Chemical Peels: What They Are, Who They Suit and What Recovery Involves

What is a chemical peel and how does it work?

In a chemical peel, a solution containing acid is applied to the skin. This solution loosens the bonds between cells in the uppermost layers of the skin or creates controlled damage in these layers. Then, as the skin repairs itself, a smoother, new layer forms on the surface; with deeper peels, collagen production in the lower layers is also stimulated.

Peels are divided into three groups according to the depth at which they act. The depth depends on the type of substance used, its concentration, how long it stays on the skin, how the skin has been prepared and how many layers are applied.

The low-concentration acids found in cosmetic products are not the same as a peel applied by a doctor. Using high-concentration acids at home can cause burns and permanent pigment spots.

What is it used for?

• Sun spots and some pigment irregularities
• For spots such as melasma (mask of pregnancy), as support for other treatments and in carefully selected patients
• Acne and some acne scars
• Fine lines and texture changes due to sun damage
• A rough, dull-looking skin surface

For problems such as deep wrinkles, sagging and deep pitted scars, the effect of superficial peels is limited. You can find more detailed information on pigment spots in our article “Dark Spots and Melasma”.

Who is it suitable for?

Superficial peels can be used on many skin types when a suitable substance and concentration are chosen. Medium and deep peels, on the other hand, are done in more carefully selected patients, with a more careful assessment.

Skin type is decisive in this decision. In people with dark skin and skin that easily develops pigment spots, the risk of post-inflammatory hyperpigmentation, that is, darkening of the skin after the procedure, is higher. For this reason, more superficial peels are usually preferred for these people, and care is taken to prepare the skin before the procedure.

Who is it not suitable for, and what needs attention?

• People taking an oral vitamin A derivative acne medicine (isotretinoin) or who have stopped it recently: skin healing may be affected; a peel should not be done without a doctor’s assessment.
• People using a retinoid (vitamin A derivative) cream or other acid-based products: the skin may be more sensitive; your doctor will tell you when to stop these products before the procedure.
• People with a history of cold sores (herpes): a peel can trigger a cold sore flare-up. Preventive medicine may be needed, especially for medium and deep peels; be sure to mention your history.
• Active infection, an open wound, an active cold sore, or an eczema or psoriasis flare-up in the treatment area
• A tendency to form keloids or thick scars
• Pregnancy and breastfeeding: there are not enough safety data for many peeling substances; the procedure is usually postponed. Be sure to tell your doctor if you are pregnant or breastfeeding.
• People who will not be able to protect themselves from the sun after the procedure (for example, working outdoors, an upcoming holiday)
• For deep peels, heart rhythm disorders, kidney or liver disease: because phenol-containing solutions can affect these organs, a detailed assessment and monitoring are needed.

This list is not complete; tell your doctor about all your health conditions and the medicines you use.

Who should perform it, and where?

The result of a peel depends largely on the knowledge and experience of the person performing it. A doctor who assesses your skin type and your problem should decide which substance to use, at what concentration and for how long. In Turkey, these matters are regulated by the Ministry of Health, including who may perform which peel and where. Medium and deep peels are medical procedures; they should be performed by a doctor in a healthcare facility with suitable monitoring facilities.

For people with dark skin, experience with peels is especially important, because the wrong choice can lead to permanent changes in colour.

Preparing for the procedure

• Start protecting yourself from the sun in the weeks before the procedure; peels are not done on tanned skin.
• If your doctor wishes, they may recommend that you use creams to prepare the skin before the procedure; your doctor will tell you when to start.
• From the date your doctor tells you, stop treatments that irritate the skin, such as retinoids, acid-based products, exfoliating mitts and waxing.
• If you have a history of cold sores, discuss whether preventive medicine is needed.
• For medium and deep peels, set aside suitable time for the recovery period; plan time off work and your social schedule accordingly.

The day of the procedure, step by step

1. Your medical history, medicines and expectations are reviewed again; informed consent is obtained.
2. Your face is cleaned and the skin is degreased. Sensitive areas such as around the eyes, the sides of the nose and the corners of the mouth are protected.
3. The peel solution is applied evenly with a brush, gauze or cotton. You may feel burning, stinging or warmth during this; deep peels require pain control and monitoring.
4. The solution is left on the skin for a set time, or its effect is monitored according to the changes in the skin.
5. Depending on the substance used, the solution is neutralised or washed off; some peels complete their action on the skin on their own.
6. A soothing care product and sunscreen are applied; home care and a follow-up appointment are planned.

After the procedure: the first 24 hours and the first week

The recovery process varies markedly depending on the depth of the peel:

• Do not pull, pick or scratch peeling skin; this increases the risk of scarring and pigment spots.
• Use the moisturisers and care products your doctor recommends; do not try new products.
• Protect yourself carefully from the sun: broad-spectrum sunscreen, a hat and shade should be used together.
• Stay away from make-up, saunas, Turkish baths and intense exercise until the skin has healed.
• With medium and deep peels, follow the dressing and medicine instructions your doctor gives you exactly.

Expected side effects

• Redness, burning, tightness and peeling: an expected part of a peel.
• Swelling: may be marked around the eyes, especially with medium and deep peels.
• Temporary darkening: the skin may temporarily darken during the recovery period.
• Acne-like rash or small white cysts (milia)

Less common but important risks are: post-inflammatory hyperpigmentation (darkening that can be permanent), light-coloured patches (hypopigmentation), cold sore flare-ups, bacterial or fungal infection, prolonged redness and scarring. Some of these risks increase with greater depth and on dark skin. Deep peels also carry systemic risks related to heart rhythm and the kidneys.

Unless your doctor advises it, do not apply any cream, heat or ice to the area on your own.

When will I see the result, and how long does it last?

With superficial peels, increased radiance and smoothness of the skin surface may be noticed after the first sessions; however, for problems such as pigment spots and acne, more than one session a few weeks apart is usually needed for a noticeable change.

With medium-depth peels, the result appears after the skin has fully healed, and the peel can be repeated months later if needed. The effect of deep peels lasts longer, but their recovery process and risks are also greater.

No peel stops skin ageing or the formation of new pigment spots. Maintaining the result depends largely on daily sun protection and the care routine your doctor recommends.

Realistic expectations: what a peel cannot do

• It does not correct sagging skin and does not lift the face.
• It is usually not possible to noticeably correct deep wrinkles and deep pitted scars with superficial peels.
• It cannot eliminate recurring spots such as melasma; it can only contribute to improvement together with other treatments.
• It is usually not effective for problems such as dilated blood vessels and some birthmarks.
• A lasting change should not be expected from a single session.

Alternatives