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Chemical peels have been around for decades. The first that I remember, in the early 1970’s, were the “phenol peels” in which I first saw performed by Dr. Thomas Baker from Miami, Florida. These were aggressive, but very effective in tightening faces, dramatically reducing wrinkles and pigmentation spots. The downside was the long recovery and the risk of excessive skin lightening and even occasional scaring. Originally, these “phenol” peels were used by non-medical people who had figured out the formula without the help of scientific experimentation. The local physicians noted the extraordinary results and finally managed to acquire the formula.
My experience and those of others that I knew felt it was too harsh, the recovery time was excessive and rough and the risks were too high, such as too much bleaching of the skin and even occasional scars or a color demarcation between the peeled face and the neck..
Gregarie Hetter, MD then re-examined the “phenol” peel and found that the phenol wasn’t the actual peeling agent at all! It was the Croton oil. Previously to get a reduced peel, doctors would reduce the phenol and this would only increase the Croton oil concentration, which increased the strength of the peel. Thanks to Dr. Hetter, the formula is now weak enough to reach the proper depth of the peel, gradually. Also, one can “tune” the peel depth for the individual patient’s particular problem, age, and goals.
Classification of chemical peels based on strength, effectiveness, and recovery
- Superficial peels: these are the AHA’s (alpha hydrolic acids) – these are the most common peels, most of which are glycolic acids or lactic acids, often called fruit acids. They are performed by aestheticians in doctor’s offices and various spas. They are weak peels and mostly penetrate the superficial epidermis for very superficial, refreshing peels, such as the “lunch-time” peel. There is no down-time, and the results are much like a microdermabrasion, but in my opinion, better.
- Medium peels: these are usually performed with TCA (trichloroacetic acid) and should be performed by your plastic surgeon or a well trained RN or aesthetician with Physician supervision. These peels can be taken quite deep into the dermis, therefore, great care should be used with TCA peels. This is where the talent and experience comes in. The treating person must be able to read the depth of the peel by the frost that occurs during the peel. The “frost” is when the skin turns white, which is the denaturing of the protein in the epidermis and dermis. A white frost with a pink base is fairly superficial, but into the superficial dermis. A white frost when you can see white and no pink in the background is deeper yet and if it turns a yellowish color, you have gone deep enough and maybe too deep. I stay away from the yellow color – too risky. The benefits of a proper depth peel are: improvement in texture, color, reduction in age spots and pigmentation problems, and maybe some subtle tightening of the skin. There are also smaller pores and more clarity of the skin. Some recovery time is necessary with a moderate level TCA peel. For several days there is mild swelling and peeling. The skin will then be pink for a couple of weeks, which can be covered with make-up. I have not been impressed with the improvement in wrinkles with a TCA peel, particularly around the mouth and lower eyelids. For these problems, I use the Croton oil peel, discussed below.
- Deep peels: these are in the domain of the Hetter or Croton oil peels (formerly called Phenol peels). Only experienced and well trained plastic surgeons should perform these peels. It is critical for the surgeon to be able to read the depth of the frost that occurs from the peel during the procedure. The depth is the most important aspect of the Croton oil peel. These peels have more risk because they are deeper, and again, the depth is the issue. The deeper the peel, the longer the recovery, the better the results, but the more the risks. Other than reading the frost to determine the depth, the concentration of the Croton oil in the peel mixture must be altered according to the area being treated. Even at the same depth, the Croton oil peel gives a better result than the TCA peel, in my opinion, and that of other plastic surgeons.