Peeling is a procedure in cosmetic medicine used to treat various situations that may appear over time. In general, it serves to restore the physiological pH of the dermis, smoothing and improving the texture, as well as obviously eliminating dyschromia.
How the Peeling treatment takes place
The chemical peel is an accelerated form of exfoliation that occurs through the use of a chemical. A very superficial peeling accelerates the natural exfoliation of the stratum corneum, while a peeling that acts at a deeper level creates necrosis and inflammation in the epidermis, in the papillary dermis or in the reticular dermis.
Purpose of the treatment
The chemical peel creates clear changes in the skin through three mechanisms of action:
- Stimulation of cell turnover through the removal of dead cells of the stratum corneum;
- Elimination of damaged and degenerated epidermal cells, which will be replaced by normal epidermal cells. This result will be particularly evident in the treatment of actinic keratoses and anomalous pigmentations;
- Introduction of an inflammatory reaction and activation of inflammatory mediators (a mechanism that is not yet known) that activates the production of new collagen and glycosaminoglycan fibers (revitalising mechanisms of the dermis).
There are various types of peels, more or less important for the skin, depending on the chemical composition and the reactive agents:
Chemical peeling with AHA or Glycolic Acid
Generally the peels are subdivided into superficial, medium and deep. Surface peels are usually represented by Alpha Hydroxy acids (AHA) such as glycolic acid. Often even a single treatment of glycolic acid is able to give a fresher skin, a healthier appearance and a more radiant face. Repeated treatments can help eliminate superficial facial wrinkles. AHAs are used to reduce the effect of skin aging due to age and the sun and still to reduce or eliminate wrinkles and stains. When the AHA is applied, it will cause a tingling and / or a modest burning sensation and nothing else. At the end of the application it is possible to put on make-up immediately and return to work or to your usual activities.
Chemical peel with mandelic acid
Another superficial peeling agent is mandelic acid, an AHA like glycolic acid. Mandelic acid, derived from almonds, has a very light and superficial action on the skin, milder than glycolic acid. However, it has the advantage of being able to be used in every season as it has no side effects related to sun exposure. When the mandelic acid is applied, it is possible to feel a slight tingle. Very sensitive skin can redden, but you can immediately wear make-up to mask the redness. Due to its low aggressive action it can be used to prepare the skin for the application of other acids or other substances, reducing the dose and the side effects.
Chemical peeling with Pyruvic acid
Pyruvic acid is a medium-depth peeling substance, very versatile, successfully used in the treatment of acne, dark spots of skin and skin aging. With the application of pyruvic acid, a feeling of modest burning can be felt. At the end of the application, a moisturising cream will be applied for a few days to help the skin, stimulated by pyruvic acid, to renew itself, reducing stains and improving appearance.
Chemical peel with salicylic acid
Salicylic acid is used for the treatment of skin spots, skin aging, thickening of the skin and acne. At the application it can bring a slight redness, a burning of variable degree, and a whitish appearance of the skin, which derives from the evaporation of the solution. Repetition of treatment is important in long-term treatment, especially of spots and acne.
Peeling with TCA (trichloroacetic acid)
Trichloroacetic acid is one of the most-used substances for the realisation of medium depth peeling. The treatment protocol of peeling with TCA, even with the use of different concentrations, is similar. Concentrations ranging from 10 to 40% can be used. Generally, concentrations from 10 to 25% are used for the creation of superficial, intraepidermal peels, while concentrations from 30 to 40% are used to make peels that reach the level of the papillary dermis. The penetration of the peeling substance is influenced by numerous variables, among which the type of skin and the thickness, the method of application of the substance, the preparation of the skin to the peeling, etc. A very important factor for obtaining a satisfactory result is the correct evaluation of the different skin thicknesses. The expert doctor will evaluate the different skin areas and apply the appropriate concentrations, depending on the different areas of skin, evaluating the number of steps and the time of laying. The TCA can be used to treat: Aging of the skin, elastosis, dyschromia, hyperpigmentation, pregnancy melasma, keratosis, post-acne scars, stretch marks, post-surgical scarring, seborrheic dermatitis and rosacea. Use in combination with other methods is generally aimed at achieving more evident and lasting results.
What I need to know
At the end of a chemical peel, hypopigmentation or hyperpigmantations may remain. The phenomena are usually transient and can be treated with camouflage or lightening gels. Deep chemical peels leave the skin red and sometimes slightly swollen. Crusts can be formed depending on the type and depth of the treatment. In about 5/10 days a new skin will be formed: after a period of redness you will gradually recover your normal skin colour. You can then wear make up without problems. After every type of chemical peel it is important to avoid any sun exposure while the skin is reddened and / or sensitive: it will be essential to protect the skin of your face with total sunscreens (protective creams). Peelings need a maintenance program that the patient can do comfortably at home using specific products that will be indicated by the doctor.