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Layers of cells make up your skin. These layers are stacked on top of one another, sort of like the layers of an onion.
Chemical peels remove one or more of the outermost layers of these skin cells (depending on the type of chemical peel you get). This causes new skin cells to regrow, which can improve the appearance or texture of your skin.
Dermatologists (medical professionals who specialize in skin conditions) often use chemical peels to treat skin damage brought on by acne, sun exposure, aging, or other skin-related issues (O’Connor, 2018).
If you’re curious about chemical peels and are considering getting one, read on to learn more about the different types of chemical peels, how healthcare providers perform chemical peels, and how much you may have to pay for this popular skin treatment.
What is a chemical peel?
A chemical peel is a skin treatment that uses a chemical substance—usually an acid—to break down and remove the outer layers of skin cells. Chemical peels also go by the names chemexfoliation, chemical exfoliation, or skin resurfacing (Samargandy, 2021).
There are different types of chemical peels. Some penetrate the skin more deeply than others.
You can perform some mild, superficial chemical peels at home with store-bought creams or treatments. These products tend to include very low concentrations of chemicals. You often have to apply them daily for a week or two, and they tend to work very gradually—breaking down cells over a period of weeks (Soleymani, 2018).
Meanwhile, clinician-administered chemical peels penetrate deeper into your skin. These can create skin peeling or inflammation that lasts anywhere from a few hours to several weeks. In some cases, full recovery may take six months or longer (Soleymani, 2018).
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How does a chemical peel work?
A chemical peel is a kind of “controlled destruction” or intentional wounding of your skin. This wounding destroys cells and causes them to fall away from your skin, resulting in regeneration and remodeling of the lost skin layers, which can improve the appearance and health of your skin (O’Connor, 2018).
Types of chemical peels
There are many different chemicals that, alone or in combination, may be used during a chemical peel procedure. Based on how deeply they penetrate your skin, these procedures typically fall into one of three groups: superficial chemical peels, medium-depth peels, or deep peels (O’Connor, 2018).
Superficial chemical peels
These peels only penetrate the outermost layer or layers of your skin, which is called the epidermis. The types of chemicals used include alpha-hydroxy acids, beta-hydroxy acids, and pyruvic acid (O’Connor, 2018).
Some of these chemicals, such as glycolic acid, are sold in OTC, do-it-yourself peels. Medical providers also perform these peels using stronger concentrations of these same chemicals. These clinician-applied peels tend to cause cell fall-off for several days, and recovery is usually complete within 5-10 days (Soleymani, 2018).
People use superficial peels to treat signs of skin aging, such as fine lines or sunspots, acne and acne scarring, and some pigment disorders (O’Connor, 2018).
These peels penetrate more deeply than superficial peels—usually beyond the epidermis and into the dermis. People use medium-depth peels to treat more pronounced signs of aging or sun damage, as well as acne, scarring, or pigment disorders (Soleymani, 2018).
The chemicals used are mostly the same. But their concentrations may be higher, or they may be left on your skin longer. You may require some kind of pre-application drug or anesthetic to control pain and inflammation.
Your skin may continue to peel for several days, and redness or pain following the treatment can last for weeks (Soleymani, 2018).
These chemical peels penetrate even deeper into your skin. They’re sometimes used to treat very pronounced age- or sun-related damage, such as blotchy patches of darkened skin or major wrinkles. But they can cause scarring and other complications (more on those below).
These days, laser treatments are often used in place of deep peels because they’re safer and more precise (Soleymani, 2018).
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What is the chemical peel procedure?
When it comes to chemical peels you get from a dermatologist or other healthcare provider, there are three basic stages. These are the pretreatment stage before the peel, the treatment procedure itself, and the recovery period (O’Connor, 2018).
This often begins 2-4 weeks before the procedure. Your healthcare provider will probably ask you to avoid sun exposure and wear a high (50+) SPF sunscreen during the day. This reduces sun-related damage and limits the activity of cells in the skin that produce pigment (O’Connor, 2018).
Your healthcare provider may also tell you to use an over-the-counter (OTC) tretinoin cream for several weeks before the peel. This thins the outer layer of your skin and can enhance the peel’s effects during your procedure.
Sometimes, you may have to use other creams or topical agents to help prepare your skin for the peel. You may have to avoid wearing any makeup or moisturizers beginning the day before the peel (O’Connor, 2018).
Treatment with a chemical peel
Typically, you’ll lie flat on your back with your head slightly elevated. You’ll probably wear some kind of cap to protect your hair and eye coverings to protect your eyes (O’Connor, 2018).
During a chemical peel, a dermatologist or some other qualified professional will carefully spread the chemical solution onto your skin using a brush, cotton swab, or some other type of applicator. The application usually begins on thicker areas of your skin, such as your forehead. It usually ends on more delicate areas, such as the skin around your eyes (O’Connor, 2018).
