WHICH TYPE OF PEEL IS MOST EFFECTIVE FOR ME?
A chemical peel is most commonly performed for cosmetic reasons -- to enhance your appearance and your self confidence. Chemical peels may also remove pre-cancerous skin growths, soften acne facial scars and even control acne. Alphahydroxy acids (AHAs) , such as glycolic, lactic, or fruit acids, and Betahydroxyacids (BHAs) are the mildest of the peel formulas and produce light peels. These types of peels can provide smoother, brighter-looking skin for people who can't spare the time to recover from a TCA peel. Glycolic and Salicylic acid peels are often done in a series of 4-6 peels 2-4 weeks apart. 

Glycolic acid peels may be used to treat fine wrinkling, areas of dryness, uneven pigmentation and precancerous lesions. Increasing concentrations of glycolic acid may be applied bi weekly or at longer intervals to obtain the best result. Your doctor will make this decision during your consultation and as the treatment proceeds.

Salicylic acid peels are most often used to treat patients with acne and rosacea as well as those with more darkly pigmented skin.  Salicylic acid is more fat soluble and can concentrate in clogged pores to help break up comedones – blackheads and whiteheads – and help treat acne. 

Trichloroacetic acid (TCA) can be used in many concentrations, but it is most commonly used for medium-depth peeling. Fine surface wrinkles, superficial blemishes and pigment problems are commonly treated with TCA. More than one TCA peel may be needed to achieve the desired result. The recovery from a TCA peel is more prolonged than with Glycolic and Salicylic acid peels

WHAT ARE THE RISKS, SIDE EFFECTS AND DOWN TIME?
All chemical peels carry some uncertainty and risk. A chemical peel is normally a safe procedure when it is performed by a qualified, experienced dermatologist. However, some unpredictability and risks such as infection, dyspigmentation and scarring, while infrequent, are possible.

All peels may cause stinging, redness, irritation and crusting. However, as the skin adjusts to the treatment regimen, these problems will subside. These side effects are more common with TCA peels, and with higher strength of glycolic acid peels. Initially, there will be redness and peeling of the skin. The new skin is very sensitive to the sun. Sun exposure post peel may lead to altered pigmentation and sunburn.

PLANNING FOR A CHEMICAL PEEL
During your initial consultation, it is important that you discuss your expectations with Dr Rosenberger. Don't hesitate to ask any questions or express any concerns that you may have. If you have a history of herpes or cold sores, vitiligo, dyspigmentation or keloids, it is important to inform Dr Rosenberger. Those with a history of herpes or cold sores will need to take a prophylactic medications called Valtrex.

PREPARING FOR YOUR CHEMICAL PEEL
Retinoids, prescription medication derived from Vitamin A, are used to pre-treat the skin. Retinoids include RetinA, tretinoin, Differin and Tazorac.  Retinoids peels off the dead layer of skin, allowing the peel solution to penetrate more deeply and evenly. Hydroquinone, a bleaching agent, is sometimes used in conjunction with retinoids, especially if you have blotchy skin areas, pigmentation problems or are naturally olive or dark skinned. Dr. Rosenberger requires six weeks pretreatment with a retinoid prior to a chemical peel.

You will need to arrange for someone to drive you home and help you out for a day or two if you are having a deeper TCA peel. You probably won't need any extra assistance if you're having a glycolic or salicylic acid peel.

WHERE YOUR PEEL WILL BE PERFORMED? IS ANESTHESIA REQUIRED?
The peels will be performed by Dr. Rosenberger here in our office suite at Appalachian Spring Dermatology. Anesthesia isn't required for peels; however, there is a burning and stinging sensation during the peel which can be uncomfortable. Pain is minimal to absent during salicylic and glycolic acid, but is much more intense with TCA peels. Those with a history of anxiety will need to take their anxiety medication prior to the procedure.  Pre-medication with extra strength Tylenol will also be helpful during TCA peels.

THE PEEL
First, the skin is thoroughly cleansed by the patient. Then Dr. Rosenberger will remove any persistent oils on the skin with alcohol and acetone.  Vaseline or Aquaphor will be placed at the corners of the mouth and eyes and the nares to protect these sensitive areas. Then, the peel solution will be applied. You may feel a stinging sensation as the peel solution is applied, but this feeling will quickly pass. The peel solution will then be neutralized with a cool spray and washcloths. Then Aquaphor and/or sunscreen will be applied.

AFTER YOUR TREATMENT
After a glycolic and salicylic acid peel, it is common to experience some temporary flaking or scaling, redness and dryness of the skin. After a TCA peel, you may also have some mild pain or swelling for a few days. 

GETTING BACK TO NORMAL
With a glycolic or salicylic acid peel, the temporary redness, flaking and dryness that you experience will not physically prevent you from working or engaging in your normal activities. However, no major social or work activities in should be planned for 7 days after the peel. A fresher and improved skin texture will be revealed as the dead “peeled” skin is shed. For those with acne, the comedones will be shed over the next few weeks. Remember, protecting your skin from the sun is also important following a peel. We will recommend a sunblock be worn for at least 2 weeks post peel.

With a TCA peel, the moderate discomfort and mild swelling you may experience will subside within the first week.  The down time with a TCA is significant. While you can physically return to your activities, most people do not want to be seen for 1 week post peel. You will shed the entire surface of the skin 5-14 days after the procedure. Do not plan to return to work or social activities for 7-14 days. We will recommend a sunblock be worn for at least 4 weeks post peel

YOUR NEW LOOK
Improvements from glycolic and salicylic acid peels may be very subtle at first. You may detect a healthier glow to your skin. With continued treatments, you will notice a general improvement in the texture of your skin.

The results of a TCA peel are more obvious. Your skin will be noticeably smoother and fresher-looking.

COST AND INSURANCE COVERAGE
It is rare for health insurance to cover the peel procedure. Be sure to check your policy and contact your insurance company before the procedure is performed. At our office, payment in full is required prior to the procedure, your insurance company may reimburse you directly