Thinking About Getting a Chemical Peel? Read This First

Chemical peels have been around for a long time for good reason—they work. See how a pro peel could heal your skin woes, from acne scars and uneven skin tone to melasma and fine lines and wrinkles.

Woman having a facial massage and peeling in beauty salonTrendsetter Images/Shutterstock

Chemical peels are tried and true

Everything old is new again, and chemical peels are experiencing a rebirth of sorts as growing numbers of cosmetic doctors turn to these treatments to address a wide range of skin concerns and conditions. According to the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), more than half (52 percent) of facial plastic surgeons say that chemical peels are in high demand. “What’s great about chemical peels is that they’re low tech and not intimidating when compared to lasers, and they address the same problems—skin discoloration, texture, and wrinkles,” says Jessie Cheung, MD, director of the Jessie Cheung MD Dermatology & Laser Center in Willowbrook, IL. So just how far back do they go? “Women have been using peels for over 2,000 years! Cleopatra soaked in milk baths to smooth her skin. The active ingredient in milk is lactic acid (an alpha hydroxy acid, or AHA) and these acids (along with beta-hydroxy acids, or BHAs) are still among the most commonly used types in modern peels,” says Erin Gilbert, MD, PhD, a dermatologist in Brooklyn, NY.

Why get a chemical peel

“These days, the term ‘chemical peel‘ applies to so many different formulations ranging from weaker glycolic peels that can be done at home to the strongest Phenol peels that often require sedation or general anesthesia,” says Mark H. Schwartz, MD, a New York City plastic surgeon. These skincare workhorses can correct acne, age spots, discoloration, tone, fine lines (especially under the eyes and around the mouth), freckles, melasma, sun damage, and more, according to the American Academy of Dermatology (AAD). “Some peels produce changes that are relatively light and freshen the skin through exfoliation,” says Fred G. Fedok, MD, a facial plastic surgeon in Foley, AL. “Moderately deep peels will help various kind of pigmentation issues. The deeper peels are effective at correcting wrinkles.” Peels tend to cost less than laser skin resurfacing, averaging anywhere from $100 to $400 per treatment based on practice location and the depth of the peel. Learn more about the skincare tips dermatologists use.

Mild peels

A series of mild chemical peels—on the face, neck, and/or chest—every few weeks works well for busy people because they get significant results with minimal downtime. The weaker peels are the AHA peels or fruit acid peels, most commonly glycolic acid, citric acid, and lactic acid, and can help improve acne scars, skin tone, and texture, diminish fine lines and wrinkles, and reduce the effects of sun damage. One such treatment is the “No Peel Peel” that Manhattan-based plastic surgeon Gerald Imber, MD, offers at his Youth Corridor Clinic. “The No Peel Peel is ideal for anyone looking to boost skin’s appearance or jumpstart a new skincare routine,” Dr. Imber says. “Our exclusive formula uses a 70 percent glycolic acid peel to remove dead cells and debris to regenerate skin cells without the traditional flaking and redness or discomfort associated with more intense formulas, so you get results similar to an intense peel but without the downtime or side effects.” Here’s what you can expect from this and other mild peels: After a thorough cleansing of the face, the peel is applied with a brush, pad, or cotton swab. “You may feel a slight tingling that lasts for the duration of the peel,” Dr. Schwartz says. “With the weaker AHA peels, there is a very short-term pinkish or ruddy glow to the skin,” he says. The before-and-after difference is pronounced. “You will look brighter right away with gradual improvement in fine lines, texture, and pigmentation.” A series of mild or superficial peels is often needed for optimal results. Aftercare matters too. Apply lotion or cream until the skin heals, and use sunscreen daily. It’s OK to wear makeup immediately.

