chemical peel overview

Presented by
Lindsey Miller

Licensed Aesthetician
Advanced Educator, PCA SKIN®

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did you know…

 According to the American Society of Aesthetic Plastic Surgery

1,048,577 chemical peels were performed in the United States in
2008.

 In 2008, among the 10.4 million minimally invasive or non-surgical

cosmetic procedures, the top five were:
 Botox® (5 million)
 Hyaluronic acid fillers (1.1 million)
 Chemical peel (1 million)
 Laser hair removal (892,000)
 Microdermabrasion (842,000)

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topics of discussion

 Function of chemical peels within the skin

 Types of peeling agents
 Classification of chemical peels
 Variables determining depth of peel
 Chemical peel fundamentals
 Peel technique and contraindications
 Frequency of treatment
 Patient expectations
 Peels with medical modalities
 Pre- and post-procedure skin care

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function of chemical peels within the skin

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types of peeling agents

 AHAs
 Salicylic acid (BHA)
 Jessner’s solution
 TCA
 Phenol
 Baker-Gordon

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classification of chemical peels

 Superficial – very light to light (epidermal exfoliation)

 AHAs
 Retinoids
 Salicylic Acid
 Jessner’s solution
 Up to 30% TCA

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classification of chemical peels

 Medium Depth (papillary dermal)

 35-40% TCA
 Jessner’s solution combined with 35% TCA

 Deep (reticular dermal)

 Phenol peel
 Baker-Gordon
 TCA in concentration > 50%
 Erb:YAG/CO2 laser resurfacing

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 classification of chemical peels

Depth of Peel Penetration

• AHAs
• Retinoids Superficial Cornified Layer
• Salicylic acid Granular Layer
• Jessner’s solution Squamous Layer
• Up to 30% TCA Basal Layer

• 35-40% TCA Papillary Dermis

Medium Depth
• Jessner’s solution
combined with
35% TCA

• Phenol peel
• Baker-Gordon Deep Depth
• TCA > 50% Reticular Dermis
• Erb:YAG/CO2
laser resurfacing

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variables determining depth of a peel

 Peeling agent
 Concentration of the peeling agent
 Layers of the agent applied
 Application technique
 Prepping of the skin
 Patient skin type
 Location of the peel

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Fitzpatrick’s classification of skin types and correlating sensitivity

Fitzpatrick Skin Color Common Hereditary Visual Typical Common

Skin Type Backgrounds Reaction to Sensitivity Response to UV
Sun to Rays
Chemical
Peels
I Pale White Nordic, Scandinavian Always Burns, Very Skin Cancer &
(Swedish, Danish) Never Tans Resilient Hypopigmentation
II White Irish, English, Welsh Usually Burns Resilient Skin Cancer &
Telangiectasia
III Light Brown, Asian, Mediterranean (Italian, Mildly Burns, Moderately Telangiectasia
(Naturally Greek) Tans Relatively Responsive
Tan) Skin Well
IV Moderate Hispanic, Middle Eastern, Rarely Burns, Sensitive Hyperpigmentation
Brown African American, Native Tans Well
American
V Dark Brown Hispanic, Middle Eastern, Very Rarely Moderately Hyperpigmentation
African American, Native Burns, Tans Sensitive
American, South Asian Easily
VI Black African American, South Least Likely to Very Hyperpigmentation
Asian Burn, Tans Very Sensitive
Darkly
chemical peel fundamentals

 Do not peel a red/traumatized face

 Have antidote for heat on hand
 Use the sensitivity scale of one to ten
 Other visual factors
 Excessive erythema
 Frosting
 Blanching

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chemical peel fundamentals

 Frosting

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chemical peel fundamentals

 Blanching

© 1995, J.B.Lippincott

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peel technique

 Cleanse the skin and remove excess sebum and cell debris
 Degrease the skin with an alcohol-free toner (do not use acetone);
patch test for sensitivity
 Apply appropriate number of layers of peel
 Customize the treatment with advanced serums and moisturizers
 Occlude the treatment and protect from UV exposure with a
combination of anti-inflammatory and broad-spectrum SPF
moisturizers

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contraindications to peels

 Pregnancy
 Lactation
 Active herpetic lesions
 Allergies to ingredients found in peels
 Trentinoin/Retin-A®/Renova®/Differin®/Tazorac®/Avage®/
EpiDuo™/Ziana®: Discontinue use 5 days before and after treatment

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frequency of treatment

Day of Week 1 Week 2 Week 3 Week 4

treatment
Normal/Maintenance
(once a month) X X
Pigment/Melasma
(every three weeks to
begin, then once a month)
X X

Acne/Blemishes
(every two weeks to begin,
then once a month)
X X X
Rosacea
(once a month) X X

Aging Skin
(every three weeks, then
once a month)
X X

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what to expect immediately following a peel

 Mild to moderate erythema (redness)

 Periorbital edema (puffy eyes)
 Tightness/dryness

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immediately following treatment

day of treatment following day 2 day 3 - 5 day 5+

morning

skin ▪ tight ▪ tight ▪ skin may ▪ heaviest ▪ typically

appearance ▪ moist and dewy ▪ dry begin to peel peeling peeling is
and feeling appearance complete
▪ mild to moderate
▪ mild to moderate edema and
edema and erythema
erythema

precautions ▪ apply products in ▪ reapply products ▪ do not pick at ▪ reapply ▪ restart

an appropriate in an loose skin products in an recommended
post- procedure appropriate ▪ reapply appropriate daily care
solution post- products in an post- regimen
▪ keep cool procedure appropriate procedure
solution post- solution
▪ keep cool procedure ▪ avoid direct sun
solution exposure

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peels with medical modalities

 Enhance results by combining chemical peels with:

 Microdermabrasion
 Ultrasound
 IPL
 LED
 Non-ablative and fractionated laser
 Erb:YAG and CO2 laser resurfacing

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the importance of daily care

 Pre-treatment
 Minimize complications
 Accelerate results
 Pre-condition the skin
 Customized systems
 Hyperpigmentation
 Acne
 Rosacea
 Age control

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the importance of daily care

 Post-treatment
 Minimize complications
 Heal and soothe the skin
 Post-procedure recommendations
 Post-procedure products

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