Chemical Peels: What to Expect
Written by: Kimberly A. Wenner, MD
Chemical peels destroy the top surface of the skin, leading to an improvement in dark spots, fine wrinkles, scars, and skin texture. At Cascade Eye & Skin Centers, we have a peel that can work for anyone, regardless of skin type or area of concern, from superficial peels with no downtime to medium depth peels for scars and extensive sun damage. Each peel and recommended product are customized after a consultation with our estheticians or providers.
Preparing for a Chemical Peel
Make sure to let us know if you have a history of cold sores, as injections around the mouth can occasionally reactivate them. To alleviate any adverse symptoms, we often prescribe medications such as Valtrex or Acyclovir for you to take once you have had your chemical peel.
Before your chemical peel, the best step you can take to maximize your results is to use a prescribed tretinoin topical ointment of 0.025% to 0.05% strength for four to six weeks. Tretinoin is a vitamin A derivative that treats acne and combats signs of aging by bringing new cells to the surface of the skin.
Another product that the physicians of Cascade recommend prior to your chemical peel is a glycolic or lactic acid cream or wash, such as Glytone or SkinMedica AHA/BHA. Using one of these products for four to six weeks before your peel helps the tretinoin exfoliate and will also improve the results of the peel.
The specialists at Cascade may also suggest a prescription-strength 6% Hydroquinone for patients with darker skin or patients who have a history of melasma.
Post-Peel Expectations
After your chemical peel, you should anticipate some redness and swelling. Swelling usually peaks about 48 hours after the peel, but you can alleviate these side effects by elevating your bed or taking a Benadryl. You should also expect that the pre-existing pigment of your skin will darken to a grey-brown color and that your skin will likely feel and look tight.
Your skin may actually begin peeling about three days after your chemical peel, but not everyone who receives this treatment will peel, as this process is not necessary to see results. It is important that you do not vigorously rub, scrub, or peel dead skin. Sometimes, a clear or yellow fluid may develop, but if fluid forms that is not clear or yellow, you should contact Cascade Eye & Skin Centers.
Skin regrowth should complete seven to ten days following your chemical peel. After this time, your skin may be sensitive and pink for a few weeks.
After Care
Following your chemical peel, you should wash your skin twice every day with a non-detergent cleanser, such as Avene Trixera or Cetaphil. Make sure to use your fingertips to gently wash your skin, rather than using a washcloth or a brush.
For deeper chemical peels, the specialists at Cascade recommend Acetic Acid soaks, made of one tablespoon white vinegar and one pint of warm water. You should complete these soaks three to four times a day so as to cleanse your skin and prevent any infections from developing. You may stop the soaks once fluid accumulation and major peeling have stopped.
In addition, you should apply Aquaphor, a petroleum jelly, or Cicalfate, a protective cream to prevent any crustiness or dryness. Dermatology specialists at Cascade recommend a combination of both products for optimal results and a less greasy texture.
Remember to avoid any rubbing, picking, or peeling! If any itching occurs, you may use a 1% hydrocortisone ointment or contact Cascade Eye & Skin Centers.
Once the skin has healed, usually abou seven to ten days after treatment, you may begin using moisturizing cream again. Remember to include the following in your skin care regimen:
- Sunscreen
- Glycolic acid
- Tretinoin
Make sure to start with a light application of tretinoin, as your skin will be sensitive following your peel. It is also extremely important to use a physical or chemical sunscreen every day to protect your skin and maintain the results of your peel.
Potential Complications of Chemical Peels
Cold sores
Please let us know if you have any history of cold sores (HSV), and we can prescribe you medication to prevent an outbreak from developing after treatment.
Infection
Infection is rare, but it can occur about three to five days following the peel. Signs that you may be experiencing an infection include the presence of a thick, yellow crust or intense itching or burning. If you suspect an infection, please contact Cascade Eye & Skin Centers.
Scarring
Scarring is also rare, but it usually happens on the jawline if it does occur. Scarring will typically become apparent about one to two weeks after the peel and may appear more red, thick, and scabbed than other areas. Let us know immediately if you identify a problem area or if you have a history of keloid scars.
Pigmentation
Please let us know if you have a history of melasma, as we frequently prescribe a bleaching agent for patients with darker skin to use before and after the procedure.
Which Peel and Products Do I Need?
Listed below are the peels and products that Cascade Eye & Skin Centers recommend. Your skincare specialist will suggest which peels and products are right for you based on your skin type, underlying conditions or concerns, and your lifestyle for best results.
Recommended Peels and Products:
- Illuminize Peel: very superficial, a good starter peel for sensitive skin and those who do not want downtime.
- Vitalize Peel: contains resorcinol, lactic acid, salicylic acid, and retinoid acid.
- Rejuvenize Peel: a stronger peel that can cause more irritation.
- Glycolic Acid Peel: has various strengths depending on skin type and treatment goals; strength can be increased over time.
- Mandelic Peel: ideal for darker skin types and sensitive skin, has minimal down time.
- Salicylic Acid Peel: recommended for acne.
- Jessner’s/TCA 20%: stronger peel for sunspots and fine lines, has 3-5 day recovery.
- Jessner’s TCA 35%: a medium depth peel with a 7-10 day recovery, valuable for deeper acne scars, photodamage, and fine lines. Equivalent to a laser resurfacing procedure and is done by a physician or PA.
