This document provides an overview of chemical peels, including their history, ingredients, types, applications, contraindications, expected effects, and techniques. It discusses how chemical peels have been used since ancient Egypt to remove the outer layers of skin and promote new, healthier skin growth. The document then covers the specific ingredients and strengths of different peel types, from mild AHA peels to medium-depth peels using TCA to deep peels with phenol. It notes the appropriate applications and side effects of different strength peels.

1. In this module you will learn:
• History of chemical peeling.
• What is a chemical peel?
• Ingredients in peeling solutions.
• Peel solutions and applications:
• Contraindications
• What to expect after peel.
• Possible complications
• Technique
• After care and follow up.

2. Chemical peels are used today to improve skin's texture, smooth out skin tone and lighten
dark patches or hyperpigmentation, and to improve the appearance of fine lines and
wrinkles. They use chemicals to remove the surface of the skin, allowing healthier, smoother
new skin to grow in its place. Deep peels, performed with phenol, can treat excessive
scarring, severe hyperpigmentation, deep wrinkles and even precancerous growths. Skin
peels have a long history, going all the way back to ancient Egypt.
Chemical Peels in Ancient Times
The ancient Egyptians believed that cleanliness was vital to the health and beauty of skin.
They were the first to use skin peels. Cleopatra was known for bathing in sour milk, a
practice that was common at the time. Sour milk contains lactic acid, an ingredient still used
in mild chemical peels today.
The ancient Egyptians also bathed in old wine to achieve the same effect. Wine contains
tartaric acid, a fruit acid that is still used in mild chemical peels today.

3. Chemical Peels in the Middle Ages
Sour milk and old wine remained in use as skin peels during the Middle Ages. Europeans in
the Middle Ages began using lead oxide as a main ingredient in facial chemical peels and
skin lightening creams. They borrowed this practice from the Greeks, who used lead oxide
to whiten their faces. As pale skin became more fashionable from the 15th century onward,
skin whitening creams and chemical peels made with lead oxide became more popular. The
side effects of applying lead oxide to the skin include disfigurement, muscle paralysis and
death.
Chemical Peels in Modern Times
In the early 20th century, Americans and Europeans received chemical peels at spas and
health resorts. These facilities produced their own chemical peel solutions. They guarded
their chemical peel formulas closely. These chemical peels were mild and no doubt
contained some of the same gentle acids that have been used to perform mild peels for
centuries.
Medium-depth and deep peels weren't developed until the mid-20th century. In the 1950s,
dermatologists began administering medium-depth and deep peels using new ingredients,
like trichloroacetic acid, resorcinol, salicylic acid and phenol. These ingredients are still in
use today, along with newer ingredients like pyruvic acid and glycolic acid.

4. The advent of medium-depth and deep peels meant that chemical peels were no longer
strictly a cosmetic procedure. Dermatologists could, for the first time, begin treating skin
conditions with chemical peels. While mild and medium-depth peels are still used
cosmetically, dermatologists can now treat severe scarring, deep wrinkles, severe
discoloration of the skin, and even skin cancer using deep chemical peels. Today, mild and
medium-depth chemical peels are popular among those who want to improve the appearance
of their skin. Mild and medium-depth peels are appropriate to improve the appearance of fine
lines and wrinkles, mild hyperpigmentation, and mild scarring. They are sometimes used to
treat mild skin conditions like acne. Mild and medium-depth peels are administered on an
outpatient basis, and many people have chemical peels regularly for cosmetic reasons.
Deep peels, however, have a much longer recovery time than mild and medium-depth peels.

5. A Chemical peel or skin peel involves the application of a specific solution to the surface of
the skin to peel away the outermost layers, revealing the fresh skin beneath. Chemical
peels are most often performed on the face but may also be beneficial on the neck, chest,
back, hands, arms and legs.
Chemical peels are chemical treatments to produce an improved appearance of the face.
Chemical peels are used for the treatment of photo aging (from sun damage), wrinkles,
scarring, acne, pre-cancerous lesions, and discoloration (dyschromia) or uneven skin tone.
Chemical peels produce controlled injury to the skin to promote the growth of new skin
with an improved appearance. Many different chemicals are used including glycolic acid,
trichloroacetic acid (TCA), salicylic acid, “Jessners“ solution, and phenol. The different
chemicals produce different degrees of injury to the skin.

