Chemical peel

Dr Beulink's Personal Comments - Chemical Peel

A chemical peel attempts to create a "controlled" shedding of several layers of damaged cells from the client’s facial skin, leaving a fresh new layer. This is performed by applying some form of acid to the skin to "kill off" cells. Only the minimum of at least a medium depth, semi-aggressive peel (or stronger) is of any true value in getting down to the depths required to sort out the causes of the types of problems that patients usually complain of (eg. pigmentation, sun damage and wrinkles). However, in reality, to achieve best results (and why would anyone want anything less?!), the "control" of this process at this level, must take place within a very narrow margin of error, that is precariously perched in a finely balanced zone between brilliance and disaster. This leads to a bit of a dilemma: too shallow a peel, and there is little or no result; too deep a peel, and there is a rapidly rising risk of complications (pigmentation problems, infection, scarring, prolonged healing times).

At these depths, what makes chemical peeling even more difficult and thus more risky, is that at the time of treatment, the clinical "feedback" (the real time measure of what depth the chemical treatment is going to), is actually a case of what depth the treatment has gone to. In other words, the old saying: "the horse has already bolted", in this situation is more a case of: "the horse has bolted and is already half way down the road and long gone out of sight!", before the endpoint feedback is obtained. Clinically, in chemical peeling situations, this feedback relating to depth of peel is what people refer to as the "skin frosting". But unfortunately, the frosting has a relatively slow onset while the level of cell death that is occurring is significantly quicker (and deeper). This time delay makes precision very, very difficult.

Because of this clinical dilemma, peels are more often than not, done too light and shallow by the less experienced operators, and usually offered and performed as multiple peels over several sessions. This is marketed as being much safer and less downtime post treatment. However, the problem I see with this approach, is that no matter how many times a peel is performed, if it doesn't ever get down to the depths that really matter, then the results are always going to be second rate. Hence I have seen numerous people over the years, that have come to see me having had such peels performed elsewhere, complaining of lack of results despite multiple peels and of course cumulative multiple costs. Beware too, the promises of multiple very light peels (such as glycolic based or variations thereof), often done by beauty therapists or nurses. These usually provide little more than removing the top dead layers of skin and creating a temporary refreshening, something that can be achieved way more simply and cost effectively, with additional long term benefits using appropriate creams (yes they do work; see our active cream products which we have been dispensing now for over 20years).

As mentioned, chemical peeling essentially uses some form of topically (surface) applied chemical that is toxic to skin (and other) cells which results in an injury and cellular death. The destruction of old skin cells and resultant healing involving regeneration and replacement with new skin cells, is little different in theory to the likes of dermabrasion (not to be confused with microdermabrasion which is little more than a very light peel as described above) and laser resurfacing. In this respect, chemical peeling could and should be more correctly called chemical ablation. However this would not sit well with the marketing spin that chemical peels are safe and easy compared to other ablative techniques and technologies. Chemical peels are safe (light peels), but when "peeling" to the depths of other ablative techniques, they quickly become increasingly a problem due to their inherent lack of accuracy and precision.

So what are the alternatives?
In 1998, I trialled a brand new technology called the Erbium YAG laser. Compared to anything else at the time including medium and deep chemical peels, dermabrasion, and the older CO2 laser, the Erbium's precision control for facial ablative resurfacing was, and has remained ever since, second to none. The key to it's success is the fact that it removes perfectly reproducible, small, precise amounts of skin tissue each and every time it strikes, allows for direct visualisation and thus excellent control of depth of lasering, and generates no heat in the lasered tissue. It is the perfect resurfacing ablative device.
 
The down side of all of this: the cost of laser treatment is significantly more than that of chemical peeling, and the down time recovery is approximately 7-9days (however a chemical peel with any worthwhile result, would also have moderate down time of 5-7 days). The bottom line is, there is only one reason why chemical peeling has survived this long: it's cheap!

Still interested in a chemical peel?
If despite all the above, my suggestion would be to ensure you search out a doctor who has a lot (and I mean a lot!) of experience in using chemical peels for specifically treating the problems you have. Ask to see plenty of photos of previous work, ask about complications - how often, and how successful these problems have been managed and resolved. Ask about pre-peel preparation and post-peel management, very important aspects to achieving the best results. Peels can be done. I have done them for over twenty years with relative success. However, in the 2010's, I personally no longer can justify offering them anymore in routine patients in light of the laser results. The only exception I make to this would be certain medical conditions that would preclude the use of the laser and for which careful chemical peeling would be warranted.


For more information on Erbium laser resurfacing, go to webpage: Erbium Laser Resurfacing.