Autumn. Beautiful color on our trees brings lovely falling leaves. Cooler temperatures on bright blue skies. Chemical and enzyme peels. Oh Autumn, my favorite of the year and is YOUR best time for skin care. Absolutely! The cooler, gentler climate of Fall is the perfect time for rejuvenating peels and can prepare you for a glowing Holiday completion.
The following article is taken from the DERMAdoctor site and is very informative.
Chemical Peels
Chemical peels are one of the most popular cosmetic procedures that patients avail themselves of today. Chemical peels can give your skin a healthy, "just refreshed" look, or can be aggressive, taking years off of your appearance.
What do chemical peels do? The outer portion of the skin (epidermis) is composed of multiple layers of epidermal cells. These cells provide a barrier against the environment, protecting deeper, more delicate tissues, maintain an even internal temperature and also prevent against dehydration.
Epidermal cells are anchored together in two ways. Microscopic fibers called tonofilaments run between individual cells, helping anchor them together. An extracellular surrounds each cell, acting as a sort of "glue" to further keep cells together. Over time, these cells are invisibly shed through the body's natural means of exfoliation. Speeding up this process can instantly restore a more youthful glow to the skin and address other subtle signs of the aging process.
Whereas microdermabrasion breaks the tonofilaments through the act of physical exfoliation, chemical peels work to dissolve the "glue". One of the most frequent questions is which procedure is better? The answer is that each works well, but neither provides a thorough exfoliation when used alone. That is why incorporating both treatments into a regimen can produce a much more satisfying result.
Just like other cosmetic procedures, there is a wide range of chemical combinations, strengths and techniques used that can make it overwhelming to decide which is best for you.
Physicians typically guide the patient to the most appropriate type and level of chemical peel to address the problem and yield a satisfying result. What's realistic? What isn't? What can you do for yourself? And finally, what should your doctor do that your aesthetician shouldn't? Let's find out.
Realistic Goals Of Chemical Peels
• Chemical peels can correct actinic (sun) damage. • They can reduce mild scarring. • You can experience a reduction or eradication of your wrinkles. • Improvement of dark skin discoloration is possible. • Chemical peels can remove excessive / stubborn blackheads. • The peel may temporarily reduce excessive skin oils.
Unrealistic Goals Of Chemical Peels
• It cannot remove or reduce the appearance of blood vessels on the skin. • It is impossible to truly change pore diameter. However, by removing blackheads, the pores may actually appear less pronounced after treatment. • This is not a procedure to get rid of keloidal types of scars. • Chemical peels are not a facelift. • This is typically not appropriate for improving dark skin discoloration in people of color (Asians, African Americans, Caucasians of Mediterranean extraction, Hispanics, etc.)
There are a variety of different chemicals used for the purpose of rejuvenating the skin in what are called "chemical peels". The main reason to select an active agent is based upon the desired depth of the chemical peel. If the skin concern is predominantly superficial, then a milder, less caustic ingredient is selected. If deeply placed conditions exist, then far stronger products with matching levels of potential complications may be necessary.
Chemical peeling agents that perform mild or moderate peels typically provide a safer peel that has less associated long-term side effects. These peels work on the epidermis and possibly the most superficial portion of the dermis (known as the papillary dermis).
Deeper peels go midway into the dermal layer (into the reticular dermis), almost invariably leaving a permanently lighter skin tone. Instead of being able to tan as in the past, this lighter skin often freckles instead. These deeper peels should not be undertaken lightly, and you need to make sure in advance that the peel technique will be feathered into the scalp line and performed down the neck, possibly even the décolletage, or you may find that you have a highly noticeable line demarcating your original skin tone and the new one that is on the face.
Active ingredients used alone or in combination for mild to moderate strength chemical peels
• Glycolic Acid(AHA) • Salicylic Acid (BHA) • Lactic Acid • Jessner's Peel ( a combination of salicyclic acid, resorcinol and lactic acid mixed in ethanol) • Resorcinol • TCA (Trichloracetic Acid) TCA is used in a variety of peeling regimens such as AccuPeel and the Obagi Blue Peel.
