Lifestyle Choices

The use of chemicals to “peel away” unwanted or dead skin is a practice with a past. Chemical face peeling can be traced back to ancient Egypt, where creams of alabaster particles suspended in milk and honey were applied to the face for “tightening”. The Egyptians also used animal oils mixed with salt and natural minerals, and plant substances to “exfoliate” their faces. Later, poultices containing mustard, sulfur and limestone were used. The Ottoman Turks singed their skin with fire in an attempt to induce light exfoliation (a practice I do not recommend!). In Europe, Hungarian gypsies passed their particular chemical formulae from generation to generation. The American Indians even used urine mixed with pumice for skin application (an unattractive but not ineffective concept!).

Typical “Skin Bleaching” Medical Surgery Mechanics

A chemical peel involves the application of a substance (usually an acid) to actually burn the surface of the skin to a controlled depth. Cosmetic improvement is attained by the body’s natural healing process forming a scar of new collagen. This scar, in turn, increases the thickness of the dermis, providing extra structural support to the skin’s surface and a new resistance to wrinkling.

With chemical burning of the skin, there is also destruction of the surface pigment cells and the deeper melanocytes which form the pigmentation. Chemical peels thereby “bleach” the skin to remove dark spots. With healing, the blood supply to the treated skin is also increased, leaving the skin with a rosy glow.

Chemical peels can be divided into three categories, according to their depth:

• Superficial peels — affect the skin only to the bottom of the epidermis.
• Medium peels — affect the skin to the upper part of the dermis.
• Deep peels — burn the skin down as far as the mid-dermis.

The dermatologist selects the appropriate peel according to the type of wrinkles or scars being treated, their location on the face, and the type and sensitivity of the particular individual’s skin. The more superficial the peel, the lower the risk of complications, but also the more superficial the correction.

For superficial peels, the most commonly used material is trichloroacetic acid (TCA) in strengths of 10 to 35 percent. Other agents used for many decades are resorcinol and “Jessner’s Solution” (which combines resorcinol with salicylic and lactic acids). More recently, formulations of alpha-hydroxy and glycolic acids in concentrations ranging from 50 to 70 percent have been used. Medium peels are performed with higher concentrations of TCA (50 percent). Deep peels are accomplished using phenol or the so-called “Baker-Gordon Formula” (a mixture of phenol and croton oil).

“Skin Bleaching” Medical Surgery Cure Fine Wrinkles, Skin Roughness, Fine Lines around Lips

Superficial and medium depth chemical peels can be an effective treatment for fine wrinkles, skin roughness, crow’s feet, fine lines around the lips, and uneven, blotchy pigmentation or freckles as well as smoothly indented scars and, sometimes, dark circles under the eyes. “Weather-beaten” faces with pigmented spots and fine wrinkles can respond especially well.

Chemical peels are used not only for cosmetic treatment of wrinkles and mottled pigmentation, but also to treat actinic keratoses (pre-cancerous lesions caused by the sun). The varied skin pigmentation that can result from pregnancy, or from having taken oral contraceptives or hormonal replacement therapy, does not respond predictably to chemical peels.

The best candidates for chemical peeling are women with fair complexions and blond or red hair. Men are not as amenable, with greater chance of scarring following the peel. Patients who suffer from kidney, liver or heart disease, diabetes, and certain scarring tendencies must avoid medium and deep peels.

Prior to considering a peel, the patient should inform the dermatologist of all their allergies or reactions, especially if they have a history of any fever blisters (herpes simplex). Chemical peels have been known to activate fever blisters, so preventative medication must be administered to susceptible people.

Chemical peels cannot improve every skin imperfection. Ice-pick acne scars are not improved, and pores, far from being reduced in size, may appear even larger after a peel. The skin of the neck heals poorly from peeling, often with raised (hypertrophic) scars. Chemical peels, therefore, are done only on the face down as far as the jawbone. Individuals with dark complexions are not good candidates, since the slightest unevenness in the application of the chemical peel substance can cause the appearance on the skin of splotchy pigmentation.

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