Chemical Peeling

Chemical Peeling

Chemical peeling is of three types: superficial, medium and deep peeling, depending on the depth of the skin layers penetrated by the substance.

It is a treatment method based on applying various chemical substances to the skin and removing the upper layers by creating a kind of burn. Types of these substances, most of which are acidic in character, are used in various concentrations. The main purpose is to remove dead cells on the surface and reveal a brand new skin cover from the ground.

Basic application purposes;

1. Elimination of skin spots due to various reasons (such as pregnancy, aging, sun damage)
2. Enabling the skin to obtain a more moist and shiny appearance
3. Use as an adjunct to medical therapy in acne treatment
4. Obtaining a more elastic skin cover by stimulating the production of collagen, the basic building block of connective tissue in the skin, and as a result, the treatment of fine wrinkles.
5. Elimination of rough structures on the skin surface

How many types of chemical peels are there?

Chemical peeling is of three types: superficial, medium and deep peeling , depending on the depth of the skin layers penetrated by the substance . The type of substance, the time it stays on the skin surface and the individual structure of the skin affect the depth achieved. For blemishes, superficial or medium-superficial peeling is preferred; for deeper lesions (such as acne), medium or medium-deep peeling is preferred. In 1952, French physician Dr. After the peeling process first described by Michel Pistor, many peeling agents have been used.

superficial peeling

The most commonly used agents for this purpose are alpha hydroxy acids (AHA). These are products obtained from various fruits or milk. The main ones are glycolic acid, lactic acid, malic acid, tartaric acid and citric acid. The most commonly used one is glycolic acid, which originates from sugar cane.

The frequent use of glycolic acid is based on its ability to directly penetrate the epidermis layer of the skin due to its double-chain small molecule structure. Although the 30% version is sold as a commercial product, 50% glycolic acid can also be applied with or without labels. In both cases, the effects are under the control of the physician. Since superficial peeling agents such as glycolic acid have a patchy effect on the epidermis on their own, they are prepared in the form of special gels for more homogeneous distribution. Lactic acid is a substance produced by striated muscles in the body, but it is also milk acid. It has three carbon chains and spreads slower and more homogeneously. Therefore, it is used in concentrations up to 70%. The main visible effect of AHAs in application is the burning effect that occurs on the skin in the first minutes. Unlike other peelers, no clear whitening is observed. Therefore, the effect of the acid is terminated with neutralizing agents within 3-5 minutes, depending on the concentration. The process is continued with repeated applications and multiple sessions.

Apart from alpha hydroxy acids, another product that has been used as a peeling agent but has lost its popularity due to the tinnitus side effect in high concentration types is salicylic acid, one of the beta hydroxy acids . After applying this acid, which also contains acetyl form in aspirin, whitening occurs on the skin after a while. This whitening is especially visible under a fluorescent lamp and indicates the moment when the peeling process will be terminated. Today, 30% salicylic acid solutions can be preferred for acne.

Developed to combine the effects of superficial peeling agents and create a more balanced solution, Jessner's solution consists of alpha and beta hydroxy acids (lactic acid, salicylic acid, resorcinol and ethyl alcohol). In practice, Jessner solution is applied in layers and the depth is related to the number of layers applied. No need to treat with neutralizing agent as it evaporates rapidly. The solution creates a whitening in the area before evaporating. Apart from the peeling process, Jessner solution is also used to remove the upper dead layers of the skin (dekeratinization) before applying medium and deep peeling agents such as trichloroacetic acid.

15-20% solutions of trichloroacetic acid (TCA) can also be used for short periods as a superficial epidermal peeling agent. It produces a white color by the coagulation of proteins in the skin cells.

Medium and deep depth peeling

The most commonly used substance for this purpose is trichloroacetic acid (TCA). Medium to deep level peeling procedures may include the lower layers of the epidermis, the epidermis and dermis junction, and a part of the dermis, from more superficial to deeper. As you get closer to the dermis, the possibility of scarring may increase and therefore the application requires experience. TCA is used for this purpose in concentrations between 35 - 42.5%. To facilitate the penetration of TCA into the lower layers, dekeratinization with Jessner's solution or skin change with retinoid derivatives can be applied.

