Peeling Back the Mystery Surrounding Chemical Peels

This transcript was exported on October 16, 2023 -view latest version here.

Skincare can sometimes feel overwhelming. Whether it’s finding the right product, ingredients or treatments, there’s a lot out there, but not always for people of African, Hispanic, Middle Eastern and Eastern South Asian descent. That’s why I set out to educate myself and others so that we can all feel beautiful in our skin. Hello and welcome back to The Skin Report. I’m Dr. Simran Sethi, an internal medicine doctor, mom of three and CEO and founder of RenewMD Medical Spas and Skin by Dr. Sethi.

To close out our current theme of skincare and culture, I want to take this opportunity to speak about chemical peels. It may surprise you to learn that there is a lot of valuable skincare information, cultural influence and history teaming beneath the surface of this captivating skin procedure. Throughout the episode, I will discuss the basic information surrounding chemical peels and what you need to know if you’re considering this treatment. Finally, I’ll discuss the history of these procedures and how they relate on a cultural level.

For those of you who might not be familiar, I want to begin this episode by explaining the purpose of a chemical peel and what the process should look like. I’ll also cover what peels should be avoided, especially if you have melanin-rich skin or sensitive skin. A chemical peel is a medical grade skin treatment that is used with the primary intention of minimizing the appearance of pigment. A lot of chemical peels promise minimization of fine lines and acne scars, but the peels that do this are a lot deeper and come with a lot more risks and downtime, which we will discuss today. Going back to the treatment, it’s performed in office by a skin professional who will apply a chemical solution to the skin surface. This substance will cause a top dead layer of skin, also called a stratum corneum, to slough off revealing the new layer beneath. This fresher skin will have less visible skin insults and generally appear smoother and more even in overall tone and texture. Sounds simple, right? Well, there’s a lot of important information and science that goes into this process.

Coming up next, we’ll take a deeper look at how chemical peels affect the skin, which peels are appropriate for acne breakouts or pigment reduction or wrinkles, and which ones are safe for brown skin tones. So what does a chemical peel do to your skin to achieve its renewing effect? To understand this, let’s start with what are chemical peels made of? Chemical peels are a mixture of ingredients that will lift pigment to the top most layer of the skin and cause it to rapidly slough off through a strong exfoliation process. To achieve this, most chemical peels contain the following category of ingredients. Number one, a strong acidic chemical exfoliant. This ingredient can be ahigh concentration glycolic or lactic acid or, in some cases, a phenol. This is the main cause of the peeling that occurs with a chemical peel and is the ingredient that differentiates the strength and targets of chemical peels. Also, and probably most obviously, this is the most important part of the chemical peel as it is what is getting rid of the dull dead skin layer and allowing superior penetration of the products I’m going to list next.

Number two, a retinol. Most but not all chemical peels contain a retinol. If you listen to my podcast often, you know that retinol is one of my favorite ingredients because it speeds up skin cell renewal, which in turn clears dark spots, smoothens skin and wrinkles. When part of a chemical peel or applied as a separate step in a chemical peel application, it accelerates skin cell turnover to really boost results. To have an effective retinol booster in your chemical peel, you likely will have to get your peel at a medical office as they’re the only ones licensed to use high concentrations of retinol in the United States.

Number three, pigment reducing ingredients. There are a multitude of pigment reducing compounds that are often combined to produce the most brightening effect possible. These compounds can penetrate deep into the epidermis and quieten down our pigment producing cells. These ingredients can be medical grade like Hydroquinone or tranexamic acid or more botanical like kojic or azelaic acid. Number four, anti-inflammatory ingredients. This group of ingredients are great to have in a peel, but my research shows that most peels don’t include these. Ingredients like mandelic acid, guarana or [inaudible 00:04:57] are very anti-inflammatory and will not interfere with the peeling or pigment reduction process, but will counteract the inflammation and retinas that occurs with many peels. In fact, in darker skin tones, this inflammation actually makes the skin appear more unevenly pigmented, which defeats the purpose of the peel in the first place. I think that havinganti-inflammatory ingredients is so effective that in my skincare line, the glycolic gel peel is a high strength, 10% glycolic acid, but it can be and is meant to be used daily without any skin irritation because it is balanced by high concentration of botanical, anti-inflammatory ingredients.

