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Chemical Appeal by Elvira Maricic

It's right about this time of year, as summer vacations come to an end and nights begin to get a little cooler, that thousands of people look at the skin beneath their fading tans and scream, "Oh my god, what have I done!"

The last thing on many people's minds as they're soaking up the rays on the beach (or in the tanning booth) is the permanent damage those rays are doing to their skin. Fortunately, with the availability of chemical peels, some damage isn't nearly as permanent as it used to be.

Undoing the Damage

While nothing can take away the risk of skin cancer, other nagging symptoms associated with sun exposure can now be treated. 

Dermatologists have been using chemical peeling agents for the last 100 years. It's only recently, however, that they've gained mass popularity with the public.  Thousands of chemical peel procedures are performed each year, and it's easy to see why. They're relatively fast and painless, and they can reduce and even eliminate wrinkles caused by the sun, heredity, and just plain aging.

"Basically, there are three kinds of peels. We divide them into superficial, medium, and deep depths," explains Julie E. Voss, MD. "There are different acids that will produce different types of peels, and they overlap somewhat. The classic superficial peel is a glycolic acid peel. A salicylic acid peel, which we call a beta peel, will also produce a superficial peel, as will a very light concentration of trichloroacetic acid (TCA)," she says.

"Superficial peels are light peels, and they have very little recovery time. With these, you peel more on a microscopic basis, although some people will peel deeper. This is especially true if they are using a product like Retin-A or Renova at the same time," the Bothell, Washington, dermatologist notes.

However, with a medium-depth peel, which is a much deeper peel, patients may look like they've had something done or like they have a bad sunburn." During the procedure, the physician applies the solution to various areas of the skin. In addition to the face, areas that can be treated include the neck, chest, hands, arms and legs. The chemical applications cause the skin layers to separate and then peel, revealing smoother, less wrinkled, and more evenly colored skin. In most cases, peeling occurs between the second and fifth day following treatment.

A superficial peel is usually not painful, although it can produce a warm-to-hot sensation that lasts several minutes and may be followed by some stinging. A medium-depth or deeper peel, however, may require pain medication during or after the procedure.

How Deep?

Although it may be a little more painful, there are times when a deeper peel is called for. "Sometimes [the physician] knows what the patient needs, but the patient isn't willing to do it," says Dr. Voss. "If you have a lot of very fine wrinkling and a lot of change in pigment, then you really should go for a medium-depth peel. However, if you have acne, mild pigment changes, or very, very mild wrinkles, then you can go for a superficial peel.

Unlike a superficial peel, a deeper peel does not cover up very well. "Patients may need to put on a really thick moisturizer or even petroleum jelly while [the skin is] peeling. The results are good, though," Dr. Voss says. "A superficial peel only absorbs to a certain depth and will go no further; whereas a medium-depth peel goes down a lot further and corrects a lot more skin damage. The deeper you go [with a peel], the more difference you're going to make," she notes.

Sometimes, you need to dig even deeper. "A medium-depth peel will not do as much for the skin as a deep peel will, but it definitely helps with superficial wrinkles (wrinkles that don't go really deep). It can do wonders for mottled pigmentation, really rough-textured, sun-damaged skin, and the beginnings of crow's feet," Dr. Voss says.

After a peel, the skin is never as damaged as it was before and, hopefully, it will remain that way. "We just take [the damage] off," says Dr. Voss. "While people can accumulate additional damage with time, most people who are getting peels are becoming educated about how to take care of their skin so that they won't damage it like they used to."

Not a Miracle Cure

While the procedure can make you look younger, it's not without risk. Even though it's low, there is some risk of scarring.  However, it can usually be treated. Women using birth control pills or who are pregnant and those who have a family history of skin discoloration may develop a temporary or permanent color change in the skin. Also, if you are prone to developing oral herpes, be sure to tell you doctor before the fact. 

"For oral herpes, you need a prophylaxis (an antiviral medication) to prevent an outbreak," says Dr. Voss. "You really are taking off a layer of skin to the depth where it is kind of raw. Whenever you have raw skin exposed, the herpes virus can be reactivated and spread to all the raw skin. As a result, the whole face can become affected."

Another thing to bear in mind is that chemical peels are not face-lifts. They can't remove sagging skin or make you look like you've had a brow lift. They also won't remove deep scars. However, they can remove the added years that the sun and other factors have etched upon your skin.