Another agent in the medium-deep peeling group is phenol . Baker - Gordon formula is obtained by mixing croton oil with phenol in certain proportions to be used for deep wrinkles . This formula is only suitable for use on extremely sun damaged, thickened skin. As the end point of the application, a grayish white color is obtained on the skin. Heart rhythm disorders have been reported as an important side effect of phenol, depending on the duration of application. Therefore, it is recommended that the procedure be performed in a full-fledged hospital.

Medium to deep peeling would be more appropriate in the treatment of deep wrinkles. Because the chemical substance used must penetrate to the lower layer of the skin, called dermis, and cause cell proliferation called fibroblasts there and increase the synthesis of collagen, the basic protein of connective tissue. In short, there will be a wound healing process created by the application. This tightens the connective tissue in that area and improves skin quality.

Before chemical peeling…

In the pre-application period, sun lotions, skin bleaches and moisturizers can be used according to your doctor's recommendation. Again, in patients with a history of cold sores (herpes simplex) around the mouth, it would be appropriate to start protection with antiviral medications, especially before medium-deep chemical peeling procedures.

Chemical peeling can cause problems such as hypersensitivity reactions, up to life-threatening allergic reactions. That's why we first perform allergy testing in our practices. Less intense types of chemicals to be used for this purpose are applied in small amounts to various areas on the forearm skin, and conditions such as skin swelling, intense itching, bubble formation, shortness of breath, and widespread redness in the body are recorded. If such findings occur, the application should be abandoned. Especially shortness of breath and widespread redness and bubble formation indicate that allergy can affect the whole body. Therefore, chemical peeling applications, like all medications and treatments applied to the body, should only be performed in fully equipped hospitals with emergency life support.

Before chemical peeling, your doctor will examine your skin structure, skin quality (heavy staining, presence of acne, moisture content, oily - dry skin), skin diseases (psoriasis, systemic lupus, Sjögren's syndrome, existing infections, especially fungi on the skin, skin cancers, congenital existing swellings or spots, etc.) in terms of Fitzpatrick typing according to the skin's sensitivity to the sun. This examination determines which type of peeling (chemical, mechanical, laser) will be more suitable for skin renewal. It is important for patients with previous heart disease to inform their doctor about this issue due to heart rhythm disturbances that may occur during deep peeling procedures performed with phenol.

Smoking should be stopped at least 1 week before the peeling process due to its effects on skin blood circulation. Smoking may negatively affect application success. It can prolong the wound healing process and pave the way for wound line infections.

During the chemical peeling process…

Eye shields should be used during application, especially in applications around the eyelids with intense acid. Applying a protective eye ointment to the eyes during applications on the lid may reduce the risk of transfer of agents. Patients must be in harmony with the physician during the application. It should mention the presence of gradually increasing complaints such as burning and intense itching.

After chemical peeling…

After the application, protective and moisturizing products and supportive treatments of varying qualities are applied depending on the agents applied. Some of these products are products that the patient will apply at home during the recovery process. After applications in spring and summer, thick ultraviolet factor (45-50 SPF) sun lotions should be used. It may be possible to provide full protection with titanium dioxide type products, especially in summer.

I would like to emphasize that especially for our patients who will undergo medium and deep level peeling procedures, the skin on their faces will dry and flake off in the form of crusts after these applications, and that this process is a parallel period with the crusting and healing process that occurs on any injured surface. This is the effect that should happen.

Problems that may occur

Chemical peeling is a treatment that can have side effects ranging from simple to complex. Allergic side effects have been mentioned before. In addition, color changes (darkening or lightening of the area contrary to expectations) and acne formation may be observed, especially in patients who do not apply sufficient sun protection after the procedure. Again, as mentioned before, herpes (with HSV-1 and HSV-2 type viruses) or fungal infections can be observed, especially after medium and deep peeling procedures. These infections need to be treated most aggressively before they spread throughout the body. If necessary, the patient can be followed in the hospital according to the doctor's recommendation.

When chemical peeling is done deeply, it may cause scarring. Therefore, controlled action should be taken. One should be careful about the duration of application of the solution. This preparation should never be applied by anyone other than a physician, especially due to the side effects of phenol on the heart.