Chemical peeling: new trends

Author: Marina Landau, MD, dermatologist, Wolfson Medical Center (Israel)

Chemical peeling is a procedure that has been used for many decades to cosmetically improve the condition of the skin or to treat certain skin diseases, so sometimes it seems to us that it is no longer possible to come up with anything new in this direction. It is a well-known fact that, depending on the depth of skin damage, chemical peels are divided into three categories: superficial, medium and deep; that as a result of the chemical destruction of part of the skin through the application of a peeling composition, the possibility of tissue regeneration and rejuvenation appears. Nevertheless, the potential of peelings does not end there, and in this article we will talk about what else they can surprise us with.

Trend #1. Use of Beta Hydroxy Acids and Retinoic Acid

Superficial peeling is indicated mainly for improving skin texture, treating acne and correcting dyschromia. As a rule, to achieve the desired result, a course of superficial peeling procedures is prescribed, and home care products are also recommended between salon procedures.

Until recently, the most popular substances used for superficial peels were alpha hydroxy acids - in particular, glycolic acid, the leading member of this group. But in recent years, the situation has changed, and alpha hydroxy acids have had to give way to beta hydroxy acids (for example, salicylic acid) and retinoic acid.

As many years of practice have shown, in the case of not all patients, glycolic peeling provides the gentle exfoliation that we usually count on after a superficial peeling procedure. Some of them may develop hypersensitivity in response to AHA acids, and in patients with phototypes above IV, reactive hyperpigmentation. Thus, as a result of using “safe” AHA peels, the skin condition may paradoxically worsen.

As for salicylic and retinoic peels, today they are called “blind to skin color” - that is, they can be safely used on any phototype. Such products cause visible peeling of the skin for several days, and there are also positive results in the treatment of acne in the active stage.

Trend No. 2. Combination of non-ablative laser treatment and superficial peeling

Lighting technologies have become very popular in recent years. Fractional lasers are widely used, which make it possible to shorten the period of skin rehabilitation after laser treatment. Non-ablative fractional lasers (for example, Icon from Palomar) successfully eliminate skin pathologies (loss of tone, superficial wrinkles and acne scars). And the combination of non-ablative fractional laser treatment with superficial peels allows you to create a synergistic effect without significantly extending the rehabilitation period. In this case, both laser treatment and peeling are usually performed during one session. And it must be said that this technique has become increasingly fashionable lately.

Trend No. 3. Cross-technique in the treatment of post-acne scars

Treatment of acne scars has been and remains a direct challenge for a cosmetologist. Since even superficial post-acne scars are located deep in the skin, good results in their correction can only be achieved by fairly aggressive methods of deep chemical peeling and dermabrasion, and ice-pick scars (very narrow and deep holes in the skin, similar to enlarged pores) are practically not amenable to correction.

Several years ago, a group of Korean dermatologists published an article that described a new method called CROSS (chemical reconstruction of skin scars - chemical restoration of scar tissue). Its essence is that trichloroacetic acid in high concentration is “poured” into the ice-pick scar, thereby stimulating the synthesis of new collagen, which gradually fills the hole in the skin. CROSS peeling is repeated at six-week intervals and is the first cosmetic procedure to date that can improve the appearance of ice-pick scars.

Trend No. 4. Peeling to eliminate dark circles around the eyes

Dark circles around the eyes are very common in certain ethnic groups. The first symptoms of this aesthetic defect appear in these patients by the age of twenty, and with age, the pigmentation of this area only worsens, negatively affecting the overall perception of the face. Camouflage makeup is a widely used technique in this case, however, with pronounced pigmentation, even the best cosmetics cannot hide it completely. In addition, applying makeup for an hour and a half before each exit from the house is certainly not the best solution.

To correct this pathology, the method of choice is deep peeling. As a histological study of the skin has shown, the excess pigment in this area lies quite deep. Naturally, in this case, peeling also corrects superficial wrinkles in the periorbital zone. And despite the long rehabilitation period, the overall improvement is significant and is very popular with patients.

Trend No. 5. Peeling dark skin

Patients with phototypes above IV may develop pigmentation after invasive procedures, which is why doctors previously refused to use peels and lasers to treat dark skin. However, over the past few years, new knowledge has been gained in the field of pigment formation in dark skin types and new whitening agents have been created, thanks to which anti-aging procedures that damage the skin can now be carried out with relative safety in such people. In this case, we warn patients that after the peel they must adhere to strict sun protection and use a whitening cream daily for several weeks or even months until the pigment synthesis process returns to normal.

Trend No. 6. Combined peelings

The aging process affects everyone differently. People who smoke develop a lot of wrinkles around the mouth over the years, while the rest of the face remains smooth. For some, the periorbital area ages faster, which requires deeper rejuvenating procedures, etc. In such cases, a combination of different types of peeling is necessary. In particular, for areas that have been more damaged by time or other negative factors, deeper-acting formulations are used, while superficial peels are applied to less damaged areas. Since the entire face is treated, there is no demarcation line between different treatment areas.

Trend No. 7. Body peeling

Having accumulated significant experience in using peelings in the facial area, dermatocosmetologists took up the skin on other parts of the body. The neck, décolleté, and arms are also successfully treated with chemical peels, most often for rejuvenation and removal of sun spots. The skin in these areas is different from the skin of the face - as a rule, it is thinner, its regenerative properties are lower compared to the skin of other parts of the body. Therefore, only superficial or superficial-medium peeling can be used in these areas, and in some cases a series of procedures is required to achieve the desired aesthetic result.

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Thus, chemical peeling is still an essential component in a comprehensive program for the correction and prevention of skin aging processes. New developments in the field of chemical peels open up new prospects for their future applications. And how we can take advantage of these prospects depends on us.

Source: Les Nouvelles Esthetiques Ukraine, No. 4 (80), 2013, pp. 30-32