Alphahydroxy acids (AHAs), such as glycolic, lactic, or fruit acids are the mildest of
the peel formulas and produce light peels. These types of peels can provide smoother,
brighter-looking skin for people who can't spare the time to recover from a phenol
or TCA peel. AHA peels may be used to treat fine wrinkling, areas of dryness, uneven
pigmentation and acne. Various concentrations of an AHA may be applied weekly or
at longer intervals to obtain the best result. Your doctor 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
a daily skin-care regimen to improve the skin's texture.

Trichloroacetic acid (TCA) can be used in many concentrations, but it is most commonly
used for medium-depth peeling. Fine surface wrinkles, superficial blemishes and pigment
problems are commonly treated with TCA. The results of TCA peel are usually less dramatic
than and not as long-lasting as those of a phenol peel. In fact, more than one TCA peel
may be needed to achieve the desired result. The recovery from a TCA peel is usually
shorter than with a phenol peel.

Phenol is the strongest of the chemical solutions and produces a deep peel. It is used
mainly to treat patients with coarse facial wrinkles, areas of blotchy or damaged skin
caused by sun exposure, or pre-cancerous growths. Since phenol sometimes lightens
the treated areas, your skin pigmentation may be a determining factor as to whether
or not this is an appropriate treatment for you. Phenol is primarily used on the face;
scarring may result if it's applied to the neck or other body areas.

All chemical peels carry some uncertainty and risk. Chemical peel is normally a safe
procedure when it is performed by a qualified, experienced plastic surgeon. However,
some unpredictability and risks such as infection and scarring, while infrequent, are
possible.

AHA peels may cause stinging, redness, irritation and crusting. However, as the skin
adjusts to the treatment regimen, these problems will subside.

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.

With a phenol peel, the new skin frequently loses its ability to make pigment (that is, tan).
This means that not only will the skin be lighter in color, but you'll always have to protect
it from the sun. Phenol may pose a special risk for patients with a history of heart disease.
It's important that you make your surgeon aware of any heart problems when your medical
history is taken.

It is also possible that phenol will cause some undesired cosmetic results, such as uneven
pigment changes. Certain modified phenol peels are gentler and may be preferred in
some circumstances.

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

Phenol

Uses:
      • Corrects blotches caused by: sun exposure, birth-control pills, aging
      • Smooths out coarse wrinkles
      • Removes pre-cancerous growths

Considerations:

      • Used on the face only
      • Not recommended for dark-skinned individuals
      • Procedure may pose risk for patients with heart problems
      • Full-face treatment may take one hour or more
      • Recovery may be slow - Complete healing may take several months
      • May permanently remove facial freckles
      • Sun protection, including sunblock, must always be used
      • Results are dramatic and long-lasting
      • Permanent skin lightening and lines of demarcation may occur

Planning for a Chemical Peel

In some states, no medical degree is required to perform a chemical peel - even the
strongest phenol peels. Many states have laws that permit non-physicians to administer
certain peel solutions, but regulate the strengths which they are permitted to apply. You
should be warned that phenol and TCA peels have been offered by inadequately trained
practitioners claiming "miracletechniques" to rejuvenate the skin.

It is very important that you find a physician who has adequate training and experience
in skin resurfacing. Your plastic surgeon may offer you a choice of peel techniques or
suggest a combination of peels to obtain the best result for you.

During your initial consultation, it is important that you discuss your expectations with
your plastic surgeon. Don't hesitate to ask any questions or express any concerns that
you may have. Expect your plastic surgeon to 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 inform your physician 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

Your plastic surgeon will instruct you on how to prepare for your peel treatment.

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 the doctor will schedule your actual 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 phenol or 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

Most chemical peels may be safely performed in a plastic surgeon's office, office-based
surgical facility or outpatient surgical center. Your plastic surgeon may want you to stay
overnight in a facility or hospital if other cosmetic procedures are performed
simultaneously.

Types of Anesthesia

Anesthesia isn't required for phenol or TCA peels because the chemical solution acts
as an anesthetic. However, sedation may be used before and during the procedure to
relax you and keep you comfortable.

No anesthesia is needed for AHA peels since they cause only a slight stinging sensation
during application.

The Peel

AHA peels/treatments: Your doctor will apply the AHA solution to your cleansed facial
skin, a process that 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. Your plastic surgeon
may add Retin-A or a bleaching agent to your at-home treatment schedule. After several
weeks of at-home use, your doctor will examine your skin to determine if your regimen
needs adjustment.

Phenol and TCA peels: Typically, the skin is first thoroughly cleansed. Then, the surgeon
will carefully apply the phenol or TCA solution. You may feel a stinging sensation as the
peel solution is applied, but this feeling 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.

If phenol solution has been used, your plastic surgeon may coat the treated area with
petroleum jelly or a waterproof adhesive tape. With lighter peels, no covering is necessary.

A full-face phenol peel generally takes one or two hours to perform, while a phenol peel
to a smaller facial region (perhaps the skin above the upper lip) may take only 10 or 15
minutes. A single treatment usually suffices.

After Your Treatment

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

After a phenol or TCA peel, your doctor may prescribe a mild pain medication to relieve
any tingling or throbbing you may feel. If tape was used to cover 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 your doctor's specific post-operative
instructions.

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

If you've had a phenol peel, your face may become quite swollen. Your eyes may even
be swollen shut temporarily. You will need someone to help care for you for a day or two.
You may also be limited to a liquid diet and advised not to talk very much during the first
few days of recovery.

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 your doctor
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.

With a phenol peel, new skin will begin to form in about seven to ten days. Your face will
be very red at first, gradually fading to a pinkish color over the following weeks to months.
During this time, it is especially important that you use a sunblock or blotchy, irregular
skin coloring may result.

About two weeks after treatment, you may return to work and resume some of your
normal activities. Your skin will be healed enough for you to wear makeup. (For makeup
tips, ask your plastic surgeon for the ASPS brochure on camouflage cosmetics.)

Your New Look

Improvements from AHA 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.

The results of a TCA peel are usually not as long-lasting as those of phenol peel.
However, your skin will be noticeably smoother and fresher-looking.

If you're planning a phenol peel, you can expect dramatic improvement in the surface
of your skin - fewer fine wrinkles, fewer blemishes and more even-toned skin. Your
results will be long-lasting, although not immune to the effects of aging and sun exposure.