Chemical peels: how they work, skincare benefits and contraindications
Chemical peels are one of the most popular beauty services on the market because of the treatment’s ability to help even out clients’ skin tone, lighten unwanted pigment and even help with surgical scarring. But, how well do you know the ins and outs of the service?
In this chemical peels how-to guide, we cover the skincare benefits of chemical peels; the differences between superficial, medium-depth and deep peels; performing peels on people of colour, contraindications to be aware of and much more.
“When skin grows back after a chemical peel, it triggers the production of collagen and elastin so they can diminish signs of ageing including wrinkles, fine lines, ageing spots, uneven skin tone, roughness and dryness,” says Sarah Whitehead, aesthetic nurse and key opinion leader for BioRePeel, which is distributed by Shop Beautiful. “They can also lighten acne blemishes and prevent future outbreaks.”
How should I prepare a client’s skin before their peel treatment?
“Firstly, connect with your client and complete an in-depth consultation, in person or virtually. A thorough discussion with the client will help assess their current skin condition. Generally speaking, healthy skin is less likely to experience adverse reactions to a chemical peel,” says Janine Da Costa, training executive for skincare brand Dermalogica.
“Cracked or dehydrated skin allows chemical peel agents to penetrate further, which can intensify stinging and burning. So, prescribe the proper products to repair barrier function and increase hydration. Having skin in the best possible condition can improve its tolerance to the peel and facilitate recovery.”
Many clients can benefit from preliminary treatments or products that ‘prime’ the skin, “helping to prepare it for the high activity of a chemical peel – particularly if they are new to peels,” explains Da Costa. “Priming with at-home peels or other exfoliating agents helps to acclimate the skin and ensure that the client receives the best possible results from their peel.
“Any treatment that thins the stratum corneum increases the permeability of the epidermis and the speed of penetration of AHA. Tretinoin, AHA creams/serums and exfoliants are all examples of products that will allow the acids in the peel to penetrate more deeply. Be sure that clients observe the rules in relation to exfoliant-free days pre-peel so that the skin tolerates it well. This varies according to the type of exfoliant and product.”
She adds: “I recommend that a client reduces direct UV exposure – both natural and artificial – and applies daily SPF sunscreen in the two weeks leading up to a peel to ensure melanin production is at baseline according to their skin type. This helps reduce the risk of hyperpigmentation developing post-peel.”
Da Costa also states that clear advice and modifications should be presented on everything from retinoid use to scheduling correctly around other cosmetic procedures and treatments. “Effectively managing skin recovery is key to a great result with chemical peels. This is dependent on what is done before, during and after the peel – it is not just about selecting the right acid,” she says.
“Set up for results by putting the right procedures in place and you will reap the benefits, not only in results but in a loyal client following, too.”
How can I get optimum results for clients from chemical peels?
“Chemical peels are predominantly used for their exfoliating properties and influence on instigating a mild wound healing response to help with collagen matrix turnover,” says Martine Jarman, aesthetic therapist and founder of SkinGenius Clinic in Warrington.
“Peels are applied to achieve significant results in common skin concerns such as acne breakouts, excessive oil production, photo-ageing, pigmentation and, more recently, effective results for the treatment of reddening and rosacea-prone skin.
“Chemical peels can have substantial effects, comparable to energy-based equipment such as laser or radiofrequency, yet, they are less likely to cause post-inflammatory hyperpigmentation (PIH) when treating skin of colour.”
To achieve the best treatment outcome and manage client expectations, it is necessary to go through a client profiling system at least two weeks before a course of peels. “Client profiling involves a full skin assessment to determine which group of acids and strengths will be most suitable,” explains Jarman. “Sensitivity testing is essential to check for potential adverse reactions to the choice of acid.
“Photographic evidence is necessary to measure results throughout the course. As with any skincare procedure, the client should be committed to an advanced homecare regime using products that contain the same ingredients as those delivered within the peels. Non-compliance with skincare can lead to recovery complications and compromised treatment results.”
She adds: “When you have a range of different protocols rather than one type of peel solution, such as glycolic, you have the opportunity to change the focus of the treatment to target other issues during a course.
“It is very rare that I offer a peel procedure as a standalone treatment. Personalised combination therapy procedures are the core of the SkinGenius Clinic philosophy. In my practice, I find that treatment results are enhanced when combining peels with additional treatment modalities.”
How should I choose which type of chemical peel to use on clients?
Chemical peels are generally divided into three groups, based on the depth of penetration. “A superficial peel will remove the outer layer of the epidermis, medium-depth peels remove skin cells from the epidermis and the mid-dermis level, and deep peels are more aggressive, penetrating to the reticular dermis,” says Sarah Whitehead, key opinion leader for BioRePeel, which is distributed by Shop Beautiful.