Unfortunately, many peels do not have these, and if you have a darker skin tone or a more mature or sensitive skin, ask your skincare professional to choose a peel that includes some anti-inflammatory properties. Now that we know what category of ingredients are used to make a chemical peel, let’s go into the different strengths and depths that a peel works in. Chemical peels can be applied at different strengths with varying depths of impact correlated with different levels of change to the skin. For example, a superficial chemical peel would only change the outermost layer of skin, the epidermis, and have a more moderate result. A medium depth peel penetrates the papillary dermis and is a bit stronger with more visible results to the skin’s appearance. Finally, a deep peel would produce more intense clinical changes to the skin penetrating the reticular dermis layer and resulting in the most significant outcome.

Examples of deep peels include a phenol, VIP or high strength TCA peel. While deep chemical peels can produce the greatest change to the skin surface texture and appearance, stronger peels are also more commonly associated with more discomfort during application, longer recovery times, and most importantly, greater risk depending on your skin tone. More on it in a minute. First, let’s talk about what happens while you’re recovering from a peel. Recovery commonly consists of epithelialization where the skin will begin to form a scab or the wounded area where the acid in the peel ate away at the skin layer. This impacted skin will eventually peel off throughout the maturing process. Most superficial to medium depth chemical peels take about seven to 14 days for the affected area of skin to heal depending on the peel strength. Deeper peels require more healing times, from two months to even longer to avoid potential complications.

In a superficial peel, peeling generally starts on day three after the chemical peel procedure. So if you’re getting a peel, remember that your skin will be a little pink right after the peel and on day two, but most of the peeling will occur on day three to five. What’s interesting is that in some peels, peeling is minimal, but they still have great brightening effects, and if you frequently get chemical peels or consistently use a retinol in your skincare regimen, you may not peel as much as someone who rarely gets chemical peels or has more skin damage. Now, in a deeper peel, the skin will look very raw immediately after the peel and will develop a dark layer or scab on the skin before that peels off over a course of five to 10 days. During this process, you will not be able to be out and about, unlike after a superficial peel where you can resume your normal activities during the peeling process.

Also, as deeper peels have much greater downtime. They’re also more likely to have complications like infections or blisters during the recovery period. After the peeling process has completed, your skin should look noticeably brighter and smoother. Deeper peels will have more improvement in skin texture than superficial ones, and the results last longer. Superficial peels results can last up to four to six weeks, and medium peels tend to have results lasting two to six months. The deepest peels results can last for a few years. Of course, from what I’ve explained so far, you are probably thinking that chemical peels have a lot of benefits, but the most important factor to consider when choosing a peel is whether it’s right for the type of result you’re looking for and your skin tone. I’ll go over this and more coming up next.

As with any medical grade skin procedure, chemical peels have advantages and drawbacks. First, less discussed potency. As I said before, weaker strength peels like superficial peels are gentler on the skin, require less recovery time and are relatively easy to bounce back from, however they will not produce a significant result. Weaker peels that work in the epidermis are essentially doing a strong and rapid exfoliation of the stratum corneum or dead skin layer that makes up the top most layer of the epidermis. After this peel, the skin should feel less dull and smoother, but there won’t be a significant change in uneven pigmentation. However, these peels are safe for every skin tone and age, and I recommend this in a series of six peels every two to four weeks in people with acne. Having a lot of dead skin sitting on the surface causes dirt and debris to get trapped in follicles, which result in acne breakouts. By rapidly sloughing off that layer with a series of peels, you can effectively calm breakouts.

Medium strength peels go a little deeper into the epidermis and help with reduction of excess pigment or melanin production, while also rapidly exfoliating off the dead skin layer. This peel strength is, again, a great option and one of my favorites for creating a brightening glow after the summer months when we’re more out and about and have had more UV exposure or in preparation for a special event. These peels are generally well tolerated by all skin tones, and if you are looking for just some mild pigment reduction, doing these peels in a series of three to four sessions in one month intervals will easily achieve that. Now, on the opposite end of the spectrum, stronger peels like deep peels can produce more dramatic results, especially on skin texture, by softening wrinkles and scars, but are a lot more complicated to work with and definitely have much greater risks. Let’s start with the greatest risk. Deep peels often use intense chemicals like phenol to produce more significant wounds, but these chemical irritants can be absorbed into circulation and potentially cause cardio-toxicity.

For treatments like these, special care like monitoring may be required to ensure the patient’s health throughout the recovery and overall healing time can last two months or more. Deep peels are also contraindicated in certain skin conditions. For example, skin with melasma may be aggravated by strong chemical peels. This is because melasma compromises the skin barrier, weakening the skin’s architecture and making it more susceptible to irritation. I’m not saying that people with melasma should not do any chemical peels, but they should avoid deep peels and only work with a medical professional who specializes in treating their skin condition and skin tone. It’s also important to note that chemical peels can only impact skin pigment in the epidermis and cannot penetrate melanin deposited in the dermis. This is an important consideration as there are many peels that promised reduction of pigment that is in the dermis and obviously fail to do so, and if you have melasma, you more than likely have pigments sitting in the dermis, which means that not only will you not see any results with deep peels, but you are also putting yourself at risk of worsening your hyperpigmentation.

