How do chemical peels work?

There are different types of chemical peel, and this article explores the types and how they work. It also looks into over-the-counter products that contain similar ingredients and may also be effective.

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Chemical peels are cosmetic treatments that involve using acids to exfoliate the skin.

The acid removes a uniform amount of damaged skin cells across the treatment area. When done appropriately, this allows the skin to heal, with minimal scarring or color changes.

Chemical peels can affect two layers of the skin, the epidermis and the dermis. The epidermis is the visible outer layer, and the dermis sits just beneath. This deeper layer contains nerve endings, sweat glands, and hair follicles.

All chemical peels remove a controlled amount of skin cells from the epidermis. A stronger peel may also remove a small part of the dermis.

Dermatologists may use chemical peels to reduce the appearance of fine lines and wrinkles or to address:

• acne
• enlarged pores
• scarring
• redness
• rosacea
• hyperpigmentation

During a chemical peel, a dermatologist applies an exfoliant acid — first to the thicker areas of skin, such as the chin, nose, and cheeks, and then to the thinner areas around the eyes and mouth.

After the chemical peel, the dermatologist may use cool saline compresses to remove any remaining exfoliant.

They may recommend various ways to help the skin heal, such as applying a weak vinegar solution or unscented emollient to the face for a few days after the treatment.

The process can cause swelling and peeling, which may take 1–2 weeks to go away, depending on the depth and intensity of the peel. It is important to keep the face dry and not shower or use face wash for the first 24 hours. Also, do not use makeup until the skin has healed.

There are three types of chemical peel, based on how deeply they exfoliate the skin:

• superficial peels
• medium-depth peels
• deep peels

The right choice depends on the type and shade of a person’s skin and what issue they are hoping to address.

Superficial peels

Dermatologists recommend superficial peels if skin issues only affect the top layer of the skin, the epidermis.

Because superficial peels do not penetrate the deeper layers, they carry a lower risk of side effects and the skin tends to recover more quickly.

Superficial peels take 1–7 days to heal. It is important to wear sunscreen during this time.

Because superficial peels are the gentlest type, a person may need up to five sessions to see the results they want. People may be able to have superficial peels every 2–5 weeks.

Medium-depth peels

Dermatologists may recommend medium-depth peels for:

• fine wrinkles
• sun-damaged skin
• minor hyperpigmentation
• minor acne scars

Medium-depth peels take 7–14 days to heal. They cause swelling that worsens for 48 hours after the treatment and may cause blisters.

The dermatologist provides a solution that a person should use to help their skin heal. It is also important to avoid sun exposure during the recovery time.

The dermatologist may also prescribe an antiviral medication, which a person takes for 10–14 days. People can wear makeup after 5–7 days but must avoid total sun exposure until the skin heals fully.

Deep peels

Dermatologists do not usually use deep chemical peels. For issues affecting the deeper layers, laser therapy often provides better results.

However, a dermatologist may recommend a deep peel if a person has:

• moderate to severe sun damage
• moderate to severe wrinkles
• moderate to severe hyperpigmentation

Due to their strength, deep peels take 14–21 days to heal. A person needs to:

• Recuperate at home.
• Take antiviral medication for 10–14 days.
• Wash the skin with a special solution between four and six times a day.
• Apply an ointment for 14 days, then use a thick moisturizer.
• Avoid makeup for at least 14 days.
• Avoid sun exposure for 3–6 months.

Types of acid

Chemical peels can contain different types of acid, including:

• Alpha-hydroxy acids: Some examples include glycolic acid, lactic acid, and citric acid. At-home exfoliating treatments often contain these acids.
• Beta-hydroxy acids: Salicylic acid is one example, and it is especially beneficial for acne-prone skin and enlarged pores.
• Trichloroacetic acid: Dermatologists typically use this in medium or deep chemical peels.
• Phenol: This powerful chemical agent is useful in deep peels.

Some chemicals in peels cause the skin to develop a white coating, which the dermatologist may refer to as “frosting.”

Frosting signals the end-stage of a peel. Its presence and extent helps the doctor tell whether the peel has been sufficiently effective.

There are three levels of frosting:

• patches of white coating over red skin
• a general white coating with redness underneath
• a complete coverage of white coating with almost no redness

The side effects of a chemical peel can be mild. However, some people develop lasting adverse effects, such as:

• redness that lasts for months
• temporary dark patches of skin
• permanently lightened patches of skin
• scarring

The best way to avoid these is to visit an experienced dermatologist and follow their aftercare instructions carefully.

Many dermatologists use the Fitzpatrick scale when deciding on a type of peel to recommend. This scale classifies skin by six types:

1. white skin that always burns and never tans
2. white skin that usually burns and does not tan easily
3. darker white skin that may burn slightly and tans
4. moderate brown skin that rarely burns and tans easily
5. darker brown skin that very rarely burns and tans very easily
6. black skin that does not burn and tans very easily

People with skin types 1, 2, or 3 have a lower risk of a chemical peel changing the color of their skin or causing scarring. This means that any type of peel may be safe.

People with skin types 4, 5, or 6 have a higher risk of a peel causing severe skin discoloration or scarring. For this reason, it is crucial to visit a dermatologist who has experience with chemical peels and skin of color.

In general, superficial peels are safe for people with brown or black skin. However, the risk increases with peels of greater depth.

A dermatologist should have plenty of experience and use extreme caution when giving a medium-depth peel to someone with brown or black skin. They should not recommend or perform deep peels, due to the high risk of skin discoloration and scarring.

Many commercial products contain the same agents used in chemical peels. However, they contain lower concentrations of acid and so exfoliate the skin gradually over time.

Products with the following ingredients may exfoliate the skin in a similar way to a professional peel, but with less dramatic results:

• Glycolic acid: This can treat surface-level pigmentation, mild signs of aging, fine lines, and sun damage.
• Lactic acid: This is also useful for minor sun damage, fine lines, and hyperpigmentation. It is similarly effective to glycolic acid.
• Mandelic acid: This acid is effective for treating superficial redness and an uneven skin tone.
• Salicylic acid: This can help with oily or acne-prone skin.

A selection of chemical peel and exfoliating products are available for purchase online.

It is important to choose a dermatologist who has experience with chemical peels. This is especially important for people of color, whose skin can be more prone to the side effects of chemical peels.

The dermatologist will explain which type of peel may be best for a person’s skin and which products will support healing afterward.

People with more severe skin conditions may have better results from professional treatments, which contain higher concentrations of acid than commercial products.

However, cost can be a consideration. A superficial peel may cost at least $125, while a medium-depth peel is more expensive. According to the American Society of Plastic Surgeons, the average cost of a chemical peel is $644. Insurance companies do not cover the cost, as chemical peels are cosmetic treatments.

At-home products are cheaper, but they contain weaker solutions of chemicals. These may be better suited for people with milder skin concerns, such as minor sun damage.

While products require no downtime for healing, it is still important to avoid sun exposure.

Strong acids can cause serious side effects, even when professionals use them. A person should never use professional-strength chemical peeling agents at home.

Even the less powerful ingredients in commercial products can lead to burns. Use these with caution and follow the instructions carefully.

Chemical peels can reduce skin damage, giving the skin a more youthful or unblemished appearance. A dermatologist will recommend the most appropriate chemical peel depending on a person’s concerns and skin type.

Superficial peels are the safest for all skin types. However, any kind of chemical peel requires some downtime for recovery and may cause side effects, such as redness, skin peeling, and sensitivity to sunlight.

Commercial products contain weaker versions of the agents in chemical peels. They are much less expensive than professional peels, but they take longer to give results.