“Superficial peels are often called lunchtime peels because there’s rarely any downtime. They are a great introduction for clients who are new to aesthetics and feel nervous. They’ll experience mild to moderate tingling when the peel is applied and will only get light shedding of the skin.”
She adds: “Superficial peels tend to have alphahydroxy acids like glycolic, lactic, mandelic acid, tartaric acids and betahydroxy acids like salicylic, so it’s usually really safe to get these chemical peels every two-to-four weeks, but because they are so superficial, even with a course of three to six, we’re not going to remove really deep lines or pigmentation.”
Moving on to medium-depth peels, TCA (tryichloracetic acid) is one of the most common ingredients used, explains Whitehead: “There are different strengths and they can be blended with other acids, dependent on skin type and the results that we’re looking for. TCAs often feel very hot when on the skin; your client might liken it to sunburn.
“We have to neutralise these peels, and when removed the skin looks red and the patient is quite sore, so people often have a few days off work and get complete healing of the skin within about 10 days. Medium and deep peels are not suitable for darker skin types.”
Whitehead advises that deep chemical peels should only be applied by a medical professional as they are much more aggressive. “Phenol is the most common ingredient and most people who have these need a local anaesthetic. Downtime and redness lasts for up to a month but the effects are fantastic and can last up to 10 years. so it’s often a once-in-a-lifetime type peel.”
What should I consider when performing peels on people of colour?
“Chemical peels are among the most effective and efficient ways to maintain skin health for darker tones, but require a slightly different approach than with light skins,” says Dija Ayodele, owner of West Room Aesthetics and founder of the Black Skin Directory.
“Developing the expertise to successfully and safely treat clients with skin categorised as IV – VI on the Fitzpatrick Scale (IV is defined as skin that rarely burns and always tans, and V and VI as never burns, always tans) will broaden your clientele and reputation as a skin specialist. Here are the six key things to remember when treating these skin types with peels.”
She explains: “Darker skin is more prone to post-inflammatory keloid scarring, which is a contraindication for many treatments that cause trauma to the skin in order to influence regeneration and remodelling of collagen.
“Look at any facial piercings – is there a raised, shiny scar there? Look at the hands, where we often have cuts and nicks – is there any raised, fleshy scarring? If so, ask how it happened and how long it took for the scar to heal.”
Ask about sunscreen use too. “Regardless of skin type, daily sun protection is vital, and even more so when undertaking a course of peels. The use of sun protection must be stressed to the client before treatment and, if necessary, retailed. This is vital, even if the client has very dark skin and thinks they don’t need to use it. A non-compliant client should not be treated with peels,” explains Ayodele.
Ayodele suggests starting with a superficial peel as “in my experience, this is the best route for Fitzpatrick IV – VI,” she says. “Alpha and beta hydroxy acids such as glycolic, lactic, salicylic, mandelic or citric acids give good results either in a pure or blended formulation.
“Clients can have these superficial peels as part of monthly facial treatments to address hyperpigmentation, oil control, pore size, moisture balance, fine lines, radiance and dry, scaly skin. I use lower percentage, high pH formulations until I’m sure the client can tolerate more.”
She adds: “Following that, I can look at higher percentages and layering techniques for more efficient peeling. In addition, modifying the length of time the peeling agent is left on the skin is also helpful.”
Ayodele also suggests priming skin for at least four weeks as “this repairs the acid mantle before peeling, increases the effectiveness of the peel and avoids any complications,” she says. “This is very important to avoid causing excess trauma to the skin and post-inflammatory hyperpigmentation.”
How can I treat the body with chemical peels?
“Peeling on the body uses the same protocol as facial peels. However, only a small area on the body can be treated at one time. This means not applying a peel to any area larger than four hand palms – this is equal to the full face, neck, decolletage, upper back or lower back,” explains Daniel Isaacs, director of research at Medik8.
“We also do not recommend layering body peels, as we want to strive for the best results for our clients and not increase the chance of compromising their skin.”
He adds: “For sun-damaged areas like the hands, glycolic, mandelic and pyruvic acid help to trigger collagen production, smoothing and plumping the skin texture. This can be great for the hands, as they are prone to sun damage due to the thinness of the skin.
“For the decolletage, lactic and glycolic acid can help minimise melanin production, fade pigmentation and prevent the formation of further pigmentation. This makes it perfect for areas with age spots or post-inflammatory hyperpigmentation.”
For clients that are extremely prone to blemishes on the back, Isaacs recommends using Medik8’s Calrity peel as “it uses 40% lactic and 10% glycolic acid to help to unblock pores, minimise the formation of blemishes and promote a clearer complexion – perfect for congested and blemish-prone skin types,” he says.
“Sunscreen is exceptionally important post-peel as skin is more susceptible to UV radiation. Therefore, it is also essential for the body to help speed up the effects of peeling, and to allow the client to reach their skin goals quicker.”