Skin Peels

Skin peel, also known as chemical peel is an aesthetic procedure which improves the texture, smoothness and colour tones of the skin by removing the outer layers of skin which may be damaged by age, sun, acne, wrinkles, scarring or pigmentation problems.

The skin is made up of many layers. The deepest layers are where skin cells originate, and as they travel toward the outer layer they become less vital, ending up as the epidermis where they lose their softness and pliability and become cornified. Removing the outer skin prompts the body to generate a new layer of skin cells which are not tainted by the previous skin condition.

Undergoing a skin peel of the face can restore a healthy, youthful glow that cannot be achieved with a Facelift or similar surgical procedures. While a Facelift is performed to improve skin and soft tissue sagging, skin peels work deep within the skin to stimulate the production of collagen and elastin and encourage cell renewal thus improving skin texture and colour tones.

Reasons for Considering a Skin Peel:

  • Reduce facial wrinkles and lines.
  • Improve sun-damaged skin.
  • Correct age spots and pigmentation problems.
  • Lighten scars (especially from acne).
  • Treat precancerous skin lesions.

Types of Skin Peel

The types of skin peels differ based on how deeply the chemical penetrates and what type of chemical solution is used. Factors that may affect the depth of a peel include the acid concentration in the peeling agent, the number of coats that are applied, and the amount of time allowed before the acid is neutralized.

Superficial peels such as alpha hydroxy and beta hydroxy peels usually use liquid containing a mild (dilute) acid (i.e., glycolic, lactic, salicylic, maleic, etc.) and can be used on all skin types. The procedure is painless and without down time. The treatments can be repeated weekly for up to six weeks.

Medium peels such as TCA (Trichloroacetic Acid) involves peeling of the superficial as well as the deeper layers of the skin. TCA is used in various concentration strengths for progressively stronger effects. The most commonly used strength is 35% which removes darker sun spots/freckles, age spots, improves texture, smoothness, skin tone, fine wrinkles, acne scars and open pores.

The Obagi® Blue Peel is a very affective medium peel using a low concentration of TCA mixed with a special blue base, which allows the doctor/nurse to regulate the depth of the peel.

Higher-percentage TCA peels (50%), may require anaesthetic if left on for a longer period of time to produce deeper peeling. TCA peels are all neutralized with water to control their depth. The TCA peel can be used on the entire face or applied in select areas such as the crows feet or lower eyelids. The procedure can be repeated every six to twelve months depending on your indication.

Deep peels such as Phenol peels are much stronger than 35% TCA. They have the main effect of being able to significantly reduce coarse facial lines, and improve skin colour uniformity. Phenol peels were the gold standard in terms of improvement. Recently, however, phenol peels have been replaced with varying-depth lasers since the desired depth of exfoliation can be more precisely programmed. Due to its potency, Phenol peel can have the side effect of mild bleaching of the skin, and is not suitable for dark skinned patients. Phenol peels must be done under monitored IV sedation. Results can often be quite dramatic and permanent.

Skin Peel Procedure

Prior to undergoing a skin peel, you may need your skin prepared to accept the peel. This generally consists of pre-treating the skin for a number of weeks with Retin A or AHA creams. Pre-treatment helps to optimize the beneficial effects of the peel. Also at the time of your procedure, any active skin disease, infection, or acne needs to be under control in order to maximize results.

Superficial peels

Right before the peel your skin is cleansed. The solution is then applied to the skin with a small brush, gauze, or cotton-tipped applicators and allowed to sit for approximately 10 minutes, during which time you might experience a slight tingling sensation. The solution is then washed off and neutralized.

Medium Peel

Medium peels may be applied without anaesthetic, when treating small areas of the face (e.g. lower lids, upper lip, etc…). There is a mild burning sensation with the lighter strength peels (i.e. up to 35% TCA peels). For a full facial resurfacing, you will need sedation in order to minimize discomfort.

Right before the peel your skin is cleansed, the chemical solution is then applied with a cotton tipped applicator. The depth of a TCA peel can be varied by mechanically rubbing the chemical into the skin. At this point, the skin will turn white, a frost-like effect. The skin is then neutralized and cleansed. Ointment is applied at the end of the procedure to minimize discomfort, keep the areas from drying out and aid healing.

