The skin is the largest organ in our body.
It is made up of millions of cells that protect us from the environment and regulate our body temperature.

Every day thousands of cells die, flake off and are replaced by new cells from beneath the skin.
As we age, this process begins to slow down. Our skin may become dull. Dark blotches, fine lines and other signs of sun-damage and aging begin to appear.

Chemical Peel Skin Rejuvenation

Chemical Peels have been used for over 100 years to create an even and controlled shedding of damaged skin cells. Each year thousands of chemical peels are performed in the United States. A chemical peel uses a solution applied to the skin to remove dead skin cells and stimulate the production of new skin cells. It tightens the skin, reduces wrinkling and restores a more youthful appearance.

During your consultation with your surgeon you will want to explain the level of skin improvement you hope to achieve. Your surgeon will then review your medical history and examine your skin type and pigmentation to determine if you are a good candidate for a chemical peel. Together you can evaluate the advantages and disadvantages of the different types of chemical peels, discuss your options, your expectations and determine the best treatment for you.
Don't forget to mention any history of viral infections, sensitivity to the sun, or prior skin treatments such as dermabrasion or Accutane treatments within the past six months.

What should you expect after treatment?

Reactions to chemical peels are similar to a sunburn and range from mild to more pronounced. Generally, the deeper the peel, the longer the recovery.

A light peel usually results in some redness, and possibly some scaling for a few days. Medium and deep peels can result in swelling and blisters that break open forming a crust and turning brown, followed by peeling which can last up to two weeks. These peels may require dressings on some or all of the treated skin. Dressings are usually removed after a day or two. Ointments and creams will be applied to keep the skin moist. At first the new skin will have the color of a significant sunburn. This will gradually fade to pink over the next several weeks. Cosmetics can be applied after about two weeks. Following a chemical peel, your new skin will be tighter, smoother and may be slightly lighter than it was before surgery.

Following any skin peel, it is important that you avoid any exposure to the sun. Your new skin is very sensitive and susceptible to injury. Always apply a wide spectrum (UVA and UVB blocking) sunblock of at least SPF 15 twenty minutes before you go outside. Your surgeon will prescribe a proper home skin-care treatment program to ensure proper healing.

What skin conditions can a chemical peel improve?

Chemical peels can effectively improve a wide variety of skin conditions including:

• Fine lines and wrinkles
• Uneven pigmentation
• Shallow acne scars
• Sun-damaged skin
• Age spots
• Freckling

A chemical peel is not a substitute for a facelift. It cannot eliminate excessive or lax skin. But, in many cases a chemical peel is performed in conjunction with these procedures.

What is the treatment like?

Unlike laser peels, chemical peels can be performed in the face, neck, chest, hands and even the arms and legs.

Most chemical peels are performed as outpatient procedures in the doctor's office or surgical suite. Depending on your skin type and the desired results, your physician may recommend a superficial, medium, or deep chemical peel. Your surgeon will select the proper chemical or mix of chemicals (glycolic acid, beta lift, Jessner, TCA or trichloroacetic acid, or carbolic acid) and apply the solution to various areas of the skin.

Once applied, the chemical produces a separation and peeling of the outer layers of the skin. This stimulates the production of new skin from beneath.
Most patients experience a warm to hot sensation which may last as long as ten minutes, followed by a stinging sensation. For deeper peels, some patients require anesthesia.

REJUVENATING AND CORRECTIVE TREATMENTS
In the interest of your complete and comprehensive care, we are now offering alpha hydroxy acid (AHA) skin peeling treatments. We recommend maintenance of your skin with medically dispensed home care products to extend, maximize and enhance the results of your treatment plan.

The use of AHAs in home care products incorporates the latest in medical and scientific research for optimum results on your skin. Formulated in an all-natural healing Aloe Vera base and combined with free-radical fighting vitamins, the products will make a visible difference in your skin's appearance. They are dermatologically formulated and are free of color additives, fragrances, harsh alcohols, comedogenic (acne producing) oils and other ingredients that are known sensitizes.

DETAILED INFORMATION: CHEMICAL PEELS AT CIAO BELLA

Chemical peel uses a chemical solution to improve and smooth the texture of the facial skin by removing its damaged outer layers. It is helpful for those individuals with facial blemishes, wrinkles and uneven skin pigmentation. Phenol, trichloroacetic acid (TCA) and alphahydroxy acids (AHAs) are used for this purpose. The precise formula used may be adjusted to meet each patient's needs.

Deciding if chemical peel is right for you :

Chemical peel is most commonly performed for cosmetic reasons -- to enhance your appearance and your self confidence. Chemical peel may also remove pre-cancerous skin growths, soften acne facial scars and even control acne.

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 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. You 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 cosmetic 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.

Preparing for Your Chemical Peel

Your cosmetic 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 cosmetic surgeon's office, office-based surgical facility or outpatient surgical center. Your 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 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 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.

*Content courtesy of the American Society of Plastic Surgeons