Active ingredients used in deep chemical peels • Baker's Phenol
THE FOUR LEVELS OF PEELING
The ingredient and concentration obviously play a very big role in determining the ultimate depth of the chemical peel. However, other variables can make a difference such as whether a pre-peel de-fatting prep was performed, the amount of chemical applied, and the length of time the chemical was allowed to stay on the skin.
Another important factor is which area will be treated. The variations in skin thickness can affect the ultimate peel outcome. For instance, the face usually heals far more rapidly and typically experiences far fewer complications (such as discoloration, scar formation and infection) than areas such as the backs of the hands or neck. And regardless of what type or depth of peel used, exfoliation always increases one's sun sensitivity. Always wear a broad spectrum SPF 30 when using any type of chemical or physical exfoliation.
Very Superficial: This really isn't a true peel, more of an exfoliation. The most superficial layers of the stratum corneum (at the top of the epidermis) is removed or thinned during exfoliation. Most chemical peels have a preoperative regimen of using exfoliating agents such as Renova, Tazorac or a strong glycolic acid cream for 2-4 weeks prior to the actual procedure. This helps the chemical peeling agents penetrate more deeply and evenly. The use of these exfoliants also have the obvious beneficial properties of smoothing out thickened rough areas, helping self tanners go on more evenly and helping other skin rejuvenation products reach deeper tissues. Additionally, there has been good evidence that vitamin A exfoliants can help stimulate collagen deposition.
Superficial: Superficial chemical peels remove skin through a portion or all of the epidermal layer. These are the "refreshing" forms of skin peels. They can also help with reducing the appearance of very mild blotchy skin discoloration, remnant acne discoloration and help cleanse the pores. This is the most common form of peel that you would find performed in a spa or by an aesthetician. And typically they would only utilize glycolic, AHA blends or BHA as the active ingredients. True peels with higher levels of glycolic acid (30% or higher) or those containing TCA, resorcinol or Jessner's ideally would be performed in a medical setting. Examples of chemicals used for a superficial peel include: TCA 10-20%, Resorcin, Jessner's Solution, Salicylic Acid, Solid CO2 (also known as dry ice), AHAs (Glycolic and Lactic Acid).
Home peel kits tend to fall somewhere between very superficial and superficial. They can be excellent for helping freshen skin, eliminate blackheads, improve symptoms of oiliness and/or acne and renew texture. Home peels usually rely upon very low levels of glycolic acid (AHA) or blend with salicylic acid (BHA). Guestimate that total levels of actives will fall somewhere in the 4-12% total acid level range when looking at an average do-it-yourself products. Certainly chemical peels for home use in the 30+ range should be approached with care. Glycolic acid at 30% enters into potential medium level peel, particularly if misused. Acid is acid, so anytime a peel regimen is used at home, it is important to follow the directions. Acids are neutralized during the routine to stop their action. This prevents inflammation, discoloration or chemical burns for occurring. Most mainstream brands have been thoroughly tested and have well proven safety records. But "rogue" peels without any major brand behind them may be suspect. DERMAdoctor has periodically received frantic consumer calls about problems experienced with "no-name" chemical peels purchased online or through an infomercial. So it always boils down to buyer beware and use with care. Examples of typical home peel systems include MD Formulations My Personal Peel System, Cellex-C Speed Peel Facial Gel and Dr. Dennis Gross Skincare Alpha Beta Daily Face Peel - 30 applications. A version made for the body, Dr. Dennis Gross Skincare Alpha Beta Daily Body Peel is also available.
Medium: Here's my personal cut off point that distinguishes medically performed peels from those offered in a spa, by an aesthetician or facialist. A medium strength chemical peel allows the acid to penetrate through the epidermis, down into the upper most portion of the dermis known as the papillary dermis. A medium strength peel will be far more likely to be associated with complications, both temporary and permanent. In addition to the pre-peel use of exfoliants, the use of a skin bleaching agent, such as 4% hydroquinone, and a broad-spectrum sunscreen a month prior to the procedure, may be added for more aggressive forms of these peels, or for patients who already suffer from some form of skin discoloration. Inflammation from this level peel may temporarily produce an increase in skin tone. Medium peels are typically not appropriate for people with darker skin tones or of ethnic background again due to the risk of irregular pigmentation following the procedure.