6. The depth of chemical peeling depends on the type of chemical used. It's best not to assume
that a low % of acid is less abrasive than a higher percentage. For example: Salicylic Acid 20%
is almost as strong as Glycolic 50%. TCA 30% is a completely different peeling agent and can
penetrate into the upper layers of the dermis, causing burns if not used properly.
Chemical peels however, are not for everyone. Those in poor general health, for example,
should not receive a chemical peel. Active infections and certain medications (i.e. isotretinoin
(Accutane) may preclude the use of certain types of chemical peels (especially medium and
deep). Those with abnormal scarring, certain skin diseases, or recent surgeries should also
not have a chemical peel.
Chemical peels usually begin with vigorous a cleansing of the skin. The depth of the peel
depends on the chemical used. Very light peels (low potency glycolic acid 10%- 20%)
penetrate only the dead skin cells that sit atop the epidermis and produce almost no injury.
Sometimes this level of peel is called “exfoliation”. Medium peels (Glycolic 30%-40%) injure
the epidermis and stimulate the regeneration of a new epidermis. This level of chemical peel
may produce a burning sensation during the procedure. Recovery from light-medium peels is
quick- thus the name “lunchtime”peel. Improvement in the appearance of photo aged skin
and scarring is noticeable. Injury to the dermis stimulates formation of collagen and “plumps”
up the skin.

7. Alphahydroxy acids, or AHAs, occur naturally in some foods, although they can be
artificially made in a laboratory. Naturally-occurring AHAs, however, can be found in such
things as sugar, fruit, and even milk (ever hear of lactic acid?)
Here are a few common fruits and the specific acid that they
produce:
Grapes: tartaric acid
Apples and pears: malic acid
Oranges, grapefruit, and other citrus fruits: citric acid.
Of all the acids found naturally in foods and other substances, glycolic acid is perhaps the
most popular one when it comes to substances which may be used in a chemical acid peel.
That is because glycolic acid is derived from sugar cane, and is considered one of the safest
and most gentle of all acids used in a chemical peel. Of all the acids, any of the AHAs, such
as those listed above, and glycolic acid are the weakest, and thus are used most often.

8. For those wanting or requiring a deeper chemical acid peel, trichloracetic acid, is often used
as a chemical peel. The word “trichloracetic” itself may look complicated, but when broken
down, it actually becomes quite simple.
Trichloracetic acid, also known as TCA, is a variation of ordinary acetic acid. Acetic is an
organic compound, found in such products as ordinary household vinegar. In fact, it is this
acid that makes vinegar smell like, well, vinegar.
Acetic acid becomes TCA when the three hydrogen atoms that are part of the make-up of
acetic acid are replaced with chlorine atoms. Thus the name tri (meaning three) chlor
(denoting chlorine) acetic (for the acid from which it originated) acid.
TCA is definitely stronger than the AHAs or Glycolic Acid treatments, and is used, as
mentioned earlier, for a more extensive chemical peel. It is possible to buy TCA acid peels
for home use; however, extreme care should be taken when using it.
Phenol acid, also called carbolic acid (yes, it’s the same very corrosive acid that you’ve
always heard about and were warned about getting close to) comes from either coal tar or
is a particular type of benzene derivative. This acid is VERY STRONG, and is generally only
used by trained professionals. It is possible to buy a chemical peel with this strong acid;
however, it is probably best to allow a dermatologist to perform a treatment with this
substance.

9. Depending on the type of chemical used. It's best not to assume that a low % of
acid is less abrasive than a higher percentage. For example: Salicylic Acid 20% is
almost as strong as Glycolic 50%. TCA 30% is a completely different peeling agent
and can penetrate into the upper layers of the dermis, causing burns if not used
properly.

