A chemical skin peel is an impressive rejuvenating procedure. Skin improvement gives a youthful dimension never obtainable by surgery alone. The skin looks younger because in essence younger skin is being created. It takes time and commitment but in the end your skin will be just beautiful. Patients must be motivated and have a longterm perspective. The reward is an impressive and longterm improvement in skin texture, which we believe is not obtainable by any other modality. A chemical skin peel can be performedd during the same operation as your facial feminization surgery.
What is a chemical peel?
A chemical peel is a skin-resurfacing procedure in which a chemical solution is applied to skin to peel away the top layers. The skin that grows back after a chemical peel is smoother and younger.
Chemical peels can be done at different depths — light, medium or deep — depending on the depth of the skin damage. Deeper chemical peels produce more-dramatic results, but also involve longer recovery times.
Look at the diagram below to see where the different layers are and where different types of peels act on the skin.
A peel can be done on the entire face for an overall skin rejuvenation, or only in localized areas such as under the eyes for “crepey” lower lids or around the mouth to remove the vertical smoker’s lines.
The full face procedure is performed under general anesthesia and takes about 1 hour, including preparation and recovery from anesthesia. The peel requires 5-12 days of recovery depending on the depth of the peel.
Localized peels are possible but not on every skin type. In brown skin types they carry the risk that there will be a mismatch in coloration, therefore good judgment must be exercised. The localised peeling can be to a medium depth at most. The color takes 8 to 10 weeks to blend adequately. An excellent location for segmental peeling is the eyelids and the area around the mouth.
A peel can produce dramatic improvement in skin texture, tone, skin tightness, scars and wrinkles. Skin treatment is the only to truly address the textural changes of the severely damaged skin caused by sun damage, smoking and aging. When the skin re-grows, it will not “remember” the blemishes that were there before. As the new skin develops, a new band of collagen in the dermis will grow along with a thicker epidermis. The skin is really put back 10 years in time (not only in appearance but in real fact). By improving the deep structure of the skin, a deep chemical peel results in dramatic and permanent change of sun damaged and wrinkled skin. The end result is healthier skin that is radiant, smoother and thicker.
We also use this peel as an adjunct to facelift, during the same procedure. It enables the treatment of the vertical lines around the lips and mouth that are not affected by facelift. It is also very effective in the treatment of crepey eyelid skin that is not redundant enough for excision.
- Tighter skin—Following a medium or deep peel, patients also will show between 15 – 30% facial skin tightening.
- Less age spots and pigmentation problems
- Less wrinkles around the mouth, crow’s feet, forehead furrows and cheeks.
The medium and deep peels are impressive for peri-oral wrinkles (those around the mouth) and of the lower eyelids. These areas can be done isolated with much less recovery time.
Peeling requires preparation and recovery time (downtime).
The medium and deep peels are reserved for patients who are seeking significant, long-lasting effects and who are willing and able to take the time to carefully follow pre- and post-procedure care instructions.
Skins needs to be prepared with ointments for 6 weeks.
Full peel preparation instructions
- Superficial peel—4 days recovery + 2 weeks redness
- Medium peel—7 days recovery + 1-2 months redness
- Deep peel—12 days recovery + 2-3 months redness
Recovery and aftercare
Indications: Are you a good candidate for a chemical peel?
There are many things to consider prior to having a medium or deep chemical peel.
- Health—You must be healthy and not have medical conditions that would impair healing.
- Of work—You must be able to commit about 10-14 days to be off of work. Patients should expect to spend 10-14 days off work, have crusting, swelling and peeling for 1 week. After that makeup can be applied and patients are able to return to work. You should plan on your recovery week to be calm and quiet.
- Protocol—You must follow a prescribed skin care protocol before and after your peel.
- Sun exposure—You should limit sun exposure for several weeks before and after your peel and use sunscreen
- General anesthesia—The procedure is performed in general anesthesia with continuous heart monitoring (as phenol has the potential to cause irregular heartbeats in some patients)
- Skin cleaning—The skin is thoroughly cleansed before the croton oil is applied to ensure an even take up.
