#SkinSchool: Everything you should know about chemical peels
It doesn’t feel so long ago that the words ‘chemical peel’ would conjure up images of Sex and the City's Samantha Jones, red-raw after a treatment gone awry. But skin peels have come a long way since the reductive methods of decades past, and are now a much-utilised treatment for a variety of skin concerns, from wrinkles to pigmentation (and much more in-between).
So common – and controlled – are today’s skin peels, that some can be performed with zero downtime, while others require a little more commitment, yet deliver remarkable results. Others can be done at home to maintain results. Here, dermatologist and director of Eudelo clinic Dr. Stefanie Williams, and dermatologist and co-founder of Kivu Skincare, Dr Benedetta Brazzini, break down everything you should know about chemical face peels, from the different types to the benefits they can deliver, and that all-important aftercare.
What exactly is a chemical peel?
According to Dr Williams, chemical peels work by removing certain layers of the skin, and the layers they reach depends on their depth. “Peels exfoliate the skin, improving cell turnover and skin renewal, but they also indirectly encourage collagen and elastin formation,” she explains. “Chemical peels, despite being very low-tech, can be highly effective on a clinical and cellular level, and are in my opinion greatly undervalued.”
Peels can be performed using a variety of ingredients. Glycolic acid, salicylic acid and other exfoliating acids are often used, and your practitioner will tailor your active ingredients to suit your skin type and the desired outcome.
What are the benefits of a chemical peel?
“A peel can be a very effective way of softening fine lines and wrinkles, improving skin texture, minimising pigmentation and even reducing blackheads and whiteheads,” says Dr Williams.
Which depth is best?
There are four main strengths and depths of chemical peel. Very superficial peels work on the dead surface cells only, and can be performed in-clinic or at home with over-the-counter products (more on that below). In the clinic, superficial peels work on the epidermis, while medium-depth peels target both the epidermis and the upper dermis. Deep peels travel down to the lower layers of the dermis. “The exact strength of the peel should always be tailored to the patient’s individual skin and needs,” says Dr Williams.
Most superficial peels don’t involve much downtime. “Hydroxy-acid peels are great starter peels and also well suited to younger patients or those who prefer their skin not to be visibly flaking after treatment,” says Dr Williams. “Superficial peels are mild and the most commonly used type for improving skin texture and overall complexion. They work by removing part of the stratum corneum and sometimes the upper epidermis. They can improve discolouration, surface roughness and texture, but also stimulate collagen production via communication between epidermal and dermal cells. With a superficial peel, you’ll achieve a more refined skin surface with a fresher, more vibrant skin tone and improved skin texture,” she says.
“Medium-depth peels work particularly well for more mature skin with visible sun damage. They have more pronounced effects, but come with some downtime,” says Dr Williams, who adds that you can expect to experience flaking, tightness, and redness in the days that follow.
“(True) deep peels are mainly used to improve more severe skin conditions. They are often done in full anaesthesia, for example as part of a surgical face lift. An example of a deep peel agent is Phenol. I don’t endorse such peels, as they come with a much higher risk of complications. However, please note that often in layman’s language, medium-depth peels are referred to as 'deep', although strictly speaking they are not deep as per the traditional definition.”
Which skin types can benefit from a chemical peel?
Many skin types can benefit from a chemical face peel – the trick is all in the depth chosen and the active ingredients used.
“Superficial hydroxy-acid peels improve overall skin quality and texture, so are great for ageing skin and sun damage, but also for patients with comedones (blackheads and whiteheads) and a tendency for breakouts. This is because every single acne spot starts with a comedone (sometimes invisible to the naked eye, called micro-comedones), and clearing comedones with a chemical peel can help ‘starve’ the acne of its fuel. Salicylic acid peels can also be a useful acne-management adjunct, as they clear pores at an even deeper level.”
Unlike acne types, people with rosacea need to approach chemical peels with more caution.
“Rosacea skin generally tends to be more sensitive and less oily compared to acne-prone skin, so we have to be a little more careful with peels in rosacea patients. They’re not generally contraindicated in rosacea skin, however we may choose a gentler version depending on the individual skin type and condition to avoid issues”
How often should you have a chemical peel?
According to Dr Williams, the answer to this depends largely on the depth of your peel. “While medium and deep peels are often a one-off session, superficial peels generally come as a course. To achieve the best results, a course of treatments (for example, four-to-six sessions at one-to-four week intervals, depending on the exact peel type and skin type) is often recommended for superficial peels.”
What is the downtime to expect after an in-clinic peel?
Again, your downtime will be determined by the depth and type of peel used. “With superficial peels, the treatment is quick and generally isn’t painful, although you might feel tingling or slight stinging with AHA peels; with retinol-based peels you often don’t feel anything. You may be a little pink afterwards and in some cases experience mild flaking a couple of days later. But generally, there’s no significant downtime,” says Dr Williams.
“Medium-depth peels involve more downtime than superficial peels. Redness, swelling, flaking and potentially some minor crusting may occur. The flaking often arrives with a delay of two-to-three days after treatment and is more pronounced compared to superficial peels,” she says.
And finally, true deep peels are not for the faint-hearted. “Downtime is significant, with oozing and crusting, and risks are much higher than for all other types of peels, so I don’t routinely recommend these,” Dr Williams adds.
What is the best chemical peel aftercare?
It goes without saying that skin requires gentle treatment following any kind of peel, so strip your skincare routine back and place any retinols, scrubs and exfoliating acids on hold. It’s also beneficial to avoid applying make-up the following day.
“After any peel, it’s essential to wear daily broad-spectrum sun protection with SPF30 to 50 for around four months – if you don’t already do this as a matter of routine!” adds Dr Williams.
How different are at-home chemical peels?
As we become more collectively confident in using chemical exfoliators, the industry has responded with plenty of at-home products using acids to mimic the effects of a traditional in-clinic peel – but can they really live up to their promises?
"At-home peels are very light chemical peels that are intended to be used safely at home, without the direction of a professional," explains Dr Brazzini.
"The depth of the peels depends on the substances in the formula, the concentrations and the PH," she explains – though all at-home peels will only work superficially. "Results are not even comparable to medical chemical peels, but they're a good maintenance solution if you can't get to a clinic," she adds. "Their main function is to deliver a nice glow and improve the skin texture." Think of them as an exfoliation treatment to remove dead cells from the skin surface.
That's not to say that they shouldn't be taken very seriously. "I see a lot of patients who buy peels online and have nasty side effects, like minor burns," Dr Brazzini reveals. "Users must be very careful when buying at-home kits. I strongly recommend following a specialist's advise to avoid damaging your skin, and always read the instructions on any packaging thoroughly to prevent any easy mistakes."
If you want to try a home peel for exfoliation, pore-clearing or to reduce oiliness, Dr Williams endorses the brand NeoStrata. "For patients looking for a gentle home peel, I often recommend NeoStrata’s Resurface Daily Smooth Surface Peel, which is a glycolic home peel product.”
Meanwhile, Dr Brazzini says to look out for mandelic acid in a home peel. "It is anti-inflammatory, great for rosacea-prone skin, gives an all-over exfoliation, and is suitable for darker skin types," she says, recommending Peel2Glow.
And note: "If you're going to do at-home peels, I'd recommend avoiding other exfoliating acids and retinoids on the same day. It's also important to wear SPF and to not expose your skin to the sun afterwards."
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