Chemical peels

An acid removes skin layers in a controlled way. Superficial, medium and deep peels are different treatments with different recoveries and risks. Do not assume a med spa offers all three.

• Superficial. Works on the outer layer. Common acids include glycolic, lactic and salicylic acid.
• Medium. Reaches into the layer beneath it. Often uses trichloroacetic acid, called TCA.
• Deep. Reaches farther into that layer. Phenol is one chemical used.

The acid's name does not tell you the whole story. Its concentration, application time and number of coats affect depth. Depth sets the recovery and the risks that follow. Deep peels need a surgical setting.

Superficial peels are used for uneven tone, roughness from sun damage and fine lines. Some are used for acne. The evidence for treating acne is limited. US dermatology guidelines do not have enough evidence to recommend peels for it.

Medium peels are used for more pronounced sun spots, lines and some shallow acne scars. Deep peels may address more extensive sun damage and deeper wrinkles in selected patients.

If your concern is skin texture, name what you mean at the consult. Point out the rough patches or indented scars you want assessed. A peel will not lift sagging skin. Deep scars are not reliably removed by a peel.

Some people need a skin care plan for 2 to 4 weeks beforehand. Ask which products to use or pause. A stronger peel needs a consult and a plan. It is not a walk-in treatment.

Your skin is cleansed first. The acid goes on next. For a light peel, it usually stays on for a few minutes. Your provider watches your skin as well as the clock. Stinging is possible.

Some acids need washing off or neutralizing. TCA does not need a separate neutralizing solution. The next steps depend on the peel.

A superficial session takes about 30 minutes. A full-face deep phenol peel takes about 90 minutes. Deep phenol peels require heart monitoring. Ask for the total appointment time, including preparation and recovery before going home.

Superficial peels are often a course because changes build across repeated treatments. That means several appointments with time to heal between them.

Medium peels may need repeating to maintain the effect. Deep peels can have effects that last for years. They are not a routine repeat treatment.

No peel stops aging or future sun damage.

A light peel can mean days of visible flaking. A medium peel can mean a week or more of real downtime.

• Superficial. Healing usually takes 1 to 7 days. Redness and scaling can occur.
• Medium. Healing usually takes 7 to 14 days. Swelling, crusting and peeling can make work or social plans difficult.
• Deep. Healing usually takes 14 to 21 days. Expect dressings and wound care at home. Redness can last for months.

Skin can turn darker or lighter. Some color changes are permanent. Scarring and infection are possible. Picking skin or skipping wound care raises those risks. Phenol also carries risks to the heart, kidneys and liver.

Darker skin carries a higher risk of pigment change. This makes the choice of acid and your provider's experience with your skin tone especially important. Skin color alone is not a reason to turn you away.

Active cold sores, other skin infections and open wounds rule out peeling the affected area until it has healed. A history of cold sores matters even without a current outbreak. A peel can bring them back.

Current or past isotretinoin use needs review before booking. Tell the clinician when you took it.

Recent laser or waxing may mean postponing treatment. Give the clinician the dates. A history of raised scars can also make a peel unsuitable.

A clinician may advise against a peel during pregnancy. Tell them before any preparation products are prescribed. Being unable to follow the sun restrictions can also rule out treatment.

• Which acid and what depth are you proposing for my concern?
• Who will perform it, and what license do they hold?
• What experience do they have using this peel on my skin tone?
• What will recovery look like day by day, including work and makeup?
• What are the sun rules afterward, and for how long?

The price depends on the depth, the acid used and whether you are paying for a course. Your provider and the treatment setting also affect the bill.

Consults, preparation products, aftercare and follow-up visits all count toward the total course cost. For a deep peel, so do anesthesia and facility fees. Keep time away from work in your comparison.

This is a guide, not medical advice. Whether a treatment is right for you is a decision for a licensed provider who has examined you.