- Chemical application—The peeling solution is applied to the area to be treated whereupon the skin immediately turns white or “frosted” in appearance.
- Antibiotic and anesthetic cream—An antibiotic and anesthetic cream is applied over all the peeled areas.The remainder of the tube is placed in a container and given to the patient after the operation. The purpose is to moisturize the peeled skin to prevent crusting, to provide analgesia and to prevent infection.
Transient complications during recovery phase:
- Milia or acne— Milia (small raised cysts or white spots on the face) can occur during the first 6 – 8 weeks after peeling, and may last from a few days to many weeks. Acne can also develop as treated skin heals due to previous acne or the use of oily creams on newly formed skin.
- Dark spots—These spots are signs of hyperpigmentation. This is a transient (so temporary) complication of chemical peelings. Best is to continue the daily application of tretinoïn- and hydroquinone-ointment that you have received before the peeling, starting 6 weeks after the peeling. Also it is very important avoid long sun exposures and use a sunblocker every morning the first 6 months after the peeling.
- Changes in skin color—A chemical peel can cause treated skin to become darker than normal (hyperpigmentation) or lighter than normal (hypopigmentation). Hyperpigmentation is more common after superficial peels, while hypopigmentation is more common after a deep peel. Changes in skin color are more common in people who have darker skin and can be permanent.Hyperpigmentation may be seen during the recovery period. It is transient and responds well to tretinoin and hydroquinone 4%. Sun protection is important in preventing hyperpigmentation, and permanent problems have not been seen when adequate sun protection is used.
- Scarring—Rarely, a chemical peel has been reported to cause scarring.
FAQ Before operation
The skin needs to be completely healed and I would wait a minimum of 8 weeks. By the way, a croton oil peel may be as curative and protective as Efudex.
We offer a complete chemical peeling in local anesthesia with deep sedation. The anesthesiologist is present, the patient is asleep but breathes spontaneously.
A peeling just around the eyes or just around the mouth can be done without any anesthesia. There will be an absolutely bearable burning sensation that lasts for about 10 seconds. After that the treatment is completely painless.
One week before the peel avoid waxing, electrolysis, deploritory creams, and laser hair removal. In general you should avoid anything that can irritate the skin, including the medical preparation ointments we prescribed to you (stopping 5 days before is enough).
You can have a laser hair removal session until one week before the peeling. One week is enough time for the skin to recover from this irritation.
An excellent location for segmental peeling is the eyelids. Lower eyelid skin in particular responds very well to a croton oil peeling. When peeled appropriately, the thin eyelid skin contained within the borders of the orbital rim is very forgiving, and healing is well tolerated and easily camouflaged with makeup or glasses. Another advantage of the lower eyelid peel is that it can easily be done with the patient under local anesthesia and in a gradual fashion. If a patient requests a quicker recovery, a lighter peel can be done and repeated in the future with additive effect. The lower eyelid can ultimately be peeled to the patient’s satisfaction.
This is one of the best applications of the croton oil peel and is a good starting point for those who are reluctant to begin with a full face peel.
FAQ After operation
These darks spots are signs of postinflammatory hyperpigmentation (PIH). This This is a frequent and transient (so temporary) complication of croton oil peeling. Permanent problems have not been seen. Best is to continue the daily application of tretinoïn- and hydroquinone-ointment that you have received from us before the peeling for 3 to 6 weeks. It will help to remove the hyperpigmentation. Also it is very important for you to stay out of the sun until 6 months after the peeling and use the sunblocker that we gave you.
You should wait two weeks to have your laser hair removal treatment done provided all signs of inflammation have resolved and there are no signs of increased pigmentation.
You should wait until the skin has completely healed, which takes about 10-14 days.
You still have another question? Feel free to ask! We will answer your question and if generally applicable add it to the FAQ of this page.