed for AHA peels since they cause only a slight stinging sensation during application. Anesthesia isn't required for TCA peels because the chemical solution acts as an anesthetic. However, you may request some mild sedation before and during the procedure to relax you and keep you comfortable, if you think you require it.

The Peel
AHA peels/treatments: Dr. Kapoor will first cleanse the skin and then apply the AHA solution, which usually takes no more than 10 minutes. No "after-peel" ointment or covering is required. Depending on the strength of the peel, periodic treatments may be necessary until the desired effects are achieved.
For some patients, the application of an AHA-based face wash or cream once or twice a day at home will be sufficient to accomplish the desired goal. Dr. Kapoor may add Retin-A or a bleaching agent to your at-home treatment schedule. After several weeks of at-home use, Dr. Kapoor will check your skin to determine if your regimen needs adjustment.

TCA peels: Again, the skin is first thoroughly cleansed. Then, Dr. Kapoor will apply the TCA solution. You may feel a stinging sensation as the peel solution is applied, but this will quickly pass. A full-face TCA peel usually takes no more than 15 minutes. Two or more TCA peels may be needed to obtain the desired result, and those may be spaced out over several months. Mild TCA peels may be repeated as often as every month.

After Your Treatment
After an AHA peel, it is common to experience some temporary flaking or scaling, redness and dryness of your treated skin. However, these conditions will disappear as the skin adjusts to treatment.

After a TCA peel, Dr. Kapoor may prescribe a mild pain medication to relieve any tingling or throbbing you may feel. If tape was used to cover the treated parts of your face, it will be removed after a day or two. A crust or scab will form on the treated area. To help your face heal properly, it is essential that you follow Dr. Kapoor's specific post-operative instructions.

A TCA peel may also cause swelling, depending on the strength of the peel used.

Getting Back to Normal
With an AHA peel, the temporary redness, flaking and dryness that you experience will not prevent you from working or engaging in your normal activities. A fresher and improved skin texture will result with continued AHA treatments. Remember, protecting your skin from the sun is also important following these mild acid peels. Ask Dr. Kapoor to recommend a sunblock with adequate UVA and UVB protection and use it every day.

With a TCA peel, the moderate discomfort and mild swelling you may experience will subside within the first week. In about a week to ten days, your new skin will be apparent and you should be healed sufficiently to return to your normal activities. It is best to avoid sun exposure unless you are adequately protected.

Your New Look
Improvements from peels may be very subtle at first. You may detect a healthier glow to your skin. With continued treatments, you will notice a general improvement in the texture of your skin.