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Chemical Peels by Dr. Michael Wolfeld New York Plastic Surgeon

Chemical peel uses a chemical solution to improve and smooth the texture of the facial skin by removing its damaged outer layers.  Peels are a technique used to improve the appearance of the skin.  In this treatment, a chemical solution is applied to the skin, which causes it to "blister" and eventually peel off.  The new, regenerated skin is smoother and less wrinkled than the old skin.  It is helpful for those individuals with facial blemishes, wrinkles and uneven skin pigmentation.  Trichloroacetic acid (TCA) and alphahydroxy acids (AHAs) are used most commonly for this purpose.  The precise formula used may be adjusted to meet each patient's needs.  Although a chemical peel may be performed in conjunction with a facelift, it is not a substitute for such surgery, nor will it prevent or slow the aging process.  Chemical peels are performed on the face, neck, or hands. They can be used to reduce fine lines under the eyes and around the mouth, treat wrinkles caused by sun damage, aging, and family history, improve the appearance of mild scarring, treat certain types of acne, reduce age spots, freckles, and dark patches due to pregnancy or taking birth control pills (melasma), and improve the look and feel of skin that is dull in texture and color.

The mildest of the peel formulas that produce the softest peels are the alphahydroxy acids (AHAs), such as glycolic or lactic acids. These types of peels can provide smoother, brighter-looking skin for people who can't spare the time to recover from a deeper peel, such as a TCA peel.  AHA peels may be used to treat fine wrinkling, areas of dryness, uneven pigmentation and acne.  Various concentrations of an AHA may be applied weekly or at longer intervals to obtain the best result.  Dr. Wolfeld will make this decision during your consultation and as the treatment proceeds.  An alphahydroxy acid, such as glycolic acid, can also be mixed with a facial wash or cream in lesser concentrations as part of a daily skin-care regimen to improve the skin's texture.  Trichloroacetic acid (TCA) 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.  With a TCA peel, your healed skin will be able to produce pigment as always. However, TCA peel patients are advised to avoid sun exposure for several months after treatment to protect the newly formed layers of skin.

More noticeable sags, bulges, and severe skin laxity do not respond well to chemical peels. They may require other kinds of cosmetic surgical procedures, such as a facelift, brow lift, or eyelid lift.  Dr. Wolfeld can help determine the most appropriate type of treatment for each individual case.  Generally, fair-skinned and light-haired patients are ideal candidates for chemical peels.  Darker skin types may also have good results, depending upon the type of problem being treated. However, the risk of an uneven skin tone after the procedure is increased.

A chemical peel is performed by thoroughly cleansing the skin with an agent that removes excess oils.  Sometimes Retin A - a prescription medication derived from Vitamin A - is used to pre-treat the skin. This thins out the skin's surface layer, allowing the AHA or TCA solution to penetrate more deeply and evenly. If your skin won't tolerate Retin-A pre-treatment, an AHA cream may be used instead. Hydroquinone, a bleaching agent, is sometimes used in conjunction with Retin-A or AHA pre-treatment, especially if you have blotchy skin areas or pigmentation problems.

Dr. Wolfeld will apply the AHA solution to your cleansed facial skin, a process that usually takes approximately 10-15 minutes.  Depending on the strength of the peel, periodic treatments may be necessary until the desired effects are achieved.  For TCA peels, typically, the skin is first thoroughly cleansed. Then, Dr. Wolfeld will carefully apply the TCA solution. You may feel a stinging sensation as the peel solution is applied, but this feeling will quickly pass.  A full-face TCA peel usually takes 15 - 20 minutes. Two or more TCA peels may be needed to obtain the desired result, and those may be spaced out over several months.

During a chemical peel, most patients experience a burning sensation that lasts about five to ten minutes, followed by a stinging sensation. Cool compresses may be applied to help alleviate this stinging.  Depending upon the type of chemical peel, a reaction similar to sunburn occurs following the procedure. Peeling usually involves redness, followed by scaling that ends within three to seven days. Mild peels may be repeated at one to four-week intervals until the desired clinical effect is achieved.  Medium-depth peels may be repeated in six to twelve months, if necessary.

After a TCA peel, Dr. Wolfeld may prescribe a mild pain medication to relieve any tingling or throbbing you may feel.  With an AHA peel, the temporary redness, flaking and dryness that you experience will not prevent you from working or engaging in your normal activities. A fresher and improved skin texture will result with continued AHA treatments. Remember, protecting your skin from the sun is also important following these mild acid peels.   With a TCA peel, the moderate discomfort and mild swelling you may experience will subside within the first week.  In about a week to ten days, your new skin will be apparent and you should be healed sufficiently to return to your normal activities.  It is important to avoid exposure to the sun after a chemical peel since the new skin is fragile and more susceptible to complications.

Improvements from AHA peels may be very subtle at first but you should see a healthier glow to your skin.  With continued treatments, you will notice a general improvement in the texture of your skin.  Following a TCA peel your skin will be noticeably smoother and fresher-looking.  If you are interested in learning more about chemical peels, we encourage you to schedule a private consultation with Dr. Wolfeld by calling 212-281-1000.

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