Answers to Most Common Questions About Chemical Peels:
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What is a Chemical Peel?
A chemical peel is the process of placing a low-strength acid on the skin which results in peeling of the skin over the next several days. A chemical peel can be used to treat sun-related changes of the skin that result in premature aging including fine wrinkles, blemishes, dark spots and pre-cancers. After the peel, the skin in the area treated looks more youthful and “refreshed.”
Will it Hurt?
Most patients report a stinging or burning sensation soon after the chemical is placed on the skin. This is temporary and may last for five to ten minutes. Once the procedure is complete you will be given ice packs to place over the treated area that will quickly decrease the burning. If necessary, it is possible to apply a topical anesthetic to the skin prior to the procedure in order to minimize the discomfort from the stinging sensation. Most patients tolerate the procedure well even without the topical anesthetic.
What are the Risks of a Chemical Peel?
Some patients may get temporary darkening of the skin in the areas treated. This is more common in patients with darker skin tones. This risk is minimized by the use of Retin-A and bleaching cream, after the procedure. If you are someone who gets cold sores or fever blisters, you may be at risk for a viral infection in the area treated with the chemical peel. This risk is minimized with the use of anti-viral medication before and after the chemical peel. It is very important that these medications are used correctly, because if not, a viral infection could result in significant scarring.
What Should I Expect After the Chemical Peel?
When you leave the office after the peel, the area treated will be red with a slight whitish “frost.” You will have a thick layer of ointment covering the area treated as well. Over the next several days your skin will peel, just as if you have experienced a bad sunburn. Once the peeling has stopped the area treated will remain slightly pink for several more weeks. Usually by three weeks after the procedure the skin in the area treated looks normal.
Will I Have to Care for my Skin at Home After the Chemical Peel?
Yes. You will be given wound care instructions that consist of daily cleansing of the area treated with a non-soap based cleanser followed by a layer of Vaseline petroleum jelly. This will be continued until your skin stops peeling.
Is the Treatment Very Expensive and Will My Insurance Pay for the Treatment?
The cost of treatment varies per person, and depends on the area being treated and the concentration of the chemical used. This treatment is considered a cosmetic treatment, and is generally not accepted by insurance companies. Therefore, payment by the patient is expected at the time of service.
Chemical Peel Pre-Op Instructions
The exact chemical and strength used will be determined by Dr. Baucom and Dr. Mina, and will be based on the extent of sun damage present, your skin type, and your goals for the procedure.
Chemical peels are not covered by most medical insurance plans because they are performed for cosmetic reasons. Occasionally, a chemical peel might be considered for coverage by an insurer when the patient has extreme sun damage and many pre-cancers are present.
Before the Peel:
- Sunscreen: plan on using sunscreen daily; there is no point in trying to reverse/reduce sun damage if you are still trying to get tan.
- Antiviral Medication: You will start an antiviral medication the evening prior to the procedure, and continue it for one week.
- Retin-A/Renova: Most patients will benefit from using tretinoin (the active agent in Retin-A and Renova) for a few weeks before the peel, as it will speed up healing. This will be continued after the area has healed to promote more new collagen formation.
- Bleaching Agent: (Lustra or other brand) will be used in some patients to maintain an even skin tone following the peel. Patients who are naturally very fair skinned often will be able to skip this.
What to Expect During the Peel:
- 2 Hours Before the Peel: apply a thin layer of the anesthetic cream, reapply after about an hour. This will reduce the stinging associated with the procedure.
- Before the Procedure: please arrive wearing no makeup or moisturizer, or arrive 10-15 minutes early to thoroughly remove these in the restroom.
- Anxiety: can be reduced with some Valium given before the procedure, but then you will not be allowed to drive yourself home. If you feel that you will be very anxious, please have someone come with you who can drive you home.
- Pain: application of the peeling agent causes a fairly intense stinging, which does not last long. As soon as the treated area “frosts” (it looks like a light pink film over the skin), cold wet compresses are applied to the area and left in place for several minutes. The stinging decreases in intensity; most patients describe it as a sunburn-like sensation. Tylenol or Advil can be taken if necessary.
What Will I Look Like?
At first, the pink frost will fade to a mild to moderate redness very similar to a sunburn. This “sunburn” period will last for about one day, and you are usually reasonably presentable. The next stage is the damaged skin drying and separating – not very pretty. Your skin will take on a brown or bronze look and feel fairly dry and tight. As you peel off the old, sun-damaged skin, the fresh new pink skin will be revealed underneath. This is the period (usually a day or two) when your skin looks really blotchy and uneven. After the main peeling takes place, your skin will be fresh and somewhat pink, and you may resume makeup and cosmetics. Final fading or the pinkness will take a few weeks.
These are extremely important and must be followed religiously!
What to Expect
When you leave the office: you will look like you have a light pink or white “film” or frosting on your skin, and you will have a thin layer of ointment on the treated areas. The light-pink look will fade, leaving a mild redness like a sunburn, typically within an hour or two.
Daily: Keep all treated areas covered with a thin layer of Aquaphor or petroleum ointment (Vaseline). The ointment application will need to be repeated several times a day as necessary to keep the area from feeling dry. Your treatment area must not be allowed to dry out (with hard scabs and crusts); doing so will increase your risk of scarring.
At Night: Apply a thicker coat of ointment prior to going to bed. You may want to place a towel or an old T-shirt over your pillow.
You may decrease the amount and frequency of ointment each day as your skin heals, eventually just spot treating any residual peeling or raw areas. Most patients will actually peel more than once; with subsequent finer peeling over two to three weeks.
Continue the antiviral prescription for its entire course. Call the office immediately if you have signs of infection such as fever, blisters, pustules, or thick yellow or green drainage (not clear yellow – that is normal).
Itching can be treated with dyphenhydramine (Benadryl) every four to six hours as needed. If this is not adequate, call the office.
Acne may flare up the week following resurfacing. Spot application of an over-the-counter benzoyl peroxide product, such as Clearasil for sensitive skin, will typically do the trick.
One to two weeks after the procedure:
- Begin tretinoin (Retin-A or Renova cream) every night or every other night as tolerated.
- Use a bleaching agent (Lustra, Glyquin, Melanex, Alphaquin, Solaquin, etc.) twice daily to minimize the risk of blotchy, dark pigmentation in the treated areas. This is not used on every patient, but if it is part of your treatment, expect to use it for approximately three months.
Note: Patients using Tri-Luma are using a combination cream with tretinoin and a bleaching agent and do not need additional products.
- As soon as the skin has peeled (you no longer have “raw” spots), begin applying sunscreen EVERY DAY. Some people will experience stinging and sensitivity to regular sunscreen lotions for a few weeks following the peel. If this is a problem, use a chemical-free sunscreen or one designed for sensitive skin. Sunscreen will need to be used for at least six months following the procedure. We recommend that you plan to use sunscreen forever!