Chemical solutions are carefully applied to the skin to improve texture by removing damaged outer layers. The chemicals used are phenol, trichloroacetic acid and alpha hydroxy acids. Each one has a different purpose. The formula used by your doctor will be adjusted to meet your specific needs.

Although chemical peels are mainly used on the face, they can also be used to improve the skin on the neck and hands.

• Acne or acne scars;
• Age spots;
• Wrinkles;
• Freckles;
• Irregular skin pigmentation;
• Rough and scaly skin;
• Scars;
• Sun-damaged skin.

Subtle improvements at first, but with gradual improvement with additional treatments.

If you have uneven pigment, dryness, acne or superficial wrinkles, a superficial chemical peel may be the right choice. This type of peel only removes the outer layer of skin (epidermis) with a light exfoliation, resulting in a healthy glow. The doctor will use a combination of alpha hydroxy acids and beta hydroxy acids, such as glycolic acid, lactic acid, salicylic acid and maleic acid. All of these chemicals are mild. You can repeat these treatments weekly, for up to six weeks, to achieve the desired results.

• Your face must be clean;
• The chemical solution is spread onto your skin and remains for up to 10 minutes. You may feel a slight burning sensation;
• The chemical peel is then removed and neutralized.

Return once a month to keep your skin treated.

Superficial chemical peeling

You are likely to experience some redness, peeling skin, burning and irritation. After repeated treatments, these side effects are likely to subside.

Other risks include:

• Hyperpigmentation. The new skin may have a lot of pigment, and brownish spots may appear due to exposure to sunlight. Therefore, always use sunscreen with a high protection factor;
• Infection.

Your skin will appear smoother

Acne scars, deeper wrinkles and uneven skin tone can be treated with a medium chemical peel . The chemicals used for this type of peeling will remove epithelial cells from both the outer layer of the skin (epidermis) and the upper part of its middle layer (dermis). The doctor will use trichloroacetic acid, sometimes used in combination with glycolic acid.

• Your face must be clean;
• The chemical solution is spread onto your skin and left on for just a few minutes. You may feel a slight burning sensation;
• The treated area may appear whitish-gray;
• Chemicals are neutralized with cold saline compresses;
• The skin may turn red or brown in the days following the peel. It may take up to six weeks for the results to appear.

Medium chemical peeling can be performed every 6 – 12 months.

Medium chemical peel

When trichloroacetic acid is used in a medium chemical peel procedure , you will experience redness, burning, and peeling of the skin like a superficial chemical peel . Although these substances do not bleach your skin, some color changes may occur. You are asked to avoid the sun for several months to protect the new layer of skin.

Other risks include:

• Hyperpigmentation (brown spots), which can even occur with the use of sunscreen;
• Redness, which occurs in everyone after peeling, and may take more than a few months to subside in some people;
• Permanent scars are another risk, but infrequent.

The results are excellent, however, recovery takes longer.

If you have deep facial wrinkles, sun-damaged skin, scars, blotchy-looking areas, or even precancerous lesions, a deep peel may be the right choice for you. Your doctor will use a stronger substance called phenol, which penetrates the lower layer of your skin (dermis). For this type of peeling, local anesthetic and sedation may be necessary to reduce any discomfort.

Deep chemical peels usually involve some type of pre-treatment for up to eight weeks. This stage of the treatment will prepare your skin for the peel and speed up the healing process. Pre-treatment may include the use of a medication derived from vitamin A, with the aim of thinning the superficial layer of the skin, allowing the chemical solution to penetrate more evenly and deeply. If you cannot tolerate this pretreatment, your doctor may prescribe other options.

• You will undergo sedation. Local anesthetic will be applied to your face;
• Your face will be clean;
• Phenol is spread over the area and can remain for 30 minutes, up to two hours. The chemical is neutralized with water;
• After letting the skin rest for an hour, a thick layer of petroleum jelly is applied to the skin, covering any scabs that have developed. The petroleum jelly should remain in place for up to two days. Occasionally, the doctor will choose to cover the skin with strips of tape opening for the eyes and mouth, rather than applying a layer of petroleum jelly. Your doctor will choose this approach if you have severe wrinkles.

Deep chemical peeling

The chemical used for this type of peel , phenol, lightens the skin. Your skin tone can be a determining factor in whether or not this is a suitable treatment for you. With this type of peel , your new skin may lose its ability to develop pigment (tan). It will always be necessary to protect your skin from the sun. Phenol may also pose a special risk to people with heart disease. Be sure to tell your doctor about any heart problems and put them in your medical history. Other risks include:

• Redness, which can last three to four months;
• Cysts or white spots may appear with a deep peel and may last for several weeks;
• Scarring is a frequent risk;
• Some areas of your skin may permanently lose pigment;
• Hyperpigmentation (brown spots), which can appear even with the use of sunscreen.

A deep chemical peel requires that you have adequate recovery time. You can return to work and some of your normal activities two weeks after treatment. During this time your skin already tolerates the use of makeup.

It is necessary to understand that all chemical peels present some risks and uncertainties. It is generally a very safe procedure when performed by a qualified and experienced plastic surgeon. It happens rarely, but there may be infection or scarring. For people with certain skin types, there is a risk of temporary or permanent skin color changes. Use of birth control, pregnancy, or a family history of brownish discoloration of the skin may increase the possibility of developing abnormal pigmentation.

If you've already had cold sores, there's a small risk of reactivation. Be sure to inform your doctor as he or she may prescribe medication before and immediately after the chemical peel in order to prevent reappearance. Tell your doctor if you have a history of keloids or any unusual scarring tendencies.

Now that you know how facial chemical peeling can act on your skin, it is important to understand what cannot be achieved with chemical peeling treatment:
• Treat deep wrinkles;
• Treat excess or sagging skin;
• Stimulate collagen production;
• Remove small visible vessels;
• Change pore size;
• Remove deep scars.

You are not a good candidate for chemical peeling if you have:

• History of scarred skin;
• Abnormal pigmentation;
• Black or Asian origin;
• Warts;
• Red hair and fair skin with freckles;
• Have had acne treatments in the last year.

Cost is always a consideration in elective procedures or treatment. The cost of a chemical peel can vary depending on experience and qualifications.

• Operating room costs;
• Anesthetist's fees;
• Prescription medications.

When choosing a plastic surgeon to perform a chemical peel , remember that the surgeon's experience and your good relationship with him are as important as the final cost of the procedure.

• Are you a specialist by the Brazilian Society of Plastic Surgery?
• Have you been trained specifically in the field of plastic surgery?
• Is the installation of the surgical center in the office authorized by the Health Surveillance?
• Am I a good candidate for chemical peeling ?
• What is expected of me so that the best results are obtained?
• Where and how will the procedure and treatment be carried out?
• What will be the recovery time?
• What are the risks and possible complications associated with the procedure?
• How will the result evolve over time?