10. AHA Peels
Glycolic acid has long been heralded as a cure-all for dull, lackluster skin. Used in a plethora
of skin care products, this natural acid boasts the ability to refine and renew the skin,
diminishing fine lines, sun-spots, and acne.
How Does Glycolic Acid Work?
Glycolic acid is the smallest type of alpha-hydroxy-acid and has many applications
in skin care products as a natural skin exfoliant. Its capability to penetrate the skin
is key when allowing old, sun-damaged skin cells to shed, renewing the skin’s
texture and vitality. By loosening the glue-like substance that keeps dead skin cells
on the surface of the skin, glycolic acid can help you gain back that healthy glow.
This exfoliation process may help reduce wrinkles and hyper pigmentation, and
promote an overall rejuvenated appearance.
Through stimulating new cell and collagen production, fine lines and shallow acne
scars are reduced, improving the skin’s tone and texture. As well as promoting new
skin cell growth, glycolic acid can also help unclog pores -aiding those with acne
prone skin.

11. Jessner’s Solution
What is Jessner's Solution ?
Jessner's Solution is a skin peel made with a mixture of AHA Lactic Acid and BHA Salicylic
acid with the Phenol derivative of Resorcinol. This peel, which has also been known as the
Combe's Peel was made popular by Max Jessner, a New York dermatologist. He originally
formulated the solution to reduce the toxicity and high potency of the individual
ingredients.
Skin Conditions Jessner's Solution Treats:
This peel is ideal for an extensive range of skin conditions such as lightening hyper-
pigmentation areas, treating acne and acne scars, treating aged, photo-damaged and sun-
damaged skin. (Darker skin types particularly African American, should proceed with caution
due to an increased risk of post-inflammatory hyper pigmentation from the Resorcinol
exposure).
Application
However, the Jessner's Solution should only be applied by experience professionals. When
the professional is applying the solution, they will gently paint onto the skin (it can be
layered). Up to 4-6 coats are applied until a white frost develops (this means the peel is
getting rid of your dead, dull skin) or until the pain sensation is too intense.
Then rinse your face thoroughly with cool water and pat dry. Be sure to wear a light
moisturizer or a sunscreen for a few days following the Jessner's Solution Peel treatment.
The three individual ingredients, Lactic Acid, Salicylic Acid, and Resorcinol in the Jessner's
Solution work together to give you the best results.

12. Jessner Ingredients
Lactic Acid
The Lactic Acid in the peel accelerates the skin’s cells renewal rate which then softens the
epidermis and stimulates collagen growth.
Salicylic Acid
The Salicylic Acid exfoliates deep into the lining of the pores to rid of dirt, sebum and debris
that can cause blackheads, whiteheads and enlarged pores.
Resorcinol
The Resorcinol breaks down dead, uneven and rough skin due to its anti-septic properties
it actively sterilizes bacteria upon contact. Combination of these three ingredients in the
Jessner's Solution result in a even toned, clear complexion.
Jessner’s Solution can be used in conjunction with other peels, such as Glycolic peels, and
TCA peels to enhance the effectiveness of the peel.

13. TCA Peels
What is TCA?
TCA (Trichloroacetic Acid) is an effective chemical agent used to exfoliate and renew the skin on a more
superficial level. TCA is most frequently applied to the face, neck, chest, and hands. In addition, TCA is
also an excellent “spot treatment” and can be used to exclusively peel isolated areas of the skin.
The range of depth that the TCA peel achieves varies according to concentration potency (available
strengths range from 10% -30%), application methods: time and pressure, and of course skin type.
When applied, the solution penetrates deep into the skin continually seeking protein to neutralize itself.
Unlike the progressive peels such as Glycolic or Salicylic, TCA Peels exfoliate the skin more rapidly upon
initial contact. The long-lasting results make it an ideal peel for those who prefer less peeling sessions at
the cost of moderate downtime.
TCA’s ability to treat a wide range of skin conditions makes it the perfect chemical peel for individuals
with multiple concerns.
Skin types/conditions treated by TCA Peels:
• Melanoma
• Fine lines and wrinkles
• Hyper-pigmentation
• Stretch marks
• Acne
• Uneven skin tone
Due to it's antibacterial properties, the TCA Peel is an excellent choice for individuals suffering from
chronic acne vulgaris as well as the above.

