A chemical peel is a skin-resurfacing procedure in which a chemical solution is applied to the skin to peel away the top layers. The skin that grows back after a chemical peel is smoother and younger. Chemical peels can be performed at different depths (light, medium or deep), depending on the depth of the skin damage. Deeper chemical peels produce more drastic results, but also involve longer recovery times. Look at the diagram below to see where the different layers are and where different types of peels act on the skin.

A peel is best performed on the entire face for an overall skin rejuvenation, or only in localised areas such as under the eyes for ‘creepy’ lower lids or around the mouth to remove the vertical smoker’s lines. The full-face procedure is performed under general anaesthesia and takes about one hour. The peel requires five to twelve days of recovery depending on the depth of the peel. Localised peels are possible but not on every skin type. In brown skin types they carry the risk that there will be a mismatch in coloration, as a result good judgment is essential. The localised peeling can be to a medium depth at most. The colour takes eight to ten weeks to blend adequately. An excellent location for segmental peeling is the eyelids and the area around the mouth.

What are the advantages?
A peel can produce drastic improvement in skin texture, tone, skin tightness, scars and wrinkles. The croton oil peel is increasingly seen as the number one procedure to truly address the textural changes of the severely damaged skin caused by sun damage, smoking and ageing. When the skin re-grows, it will not ‘remember’ the blemishes that were there before. As the new skin develops, a new band of collagen in the dermis will grow along with a thicker epidermis. The skin is really put back ten years in time, not only in appearance but in structure! By improving the deep structure of the skin, a deep chemical peel results in a drastic and permanent change of sun damaged and wrinkled skin. The end result is a healthier skin that is radiant, smoother and thicker. It is also very effective in the treatment of creepy eyelid skin that is not redundant enough for excision (inferior blepharoplasty).

Main advantages:
Tighter skin – Following a medium or deep peel, patients also show between 15 – 30% facial skin tightening.
Less age spots and pigmentation problems.
Less wrinkles around the mouth, crow’s feet, forehead furrows and cheeks.
The medium and deep peels are impressive for peri-oral wrinkles (those around the mouth) and of the lower eyelids. These areas can be done isolated with much less recovery time.
The medium and deep peels are reserved for patients who are seeking significant, long-lasting effects and who are willing and able to take the time to carefully follow pre- and post-procedure care instructions.

Preparation
The skin needs to be prepared with ointments for six weeks.

Recovery
Superficial peel—four days of recovery + two weeks of redness
Medium peel—seven days of recovery + one to two months of redness
Deep peel—twelve days of recovery + two to three months of redness
Are you a good candidate for a chemical peel?
Health: You must be healthy and not have medical conditions that would impair healing.
Work: You must be able to stay at home for ten to fourteen days. Patients should expect a wet drooping face that needs a lot of continuous slight moistening to prevent crusting, there will also be swelling for a week. After seven to ten days however, the skin dries up and makeup can be applied and patients are able to return to work. You should plan for your recovery week to stay at home with light household work and without seeing too many people.
Protocol: You must follow a prescribed skin care protocol before and after your peel.
Sun exposure: You should limit sun exposure for several weeks before and after your peel and use sunscreen (UV 50).
The procedure itself
General anaesthesia: The procedure is performed under general anaesthesia with continuous heart monitoring.

Skin cleaning: The skin is thoroughly cleaned (alcohol & acetone) before the croton oil is applied to ensure an even take-up.

Chemical application: The peeling solution is applied following the concentrations we clinically decided and mapped down on your facial photo. Immediately after application the skin turns white or ‘frosted’ in appearance.

Antibiotic and anaesthetic cream: Directly after the peel, an antibiotic – anaesthetic cream is applied over all the peeled areas. This ointment is continued by the patient after the operation. The purpose is to moisturise the peeled skin to prevent drying out and crusting, to prevent infection and to provide analgesia.

Transient difficulties during recovery phase:
Milia or acne: Milia (small raised cysts or white spots on the face) can occur during the first six to eight weeks after peeling, and may last from a few days to many weeks. Acne can also develop as treated skin heals due to previous acne or the use of oily creams on newly formed skin.

Changes in skin colour: A chemical peel can cause treated skin to become darker than normal (hyperpigmentation) or lighter than normal (hypopigmentation). Hypopigmentation happens sometimes after a deep peel. Changes in skin colour are more common in people who have darker skin. Hyperpigmentation may be seen during the recovery period. It is transient and responds well to tretinoin and hydroquinone 4%. Sun protection is important in preventing hyperpigmentation, and permanent problems have not been seen when adequate sun protection is used.

Dark spots: Some people develop dark spots in parts of the face. Those spots are signs of hyperpigmentation. If it happens, it is transient (i.e. temporary) and will go away. Best is to continue the daily application of tretinoin- and hydroquinone ointment that you have received before the peeling, starting six weeks after the peeling. Also make sure you avoid long sun exposures and use a sun blocker every morning the first six months after the peeling.

Scarring: Extremely rare but up till now a non-event.

Frequently asked questions
I have been treated for skin cancer on my face for the past three weeks with Efudex topical creme 5%. I would like to know approximately how long I would have to wait before getting a croton oil peel?
Can the croton oil peel be used under the eye area for crow’s feet and wrinkles?
Can a chemical peeling of the whole face also be done without general anaesthesia?
Can I apply makeup after my morning ointments?
What products or procedures should I avoid before a chemical peel?
How long do I need to wait before I can shave again?