This Chemical Peel Can Smooth Wrinkles—But It's So Intense You'll Have To Be Sedated For It
When it comes to not just preventing but actually reversing visible signs of aging, there are several different courses of actions you can take: invasive procedures like facelifts, injectables like Botox and filler, lasers, and last but not least, glycolic acid peels and other chemical peels.
Which brings us to what is widely considered the most aggressive type of peel out there—the phenol peel. It's so intense that many dermatologists choose not to offer this treatment due to the potential risks. But along with those risks come some seriously dramatic results. So how does it all work? We spoke with three board-certified dermatologists for the full breakdown.
Meet the experts: Patricia Oyetakin, MD, a board-certified dermatologist based in Atlanta, GA, Joshua Zeichner, MD, a Women's Health advisory board member and board-certified dermatologist based in New York City, Marisa Garshick, MD is a board-certified dermatologist and clinical assistant professor at Cornell-New York Presbyterian Medical Center in New York City.
What is a phenol peel?
Unlike more common chemical peels—like alpha hydroxy acid (AHA) ones, which typically include glycolic acid—phenol peels penetrate much deeper into the skin and should never be done at home, but instead by a board-certified dermatologist or plastic surgeon. “A phenol peel is a deep chemical peel that acts on skin's outer epidermis and the superficial part of the dermis,” explains Patricia Oyetakin, MD, a board-certified dermatologist based in Atlanta, GA. “When the term ‘phenol peel’ is used, one should assume that the solution is a combination of liquid phenol, croton oil, and soaps to help all of these ingredients dissolve properly.”
So what is phenol? It's an organic compound that has antimicrobial properties, says Joshua Zeichner MD, a board-certified dermatologist based in New York City. “In its pure form, it can be quite irritating so it's not used in commercial products, except when it is applied to the skin as a chemical peel,” he says. “Phenol peels are considered a very aggressive treatment, and they can provide significant improvements to the skin because of how deeply the solution penetrates—but that’s also what makes the treatment risky.”
Phenol peels are so strong that sometime IV sedation is performed, adds board-certified dermatologist Marisa Garshick, MD. That should give you a clear picture of the kind of intensity we're talking about.
What are the benefits of phenol peels?
As the saying goes, with great risk comes great reward—and phenol peels are no exception. “The before and after photos of phenol peels are very impressive as we can really achieve surgical-quality results with this office-based treatment,” says Dr. Oyetakin. “Dramatic improvement of deep wrinkles as well as collagen and elastin remodeling in the dermis of the skin can be seen.” Some studies have shown that phenol peel results can be maintained even decades later.
Dr. Garshick adds that phenol peels can help improve the appearance of dark spots and hyperpigmentation as well as uneven texture—including acne scarring, fine lines, and wrinkles. The best part? “Results are permanent as it helps to undo previous skin damage,” says Dr. Zeichner. “However, the skin will continue to chronologically age as time goes on.”
What are the side effects of phenol peels?
“While we know the end result of a safe phenol peel procedure will have excellent results, the potential risks and complications have to be carefully discussed with patients,” says Dr. Oyetakin. “In general all chemical peels have a potential risk of pigmentary changes, infections, milia, acne eruptions and scarring, however, phenol peels also have a risk of cardiac effects as the molecule is toxic to the heart muscle if it is absorbed into the bloodstream.”
Dr. Garshick notes that phenol peels require close monitoring of vital signs because of the potential adverse effects they can have on organs like the heart, kidney, and liver. Additionally, the procedure can be quite painful—so much so that IV sedation is often suggested, if not required.
Reasons to get a phenol peel
Given their intensity level and long-term downtime, phenol peels are definitely not for everyone. Only the “brave” and “diligent” should proceed, according to Dr. Oyetakin. “I don't say this to be facetious, but it's one of the strongest and deepest peels available,” she says. The two main reasons why someone might want to get this treatment are:
Scarring and wrinkles: “[The peel] is mostly used for deeper static wrinkles etched in lines and photodamage but can also be used to treat other conditions such as actinic keratosis, facial scars, and Bowen's disease,” says Dr. Oyetakin.
Severe acne: “Those who should consider a phenol peel include those with deep lines and wrinkles, moderate to severe acne scarring, or photo damage,” says Dr. Garshick. In fact, those with post-acne atrophic scars who did phenol peels saw improved scar severity by 75 percent, according to a study in the Journal of Dermatological Treatment.
Phenol peels are not recommended for those with deep skin tones due to their significant skin-lightening effects. Only those who fall under I-III on the Fitzpatrick scale of skin types who have moderate to severe skin damage should consider undergoing this procedure. Additionally, anyone who has melasma or rosacea should proceed with caution when it comes to phenol peels, as in some cases, they can exacerbate symptoms.
TL;DR: Book a consultation with a board-certified dermatologist and/or plastic surgeon to discuss in-depth if a phenol peel could be right for you. Never just wing it or go to someone without ample experience doing phenol peels.
How much does a phenol peel cost?
Due to their aggressive nature and significant, long-lasting results, phenol peels can cost you a pretty penny. “Phenol peels can range in cost from $1,000 to $6,000,” says Dr. Garshick. This, of course, will depend on a variety of factors like where you go, if sedation is required, and how much surface area is included.
How long does a phenol peel take to heal?
While many mild chemical peels can be done safely at home with little to no downtime, phenol peels don't qualify. “This type of peel creates wound injury to the full epidermis and part of the dermis so these areas will need a minimum of two to three weeks if not longer to recover,” says Dr. Oyetakin. “Post-procedure care is very important in minimizing complications and optimizing results.”
While post-procedure care can vary among doctors, Dr. Oyetakin says some of the common steps include:
Covering the face with zinc oxide tape and stabilizing it with a mesh dressing
Removing the zinc oxide tape/mask the following day and washing the skin with saline
Gently removing any loose skin or debris
Applying bismuth subgallate powder to all peeled areas, allowing them to dry to a solid crust
Leaving the mask on and untouched for seven to 12 days
Applying petroleum ointment to any crusted areas continuously until all of the areas are healed
The verdict?
Experts agree that phenol peels deliver some seriously impressive results that can last for decades—however, the procedure doesn’t come without major downtime and several serious risks, including potential organ damage. For this reason, you should always see a board-certified dermatologist or plastic surgeon who’s well-trained in phenol peels to determine if it’s the right fit for you. Talk to them about your skin type, skin history, what your skin goals are, and if you have any reservations. And remember: a second opinion never hurts.
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