Cosmetic Dermatology

Chemical Peels

Chemical Peels | Photodynamic Therapy (PDT) | St. Louis Chemical peels remove damaged outer layers of skin on the face to smooth texture, reduce scarring, and remove blemishes to produce healthy, glowing skin. There are three types of chemical peels, ranging from mild to strong – alpha hydroxy acids (AHAs), trichloroacetic acid (TCA) and phenol - and formula strengths are tailored to each patient. Peels can be combined with other procedures such as facelifts for a younger look.

Types of Chemical Peels

AHAs are the gentlest of the three types of chemical peel. They consist of a group of glycolic, lactic and fruit acids that smooth and brighten skin by treating fine wrinkles, dryness, uneven pigmentation and acne. AHAs are typically applied once a week, or may be mixed in a milder concentration with a cream or cleanser to be used daily; treatment takes 10 minutes or less. Patients may choose AHAs if they do not want the lengthy recovery time of a phenol or TCA peel. Occasionally AHAs, Retin-A (a prescription medication containing Vitamin A) or hydroquinone (a bleach solution) are used to thin the skin and even its tone as a pre-treatment for TCA peels.

TCAs are commonly used for medium-depth peeling (though depth is adjustable) to treat fine surface wrinkles, superficial blemishes and pigment problems, sometimes in combination with AHAs. TCAs are the preferred chemical solution for darker-skinned patients and may be used on the neck and other areas of the body. Results are often less impressive and do not last as long as with phenol peels, and multiple treatments may be required, but treatments only last 10-15 minutes and recovery time is shorter.

Phenol, the strongest chemical peel, treats deeper skin problems such as coarse facial wrinkles, pre-cancerous growths, and areas of blotchy or damaged skin caused by sun exposure, aging or birth-control pills. Because phenol can lighten skin where it is applied, the patient's natural pigmentation is a factor in determining eligibility. Phenol is used only on the face, as it may cause scarring elsewhere. Full-facial treatment can last an hour or two and recovery can take a few months, with possible permanent skin lightening and removal of freckles.

The Procedure

Chemical peels may be performed in the doctor's office, office-based facility or outpatient surgical center. Anesthesia is not required because phenol and TCAs act as an anesthetic while AHAs produces only a slight stinging, though you may be given a sedative.

In an AHA peel, the skin is cleaned and the solution applied; there is no need for "after-peel" ointment or covering. During TCA and phenol peels, the skin is cleansed and solution is applied, which may cause a brief stinging sensation. Petroleum jelly or a waterproof adhesive tape may be put on the skin following a phenol treatment.

After the Procedure

AHA peels can cause temporary stinging, redness, irritation and flaking or crusting. Phenol and TCA peels can result in tingling or throbbing, reddened skin, a crust or scab, and significant swelling which lasts about a week, depending on the strength of the peel used.

Photodynamic Therapy (PDT)

Chemical Peels | Photodynamic Therapy (PDT) | St. Louis Photodynamic therapy (PDT) is a three-step treatment used to treat mild or serious conditions of the skin through the use of a photosensitizing drug and a light source to activate it. PDT destroys abnormal cells that cause actinic keratosis, a pre-cancerous condition, and can also minimize pores and reduce oil glands to treat acne, rosacea and some scarring as well.

During the PDT procedure, a topical photo sensitizer called Levulan is applied to the skin and left for an incubation period of several minutes to several days. Levulan is made of aminolevulinic acid (ALA), a natural substance found in the body. After incubation, the Levulan is activated with a wavelength light source. Patients may experience sensations of warmth, tingling, heat or burning during this part of the treatment. After light activation, the treated area is washed and patients can return home, and most return to work within one to two days of the procedure. Rarely, patients may experience a slightly prolonged healing course but typically less than 7-10 days.

For optimal results, patients may need up to five treatment sessions, depending on the severity of their condition and the aggressiveness of their treatment. Sessions are spaced two to five weeks apart, and can be continued afterwards to help maintain the initial results of the treatment.

Although PDT is considered a safe treatment option, there are certain risks and side effects associated with any medical procedure. Some of these risks and side effects may include redness, pigmentation, bruising, infection and scarring. These side effects are usually mild and go away on their own within a few weeks.

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