Medium-strength peels

What makes peels a medium strength is the percentage of active ingredients. Medium-strength peels use some of the same acids in mild peels, just at a much higher level. For example, trichloroacetic acid (TCA) peels when used at more than 25 percent are medium strength, but anything lower would be considered superficial or mild, explains Chérie M. Ditre, MD, director of the Skin Enhancement Center and an associate professor of dermatology at the University of Pennsylvania School of Medicine in Philadelphia. Here’s what you can expect: Since these peels are deeper, your skin will be red and swollen after application, and blisters may form and break open. Your skin crusts and peels off in one to two weeks, according to the AAD. Your doctor may suggest taking an antiviral medication for 10 to 14 days before or after the peel if you have a history of cold sores. Other aftercare instructions include applying a lotion or cream to the treated area and avoiding the sun until healing is complete. Makeup is OK after about one week. “It is usually one and done for a while because there is downtime with these medium-strength peels,” says Dr. Ditre. Look to medium-depth peels—such as the 35 percent TCA and Jessner solution—to remedy hyperpigmentation and moderate wrinkles, according to Dr. Fedok. You may also be a candidate if you have heavy sun damage, leathery skin, and coarse wrinkles that are visible even at rest, Dr. Ditre adds. Medium-strength chemical peels may also help correct acne scars. Don’t miss these non-peel methods to get rid of acne once and for all.

Deep chemical peels

Phenol peels are the strongest chemical peels out there, and they target deep wrinkles, sun damage, and uneven tone. “They are helpful in treating vertical lines around the mouth, the so-called smoker’s lines,” Dr. Schwartz says, and they work best on lighter skin since there is less of a risk of hypopigmentation or bleaching.” Phenol peels are ordinarily used on the face only since the skin of the neck and hands tends to be thinner and more delicate. Here’s what you can expect: Given the strength of these peels, anesthesia may be required. There is some real downtime with phenol peels. “Crusting and post-procedure redness occur across the board and can last for weeks,” Dr. Schwartz says. The tradeoff is dramatic and long-term results. “These deep peels will do things that a facelift will not—improve the quality of environmentally damaged skin,” he says. Phenol-based peels can be used for more severe skin changes and wrinkles, but as Dr. Ditre notes, these deep peels have fallen out of favor given the availability of lasers as well as phenol’s possible link to heart issues.

DIY peels

Many peels are available over the counter at the drugstore or your doctor’s office, and these tend to have the same ingredients as in-office peels but at much lower concentrations. At-home peels take about 10 minutes—you apply gel or pads to the area and then wash it off. “Some people do it weekly,” Dr. Ditre says. It’s important not to use any retinoid products after a peel because they can irritate freshly exfoliated skin. Also, consider doing a skin patch test first. “I always tell my patients to take the time to perform a small test area before putting a product on their entire face,” says Dr. Gilbert. “Some products may be too strong for your skin type and cause redness, stinging, and irritation that is not only unpleasant but can actually be dangerous.” It’s also essential to wear a high-quality sunscreen of SPF 30+ after any peel, whether it’s being done at a doctor’s office, a spa, or at home, she stresses. (Watch that you’re not making these common sunscreen mistakes.) DIY peels are best for veterans of peels who want to do them at home for acne or fine lines, according to Dr. Ditre. “They give skin a great glow.”

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Medically reviewed by Elizabeth Bahar Houshmand, MD, on September 18, 2019

Denise Mann is a freelance health writer whose articles regularly appear in WebMD, HealthDay, and other consumer health portals. She has received numerous awards, including the Arthritis Foundation's Northeast Region Prize for Online Journalism; the Excellence in Women's Health Research Journalism Award; the Journalistic Achievement Award from the American Society for Aesthetic Plastic Surgery; National Newsmaker of the Year by the Community Anti-Drug Coalitions of America; the Gold Award for Best Service Journalism from the Magazine Association of the Southeast; a Bronze Award from The American Society of Healthcare Publication Editors (for a cover story she wrote in Plastic Surgery Practice magazine); and an honorable mention in the International Osteoporosis Foundation Journalism Awards. She was part of the writing team awarded a 2008 Sigma Delta Chi award for her part in a WebMD series on autism. Her first foray into health reporting was with the Medical Tribune News Service, where her articles appeared regularly in such newspapers as the Detroit Free Press, Chicago Sun-Times, Dallas Morning News, and Los Angeles Daily News. Mann received a graduate degree from the Medill School of Journalism at Northwestern University in Evanston, Ill., and her undergraduate degree from Lehigh University in Bethlehem, Pa. She lives in New York with her husband David; sons Teddy and Evan; and their miniature schnauzer, Perri Winkle Blu.