I have a great episode about treating skin with melasma and I highly recommend you check it out. It will be linked in the episode show notes. Next, you may have also heard that chemical peels aren’t ideal for people with melanated or brown skin. This is generally due to the risk of post-inflammatory hyperpigmentation occurring in darker skin tones, skin types four through six. However, these pigmentary changes are more often caused by deep chemical peels. Superficial and medium strength peels can be beneficial for patients with darker skin tones when administered under the supervision of a professional. Another important factor that will determine the success of your chemical peel is the post-care. Sun protection is always recommended, but it is a must in the weeks following a chemical peel to avoid hyperpigmentation. Skincare should involve cleansing with gentle products and avoiding over exfoliation as the skin recovers. I recommend avoiding any exfoliants for at least one week after a peel and a few days before getting a chemical peel.

If you normally use a retinol in your nighttime routine, go ahead and start using that also a week after the peel and stop a few days before getting one. Additionally, peels typically have to break the skin barrier so the chemical can penetrate deeper into the skin, which can strip the natural skin lipid barrier, therefore restoring your skin barrier with lipid ridge moisturizers is key. Most of my patients use the ENF serum in my skincare line post peel, which not only nourishes them with the antioxidant fighting power of vitamin E, but rebuilds their skin with lipids. Finally, your chemical peel has cleared the way for products to absorb more optimally into your skin, which means that the skincare products that you use on a daily basis are going to have an even greater impact on your skin. So choose your skincare products wisely and invest in an antioxidant serum, a moisturizer, a moisture blocking hyaluronic acid serum, and don’t forget to apply a physical barrier sunscreen daily.

Next, we’re going to go over some fun historical facts about chemical peels and when is the best time to get one. Chemical peels can be great for smoothing skin texture and brightening the skin’s appearance. Considering its popularity, you may think this hot skin treatment must be more modern, however, it actually has a long and fascinating history. Chemical peels have been used to treat the skin for centuries with roots in ancient Egyptian medicine. Even Queen Cleopatra was known to bathe her skin in sour milk to improve its softness thanks to the lactic acid within it. This naturally occurring alpha hydroxy acid was the active agent that causes the sour milk to chemically exfoliate her skin to a smoother result. Even the Romans and Greeks use corrosive agents for the same purpose, applying the corrosive supplement of limestone to their skin to benefit its appearance and texture. French courtesans in the 18th century also used to bathe in wine, likely enjoying the positive effects granted by tartrate acid, its active ingredient. In fact, tartaric acid is a common alpha hydroxy acid used in chemical peels even today.

I’ve spoken a lot this month about culture and how culture is significant in skincare and the beauty industry. As we can see from the history of chemical peels, many cultures through time have adopted similar skin treatments. While modern chemical peel practices weren’t developed until the late 19th century, ancient civilization shared common objectives. Today, we are privileged to approach treatments that merge those same intentions with our current advancements in skin science resulting in, you guessed it, the chemical peel. While we can appreciate the uniqueness of the skincare practice by different cultures, we can also recognize the shared intention behind them, a desire to feel healthy and beautiful, that unites us all.

I hope you have learned some key facts about chemical peels and now understand how to pick which peel is right for you. Chemical peels are a great way to slough off extra dead skin or sun damage after the summer months or dry winters. They will not stimulate collagen or reverse aging, but are a little enhancement. The best way to know which peel is right for you is to ask your provider if they’ve treated people with your skin tone and please be wary of any promises that the peel will significantly reduce wrinkles or scars as this will simply not happen with safe peels that fall in the superficial or medium strength category. I have nothing against deep peels but truly think that they do not deliver many benefits and the downtime required is not justified for what they deliver. Deep peels also have a much greater risk of hyperpigmentation in darker skin tones, and I definitely do not recommend them in skin types four and greater. With that, thanks for listening and until next time, love your skin, love yourself, and celebrate your beauty.

If you’d like to learn more about science-backed skincare or medical aesthetic treatments, please subscribe to and turn on notifications for the Skin Report so you always know when a new episode is up. We have a newsletter that you can sign up for on skinbydrsethi.com so that you can stay up to date on all our latest products and more. Additionally, if you have a skincare question or want to make an episode topic recommendation, please message me at theskinreportbydrsethi.com, which is linked in my show notes, and I’ll be sure to answer your question in an episode soon.

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