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Chemical peels are designed to clear up the skin's imperfections -- such as sun damage, uneven pigmentation, fine wrinkles, lesions, and growths -- by peeling away the top layers of skin. Doctors performed over 1.1 million chemical peels in 2004, an increase of 54 percent from 2003, according to the American Society for Aesthetic Plastic Surgery.
Two weeks before the procedure, you will need to cleanse your skin and apply special moisturizers and sunscreen. This skincare regimen will help with healing. Before the peel, the doctor will clean the skin. Some people receive a sedative or pain reliever, depending on the peel. Using a sponge, cotton, or a brush, doctors apply a chemical solution to the face. The solution varies by ingredients and strength depending on the desired effect. Depth of peeling action may also depend on the amount of time the solution remains on the skin, how many coats are used, and whether it is lightly or more vigorously applied. The surgeon will select the most appropriate chemical solution for each patient's needs. There are three basic types of chemical peels:
Superficial peels: Used to improve pigment changes, acne scars, and mild sun damage, superficial peels are the mildest peels and can be performed on all skin types. The solution contains a dilute acid, usually alphahydroxy acids (AHAs). Dry ice is sometimes used. The solution remains on the skin two to seven minutes. Water is applied to neutralize the acid and the chemical is wiped off.
Medium peels: These peels penetrate the skin more deeply. The chemical solution penetrates the skin to a depth that removes skin cells and can cause a sun-burned, raw appearance at first. They are used to treat mild to moderate wrinkles, long-term sun damage, pigment changes, and precancerous lesions. Trichloroacetic acid (TCA) is the main peeling agent. The procedure takes about 20 minutes.
Deep peels: This kind of peel -- used to treat severe wrinkles, long-term sun damage, more pronounced pigment changes, and lesions and growths on the skin -- is not very common. It uses trichloroacetic acid or retinoids to penetrate several layers of skin. Like medium peels, it will leave the skin with a sun-burned, raw appearance. In some cases, the patient may be put on a heart monitor and receive intravenous fluids during the procedure because phenol is toxic when absorbed by the body in large doses. After one area of the face is treated, there may be a 15-minute break to avoid absorption of too much phenol. The entire procedure may take up to 1 1/2 hours. In most cases, a deep peel can be done only once. It results in a more dramatic effect, but also has higher risks, increased pain, and a longer healing time.
Pain Level/Recovery Time: Right after the procedure, a handheld fan and cool compresses are often used to ease pain and discomfort. Recovery time depends on the type of peel. Following the procedure, the skin will peel for one to 14 days, depending on how deeply the chemical solution penetrated the skin. Proper skincare after the procedure is essential for healing and better, longer-lasting results. Your doctor will provide you with a skincare kit and instructions.
After a superficial peel, you can return to normal activities immediately. The skin may turn pink and peeling is minimal.
For medium peels, you may need a few days to recover. In five to seven days, you should be able to wear makeup to hide the redness. You may experience little or no pain, but some swelling may occur, especially around the eyes. The skin will turn reddish brown in two to three days, and then will become crusty and flake off over the next few days.
For deep peels, skin will be coated with petroleum jelly or a mask of adhesive tape for one to two days. Skin begins to grow back within 10 to 14 days. The skin will remain very red and tender up to three weeks. Some severe swelling may occur, so the head should be elevated. Antibiotics and pain relievers may be prescribed. Some people return to work and normal activities in two to three weeks. Complete healing may take several months. The effects are often dramatic and may last up to 20 years following the procedure.
$781 (national average for surgeon's fees)** Average surgeon's fee for chemical peel may vary by region:
For New England (CT, ME, MA, NH, RI, VT) and Middle Atlantic (NJ, NY, PA): $859 For East North Central (IL, IN, MI, OH, WI) and West North Central (IA, KS, MN, MO, NE, ND, SD): $718 For South Atlantic (DE, DC, FL, GA, MD, NC, SC, VA, WV): $741 For East South Central (AL, KY, MS, TN) and West South Central: (AR, LA, OK, TX): $749 For Mountain (AZ, CO, ID, MT, NV, NM, UT, WY) and Pacific (AK, CA, HI, OR, WA): $827
** Note: These averages for surgeon's fees are provided by the American Association for Aesthetic Plastic Surgery, Inc. These figures do not include fees for the surgical facility, anesthesia, medical tests, prescriptions, or other miscellaneous costs related to the procedure. In addition, most insurance companies do not cover the cost of chemical peel for cosmetic purposes. Check with your insurance company.
Superficial and medium peels require repeated treatments -- as often as every six weeks (for light peels) and two to three months (for medium peels). A deep peel may only be performed once. Deep peels may not be used on darker skin types because they tend to bleach the skin, though light-skinned people may also experience the same effect.
Chemical peels are considered safe and effective in the hands of a skilled practitioner. In some states, no medical degree is required to perform a chemical peel. Be sure to find a practitioner with adequate training and experience in skin resurfacing. Because of its seriousness, the American Society for Aesthetic Plastic Surgery recommends that deep peels be performed under the direction of a qualified physician. It is also important to note that all chemical peels carry some uncertainty and risks. These include (but are not limited to): redness lasting several weeks to months; color changes in the skin; crusting and scaling; swelling; scarring; and allergic reaction to the chemical. Though rare, deep peels using phenol may result in severe complications during the procedure, including heart, liver, or kidney failure. Discuss these and other health issues with your doctor.
Karen, 43, Miami, Florida
"My face is splotchy from pregnancy and sun damage," says Karen, a stay-at-home mother of three who lives in Florida. "I had brown spots and redness. My skin tone was uneven."
Now she regularly visits her dermatologist for a superficial chemical peel. "It burns and stings. You have to put a fan on your face while you're doing it," Karen says. "But I'm a tough patient. I have a high threshold for pain and I don't take pain killers."
Results? "You walk out looking a little jaundiced, like your face has mustard on it," she describes. "Then a few hours later, it goes away and by the time you wash your face at night it's gone. The next day your skin looks tight and fabulous. But that doesn't last. Your skin starts to peel -- for about 10 days. My skin starts to peel on the fourth or fifth day. I peel for five days.
"It's like flaking. You don't touch it. They give you a gentle cleanser and moisturizer. That burns a lot. After about 10 days, you have even toned skin."
The downside is that the red pigmentation and brown spots return. Every six to eight weeks Karen heads back to the dermatologist for "maintenance." For each visit, she pays $175.
To Learn More: Visit the Public Site section of the American Society for Aesthetic Plastic Surgery's Web site. Or call their toll-free referral line at 1-888-ASAPS-11.
Check out the Learn section of BeautySurg.com, the "cosmetic surgery supersite."
For physician referrals, call the American Society of Plastic Surgeons referral service at 1-888-4PLASTIC or visit them online. Click on "Learn About Procedures" to find out more.