The procedure takes about 40 minutes. There is little or no pain after the peel is finished.

Deep peel

Deep peels take the most time and are the most painful type of skin peel. The procedure for a deep peel using phenol is also more complicated than for other types of peels.

You may be given an oral sedative and pain relievers. General anaesthesia may also be used. You may be put on a heart monitor and receive intravenous (IV) fluids during the procedure, as phenol is toxic when absorbed into the body’s systems in large doses and carries a risk of inducing heart rhythm irregularities. These measures may not be needed if only a single, small area is being treated.

After your skin is thoroughly cleaned, the solution will be applied and allowed to penetrate. Phenol will affect the skin to a consistent depth and is not affected by mechanical modification. At this point, the skin will turn white, a frost-like effect. The skin is then neutralized and cleansed. Ointment is applied at the end of the procedure to minimize discomfort, keep the areas from drying out and aid healing. Ointment is washed off with water after 24 hours and then reapplied as needed. Depending on how large an area is being treated, the entire procedure may take 60 to 90 minutes.

Following the Procedure

Generally, post-operative instructions call for plenty of rest and limited movement in order to speed up the healing process and recovery time. Appropriate care of the skin after the peel is very important to speed healing, help results last longer, prevent infection, and avoid colour changes in the treated area caused by sun exposure. Appropriate skin care afterwards typically involves:

  • Cleansing the skin frequently with water
  • Changing the dressing or ointment on the wound (for medium and deep peels).
  • Moisturizing the skin daily.
  • Avoiding any sun exposure until peeling has stopped and sunscreen can be used. After peeling has stopped, sunscreen should be used every day. New skin is more susceptible to sun damage.

Superficial peels are done on an outpatient basis and do not require anaesthesia, and cause only slight discomfort afterwards. Most people can return to their normal activities immediately. The skin heals quickly after a superficial peel. The skin may turn pink, and usually only minimal peeling occurs. You can use makeup to hide any redness until it fades.

Medium peels are also usually done on an outpatient basis, but you may need to take a few days off work to recover. A medium peel causes a second-degree burn of the skin. An ointment and dressings are applied immediately following the procedure to aid in the healing process and to minimize swelling. You will be instructed to keep the areas constantly applied with ointment during the first 1-2 weeks. The skin takes 5 to 7 days to heal to a point where you can use makeup to hide the redness caused by the peel. There is little or no pain after the peel, but there may be some swelling, especially if the area around the eyes is treated. The skin will turn reddish brown in 2 to 3 days, become crusty, and then flake and peel over the next few days.

Deep peel causes a deeper second-degree burn of the skin. Skin regrowth takes between 10 to 14 days after a deep peel. The skin remains extremely red for 3 weeks, or up to 2 months for some people. Most people take about 2 weeks off from work. Complete healing of the skin may take several months.

  • Oral pain relievers may be given to reduce pain after the peel.
  • Some people have severe swelling, especially around the eye area. Elevating the head may reduce the swelling to some extent, and corticosteroids may be used for more severe swelling.
  • You may be given a short course of antiviral and antibiotic medicines to prevent infection after the peel.
  • Appropriate wound care is extremely important after a deep peel to speed healing and prevent infection of the wound. You may be asked to shower several times a day to reduce crusting.

Risks & Complications

Possible risks and complications involved with Skin peel range from disappointment with lack of significant improvement to serious, permanent scarring. However, there are ways to minimize your chances of experiencing a complication.

For further information concerning the risks and complications associated with Skin Peels please refer to Risks and Complications of Skin peels

Alternative treatments to Skin Peels

Medical Microdermabrasion and Laser Skin Resurfacing are alternative techniques used for improving the texture and appearance of the skin. Although these techniques use different methods, they have basically the same effect on the skin,  removing the top-most layer of dead skin cells, thus improving the tone and texture of the skin and also revealing the new, living skin cells that are soft and smooth. At the same time, the underlying epidermis is also stimulated by the treatment and this promotes new collagen, thickening the dermis and improving the resistance to the effects of ageing.

No one technique is necessarily better than the others. However, Laser Skin Resurfacing may be slightly more precise than skin peels or Medical Microdermabrasion. But the choice of technique is based on the area you want to treat, your skin type and condition among other factors. Some patients may achieve the best results using a combination of techniques.

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