14. Salicylic Peels for Acne-Prone Skin
Salicylic Acid Peel
Salicylic acid is a powerful tool to fight acne and wrinkles. Despite its dramatic results, the
salicylic acid chemical peel retains a mild and extraordinarily non-irritating approach to skin
restoration. The well-rounded composition of salicylic acid eliminates skin abnormalities
including an excess of dead skin cells, sebum and bacteria.
For Acne-Prone Skin
Acne is a multi-staged and progressive skin condition involving three critical factors: clogged
pores, bacteria and inflammation. The salicylic acid peel counteracts all three by targeting
each individually:
• Clogged Pores: Clogged pores don’t stand a chance against beta hydroxy acid, which
exfoliates excess dead skin in and around the pore lining.
• Bacteria: The antimicrobial properties of salicylic acid render it highly effective against the
acne bacteria responsible for inflammatory acne. In addition, eliminating bacteria will
substantially minimize any existing inflammation.
• Inflammation: Due to its close relation to the popular anti-inflammatory aspirin, salicylic
acid also functions as a potent anti-inflammatory.
From both a preventative and curative standpoint, the salicylic acid peel is clearly a triple
threat against acne. By and large, salicylic acid peels are considered a “textbook option” for
the treatment of inflammatory skin conditions related to a surplus of bacteria, dead skin
and/or sebum. It is no wonder the FDA approved the use of salicylic acid as an OTC acne
medication!

15. The benefits of a peel versus microdermabrasion
As we get a bit older, our skin begins to take on the all too familiar signs of aging:
the appearance of small wrinkles around the eyes and corners of the mouth,
enlarged pores that interrupt the smooth surface of the skin, and a gradual dulling
of the skin’s natural luster. But although these changes are part of the aging
process, there is much we can do to delay, halt, or even reverse the appearance of
aging. Two of the most popular techniques available to do so are chemical peels
and microdermabrasion.

16. Microdermabrasion is a physical exfoliation and chemical peels are chemical
exfoliation.
While the two procedures involve different techniques and use different active agents, the
treatments have similar goals. Both microdermabrasion and peels are undertaken by people
looking to reduce fine lines and wrinkles, the appearance of enlarged pores and acne scars, and
discolorations to the skin caused by sun exposure or age. The procedures are both mostly done
on the face but are also useful for skin rejuvenation of the hands, back, chest, or neck. The two
procedures are similar in that they work to remove the outer layer of the skin, the epidermis,
thus uncovering the firmer, more supple and younger skin that lies beneath.
Many people consider microdermabrasion the less invasive of the two treatments. In this
procedure, the skin is showered with microscopic crystals made from aluminum oxide or the
newer method of diamond imbedded tips.
The effect of this is something like having the skin on your face or other body part gently
sanded to remove the outer layers of dead skin cells. The procedure is less intensive than
chemical peels, resulting in a less rigorous removal, and thus rejuvenation, of the skin.
In the chemical peel, an acidic agent is applied to the skin, ranging from the relatively mild
glycolic acid peel, to the more intermediate trichloracetic acid peel, to the strongest of peels
that utilize phenol. These treatments work by having the caustic agents loosen, remove, and
dissolve the older skin that results in wrinkling, enlarged pores, dark spots, and scarring. The
effects of chemical peels, because the agents used are stronger than those used in
microdermabrasion, are that much more dramatic, leaving the skin looking fresh and supple.