The person performing your peel may put petroleum jelly or some other substance on certain parts of your face—for example, in the ridges along the sides of your nostrils—to prevent the chemical agent from collecting or pooling.
Depending on the depth of the peel, the person performing your procedure may use cool compresses, oral drugs, or local anesthesia to keep your pain to a minimum. For very deep peels, you may need to undergo general anesthesia—meaning you’re unconscious during the procedure (O’Connor, 2018).
Once the chemical has done its work, your clinician will apply some kind of “neutralizing agent.” This stops the chemical from destroying more of your skin cells (Soleymani, 2018).
The destroyed skin cells will gradually fall off, sometimes in the form of scales or flakes. This flaking or scaling can last anywhere from a few hours to a week or longer, depending on how deeply the chemical solution penetrates the skin (O’Connor, 2018). During this stage of the peel, your skin may also develop a white frosting-like coat of dead cells (Samargandy, 2021).
Your healthcare provider may give or prescribe to you some kind of cream or emollient to soothe your skin. In some cases, your provider may also suggest saline compresses or other means to keep you comfortable and to help your skin heal (O’Connor, 2018).
Once the chemically destroyed cells fall off, your skin next undergoes a period of healing. During this healing, your skin may look red and inflamed (Samargandy, 2021). Depending on the depth of the peel, your skin may take a month or more to heal fully (Lee, 2019).
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Common uses and benefits of chemical peels
Healthcare providers use chemical peels to treat a variety of skin-related conditions. They can improve or lighten the appearance of skin blemishes such as wrinkles or “sunspots.” They can also treat pigment-related disorders (Soleymani, 2018).
Some of the uses for chemical peels include (Soleymani, 2018):
- Pigment disorders like lentigines (sometimes called sunspots, age spots, or liver spots), ephelides (freckles), and melasma (a hyperpigmentation that presents as gray-brown patches, usually on the face)
- Inflammatory skin conditions like acne and rosacea (red or flushed skin caused by enlarged blood vessels)
- Scarring caused by acne, past injuries, or surgical procedures
- Aging or sun-related imperfections like fine lines, deep or fine wrinkles, hard or rough patches of skin, or enlarged pores (Samargandy, 2021)
To sum up, healthcare providers use chemical peels to treat anything that causes cosmetic (appearance) related skin issues (Soleymani, 2018).
Complications and risks of chemical peels
There are several risks and complications that may occur following a chemical peel. These issues tend to be more common with medium-depth and, especially, deep chemical peels (Samargandy, 2021).
Short-term risks and complications include (Samargandy, 2021):
- Skin burning, itching, or blisters
- Allergic reactions, including anaphylaxis (breathing problems)
Long-term or longer-lasting risks and side-effects include (Soleymani, 2018; Samargandy, 2021):
- Skin discolorations, such as patches, lines, or uneven skin tone
- Permanent scarring
- Bacterial, viral, or fungal infections
- Prolonged acne or skin reddening
- Development of milia (bumps) caused by blocked glands
People with darker skin types may be at greater risk for permanent skin discolorations and other complications (Samargandy, 2021).
How much does a chemical peel cost?
According to the American Society of Plastic Surgeons, the average price for a chemical peel is $519 (ASPS, 2020.). But the price of these procedures can vary widely and could be as high as a few thousand dollars. Insurance may cover part or all of the cost. But that’s not always the case.
When a knowledgeable healthcare provider performs the procedure, chemical peels can effectively treat various skin conditions or cosmetic imperfections. They’re one of the most common cosmetic procedures—medical professionals perform more than a million of them each year (Soleymani, 2018). If you’re concerned about your skin’s health or appearance, chemical peels may be worth checking out.
- American Society of Plastic Surgeons (ASPS). (n.d.). How much does a chemical peel cost? Retrieved on October 1, 2021 from https://www.plasticsurgery.org/cosmetic-procedures/chemical-peel/cost
- Lee, K. C., Wambier, C. G., Soon, S. L., Sterling, J. B., Landau, M., Rullan, P., et al (2019). Basic chemical peeling: Superficial and medium-depth peels. Journal of the American Academy of Dermatology, 81(2), 313–324. doi: 10.1016/j.jaad.2018.10.079. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30550830/
- O’Connor, A. A., Lowe, P. M., Shumack, S., Lim, A. C. (2018). Chemical peels: A review of current practice. Australian Journal of Dermatology, 59(3), 171-181. doi: 10.1111/ajd.12715. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29064096/
- Samargandy, S., & Raggio, B. S. (2021). Skin Resurfacing Chemical Peels. [Updated Jul 25, 2021]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK547752/
- Soleymani, T., Lanoue, J., Rahman, Z. (2018). A Practical Approach to Chemical Peels: A Review of Fundamentals and Step-by-step Algorithmic Protocol for Treatment. Journal of Clinical and Aesthetic Dermatology, 11(8), 21-28. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6122508/
Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.