ALPHA HYDROXY ACID PEELS
Alpha hydroxy acids (AHAs) are naturally occurring carboxylic acids such as glycolic acid, a natural constituent of sugar cane juice, and lactic acid, found in sour milk and tomato juice. This is the mildest of the peel formulas and produces light peels for the treatment of fine wrinkles, areas of dryness, uneven pigmentation, and acne. Alpha hydroxy acids can also be mixed with a facial wash or cream in lesser concentrations as part of a daily skin-care regimen to improve the skin’s texture.
There are five usual fruit acids: citric acid, glycolic acid, lactic acid, malic acid, and tartaric acid. Many other alpha hydroxy acids exist and are used.
AHA peels are not indicated for treating wrinkles.
AHA peels may cause stinging, skin redness, mild skin irritation, and dryness. You will notice immediate results.
Jessners peel solution, formerly known as the Coombes formula, was pioneered by Dr. Max Jessner, a German-American dermatologist. Dr. Jessner combined 14% salicylic acid, lactic acid, and resorcinol in an ethanol base. It is thought to break intracellular bridges between keratinocytes. It is very difficult to over-peel the skin due to the mild percentages associated with the acid combination.
RETINOIC ACID PEEL
Retinoic acid is a retinoid. This type of facial peel is also performed in the office of a facial cosmetic surgeon or a dermatologist in a medical spa setting. This is a deeper peel than the beta hydroxy acid peel and is used to remove scars as well as wrinkles and pigmentation problems. It is usually performed in conjunction with a Jessner; which is performed right before, in order to open up the skin, so the retinoic acid can penetrate on a deeper level. The client leaves with the chemical peel solution on their face. The peeling process takes place on the third day. More dramatic changes to the skin require multiple peels over time.
TRICHLOROACETIC ACID PEELS
Trichloroacetic acid (TCA) is used as an intermediate to a deep peeling agent in concentrations ranging from 20-50%. Depth of penetration is increased as concentration increases, with 50% TCA penetrating into the reticular dermis. Concentrations higher than 35% are not recommended because of the high risk of scarring.
Trichloroacetic acid peels:
- Are preferred for darker-skinned patients over Phenol
- Smooth out fine surface wrinkles
- Remove superficial blemishes
- Correct skin pigment problems
Trichloroacetic acid peels may:
- Require pre-treatment with Retin-A or AHA creams
- Require repeat treatment to maintain results
- Require the use of sunblock for several months (this is a must)
- Take several days to heal depending on the peel depth
Phenol is the strongest of the chemical solutions and produces a deep skin peel. Some publications claim that the phenol peel effect could be due to the action of croton oil and that phenol would not be effective without this oil. In reality, many phenol peel solutions exist that do not contain croton oil. This last is only a penetration enhancer, acting at the epidermal very superficial layers. Croton oil is not the only penetration enhancer that can be used. Effects of a phenol chemical peel are long-lasting, and in some cases are still readily apparent up to 20 years following the procedure. Improvements in the patient’s skin can be quite dramatic. A single treatment usually achieves the desired result.
Phenol peels are used to:
- Correct blotches caused by sun exposure or aging
- Smooth out coarse deep wrinkles
- Remove precancerous growths
Phenol peels may:
- Pose a risk of arrhythmias if applied without following strict rules
- Permanently remove facial freckles
- Many formulas cause permanent skin lightening by reducing the ability to produce pigment
- Require increased protection from the sun permanently
The deeper the peels the more complications that can arise. The possible complications include prolonged erythema, pigmentary changes, milia (whiteheads), skin atrophy, and textural changes.