17. In addition to the deeper treatment offered by peels, another advantage of chemical peels is
its much longer lasting effects. For good results, microdermabrasion requires approximately
6 to 12 initial sessions with the esthetician, with maintenance sessions performed every 2 or
3 months after that.
Peels, on the other hand, might require maintenance sessions every few months for the
milder varieties of the technique, or may only require a single, life-time session for the most
rigorous of the agents used. Certainly this is not only a significant time saver compared with
microdermabrasion but a cost saver over time as well.
Of course, as with all cosmetic procedures, safety is important. Chemical peels use intensive
chemicals in the process of rejuvenating your skin, Chemical peels, although not entirely
without their risks of side effects, are very safe when performed by those well familiar with
the technique and the aftercare of your skin. Discomfort and chances of side effects can be
greatly reduced with proper follow up and care. There are two layers of the skin. The outer
layer is called the epidermis and the inner layer, the dermis.
Superficial peels (e.g. glycolic acid, lactic acid) produce very superficial injury, confined to the
epidermis. Superficial peels can help improve conditions, such as acne and dyschromia.
Deeper peels, (e.g. phenol peels) produce injury within the dermis and can reverse
moderate-to-severe photo aging and wrinkles. In general, the deeper peels offer the most
dramatic results but require longer recovery periods and carry a higher risk of complications.

18. There are two layers of the skin. The outer layer is called the epidermis and the inner layer,
the dermis.
Superficial peels (e.g. glycolic acid, lactic acid) produce very superficial injury, confined to
the epidermis. Superficial peels can help improve conditions, such as acne and dyschromia.
Deeper peels, (e.g. phenol peels) produce injury within the dermis and can reverse
moderate-to-severe photo aging and wrinkles. In general, the deeper peels offer the most
dramatic results but require longer recovery periods and carry a higher risk of
complications.
The depth of chemical peeling depends on the type of chemical used.
It's best not to assume that a low % of acid is less abrasive than a
higher percentage. For example: Salicylic Acid 20% is almost as strong
as Glycolic 50%. TCA 30% is a completely different peeling agent and
can penetrate into the upper layers of the dermis, causing burns if not
used properly.
Chemical peels however, are not for everyone. Those in poor general health, for
example, should not receive a chemical peel. Active infections and certain medications
(i.e. isotretinoin (Accutane) may preclude the use of certain types of chemical peels
(especially medium and deep). Those with abnormal scarring, certain skin diseases, or
recent surgeries should also not have a chemical peel.

19. • Poor general health
• Cancer, especially skin cancer
• Open wounds or bacterial infections
• Certain medications: Antibiotics or Accutane(must be off
Accutane for 6 months)
• Steroids (must be off for 1 month)
• Recent sun exposure within the 10 days prior to peel
• Recent surgeries
• Recent Laser Resurfacing

20. Wash face with mild cleanser to remove dirt and oil or makeup
Apply a small amount of peel solution to a gauze pad and apply to face - avoiding eyes,
lips, and insides of nostrils (see diagram below for proper technique).
After 30 seconds to 1 minute (application time may increase with tolerance), rinse face
with cold water and use a neutralizing solution, if face continues to sting.
Gently pat skin – no rubbing.
Apply moisturizer to nourish new skin. SPF 30 or higher is essential.

21. AHA/BHA peels
• Temporary redness, light flaking and dryness
TCA Peels
• Mild discomfort and mild swelling
• Will subside within a week
• Skin Peeling substantial
• New skin nice and pink
Jessner Peel
• Mild discomfort
• Medium Peeling will subside in about 5-7 days
• New pink skin

22. • Hyperpigmentation
• Chemical burns
• Swelling
• Redness
• Allergic Reactions

24. • Wash area with lukewarm water and mild cleanser
• Wear SUNBLOCK WITH SPF 30 daily
• No irritants on ski for a week to 10 days
• Avoid direct sun exposure to the area for 1- 2 weeks
• No strenuous exercise, saunas, hot tubs, or hot showers for 24 hours.
• No Scratching or picking flaky skin
• No exfoliation for 10 days
• Problems or concerns call the office