Dealing with infection preventatively is key here. For non-buffered glycolic acid and more commonly TCA peels, the use of antiviral medication (herpes cold sore prevention) started before the peel is performed is very helpful. The use of antibiotics is sometimes also used. It is absolutely CRUCIAL that you not pick at the peeling skin during the healing phase. This is a sure way to end up with an infection and long lasting problems such as scarring or skin discoloration. Often the use of emollients during the first few days such as MD Formulations Moisture Defense Antioxidant Comfort Creme are incorporated in addition to the continued use of sunscreen such as DERMAdoctor Body Guard Exquisitely Light SPF 30 For Face & Body, and a very mild cleansing agent such as DERMAdoctor Wrinkle Revenge Antioxidant Enhanced Glycolic Acid Facial Cleanser 1. Make-up is often avoided until the skin has fully peeled away. Buffered glycolic acid chemical peels that range from 70-99% do not cause the type of significant noticeable peeling that you can see with TCA peels such as AccuPeel. However, a series of 6-12 buffered glycolic acid peels compared to usually 1 of the AccuPeel is typically performed. Skin sensitivity, degree of skin concerns, time down, and cost will determine which form of peel should be chosen.
A variety of acid compounds can be used for a medium peel: Glycolic Acid 70%+ (non-buffered), TCA 35-70%, combination peels such as solid CO2, (also called dry ice), followed by medium strength TCA, and glycolic acid followed by TCA. A word on the Obagi Blue Peel. This peel is essentially TCA blended with a blue dye, which allows the physician to accurately determine where and how evenly the chemical has been applied. This peel has the same benefits as any TCA peel; however, it is often recommended as a treatment for skin discoloration, particularly patients of color. This peel "routine" is accompanied by home treatment with hydroquinone and tretinoin (the active ingredient in Retin A, etc.). Certainly anyone with a darker skin tone should always enter into a chemical peel fully aware of potential inflammation and an increase in skin discoloration. The Blue Peel has a good track record. I merely wanted to demystify the name given its widespread use and name recognition.
Deep: This peel goes through the epidermis, papillary dermis and into the deeper portion of the dermis known as the reticular dermis. These peels are not a simple procedure. Absorption of the active ingredient, phenol, has been known to cause cardiac arrest and even death. Patients who undergo phenol peels should be placed under general anesthesia and on full cardiac and pulmonary monitoring.
A phenol peel unquestionably requires a medical setting where emergency back-up is available should anything go wrong. An anesthesiologist should be present, and preferably have this procedure done in a surgical setting, not just a room adjacent to the doctor's office. The down time from this procedure is obviously the longest, 2-3 weeks is generally required before you want to be seen in public. Due to the depth of the peel leaving deeper tissue exposed, there is an increase in photosensitivity to the sun. Sunblocks which offer UVA, UVB and visible light protection such as Total Block are ideal.
Examples of ingredients used in deep peels include: Baker's phenol alone or under occlusion by tape. The tape drives the phenol deeper into the skin. Chemical peels can truly retexturize the skin, restore radiance and a youthful appearance. Whether looking for magic or simply the ideal home treatment to maximize your rejuvenation routine, chemical peels are undoubtedly here to stay. Whatever the reason always follow the directions. Doing so will help get the most from your treatment and minimize problems down the road.
Professional products and treatments can repair summer skin problems and help avoid them in the future. m.d. Skin is offering a light peel via Pumpkin Enzyme, as well as a variety of safe Chemical Peels. Free consultations are available to determine the best protocol for you. Please access my website (http://www.themdskin.com) and book your appointment for your radiant fall face.
Please note that this BLOG was published in October under the name "Fall Skin Care . . . Correction Time" These type of treatments should be performed BEFORE the longer and more intense UV ray seasons of Spring and Summer. Please book your appointment NOW in preparation for those months when not recommended. If you have question or concerns, remember that I always offer FREE Consultations!
Marci
m.d. Skin llc,
561 Meeting Street, West Columbia, SC 29169
803-351-2922
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