News & Features

Beautiful Skin -- With No Laser

Chemical Peels Staff Report
Medically Reviewed by Joseph A. Mele, III, M.D., F.A.C.S.

CONSUMER BRIEF: Despite the appearance of several new types of lasers each year, plastic and cosmetic surgeons report doing over one million chemical peels in 2004. The 50-year-old procedure helps rejuvenate facial skin and is favored by many.

Beautiful Skin -- With No Laser When Arlene Howard, then 64, set her 2004 wedding date, she decided --despite her seemingly advanced years -- she wanted to be a trophy bride.

“I was marrying a wonderful guy and wanted to look my absolute best on the wedding day,” Arlene told “I also wanted to look as good on the outside as I felt on the inside.”

As owner of Arlene Howard Public Relations in Beverly Hills, she knew a lot about the various plastic and cosmetic procedures because some of her clients were plastic surgeons. So daily, Arlene explained plastic surgery procedures to the media.

“I chose to have a chemical peel -- rather than a laser procedure – because I’ve seen both up close,” Arlene says. “Chemical peels have been around for 50 years and are tried-and-true in my book.”

Well Worth It

Arlene wanted the deep wrinkles and lines on her face removed so she would look younger and more refreshed. While a peel is non-surgical, deep chemical peel patients are nonetheless put to sleep under a general anesthesia. The acid is just too strong for any patient to lie still.

“Recovery from the peel was rough and involved some pain but – like having a baby – the discomfort was well worth it for what I ended up with,” says Arlene who allowed television cameras to film her procedure and recovery which took place at Chanteuse, a Beverly Hills recovery center. “Now, most people say I look about 40.”

Skin peeling techniques work because old, damaged skin is taken off in one of three ways. The outer layer of skin can be ground off by dermabrasion, dissolved by acid or vaporized with a laser.

But lasers and chemical peels remove that old skin in vastly different ways. A laser vaporizes skin fluid, leaving behind dead cells and other debris which must be immediately cleaned away to prevent infection. That leaves an open wound which requires care for three to five days. In addition, a laser may redden the face anywhere from several months to a year.

Slow Loss of Skin

But a chemical peel works differently. Depending on how extensive a rejuvenation the patient wants, the peel causes a slow loss of skin over 24 to 72 hours. In about seven to ten days, healthy, beautiful new skin appears.

“When it’s all said and done, the new face is good to go for the next twenty years,” says Robert Kotler, M.D., the Beverly Hills plastic surgeon who did Arlene’s peel.

Dr. Kotler and Lawrence S. Moy, M.D., chief of dermatology at Harbor-UCLA Medical Center in Los Angles, once studied the difference between lasers and chemical peels on a group of study patients. The surgeons applied a peel solution to one side of the subjects’ faces and then used a laser on the opposite sides. When the surgeons biopsied samples from the subjects’ faces three months later, they found the peel side had resulted in a thicker zone of new skin. The results were printed in a 1999 issue of “Dermatologic Surgery,” a physicians’ professional journal.

Adds Ronald C. Russo, M.D., a plastic surgeon in Champaign, Illinois: “Lasers are extremely expensive – some cost around $100,000 -- which makes it harder for surgeons to hold their fees down.”

Moreover, surgeons must invest time learning to use each new laser.

“You don’t read more about chemical peels because a literal army of public relations people and advertisers loudly bang the drum every time another laser comes onto the market,” says Dr. Russo who also owns and operates lasers in his practice.

However, despite the popularity, chemical peels cannot remove loose or sagging skin, take away deep scars or repair broken blood vessels.

“Generally, patients have three strengths of peels available,” says Dr. Russo. “Light, medium and heavy.” Overall, the actual depth of peeling depends on the amount of time the solution remains on the skin and how many coatings are applied.

Used on all skin types to improve pigment changes, acne scars, wrinkles, age spots, scarring and mild sun damage, superficial peels use acids known as AHA (alpha hydroxy acids.)

Healthier, Radiant Look

Here’s how the process goes:

The skin is gently cleansed, and the surgeon applies the solution with a sponge, cotton pad, cotton swab or brush. Usually, no anesthesia or sedation is needed for the light peel because the patient feels only a mild tingling or stinging. Often, one treatment provides a healthier, radiant look for the patient who can immediately resume normal activities. But a light peel requires the patient to return to her surgeon to maintain the look.

Medium peels penetrate more deeply and remove sufficient skin to cause a sunburned appearance. Medium peels treat mild to moderate wrinkles, moderate sun damage, pigment changes and precancerous lesions. Stronger acids, such as TCA (trichloroacetic acid) are usually used. Medium peels can also require return treatments for freshness.

Beautiful Skin -- With No Laser Phenol is primarily used for deep peels and requires monitoring during its application. On the other hand, TCA can be used for light, medium or deep peels depending on the concentration and technique used for its application.

“The strongest peel uses phenol with croton oil, a chemical which is designed for light-eyed, fair-skinned people who have deeper wrinkles, acne scars, rosacea or a lot of sun damage,” Dr. Russo says. “The deep peel is one of the best techniques plastic surgeons have for removing deep wrinkling and can last a lifetime.”

However, phenol is not used to treat patients with dark, oily complexions and those who may be at risk for heart conditions. Deep peel patients are always given IV fluids and monitored with an EKG because phenol is dangerous to the heart in higher doses, if applied too quickly or over too large an area at once. Experts say an area about the size of a palm is treated every fifteen minutes or so minimize the risk or irregular heart beats, one of the possible adverse side effects.

Special Creams

“After the peeling agent is applied, antibiotic ointments are spread on the treated area to prevent any infections,” says Dr. Kotler. “Afterwards, we follow the patient pretty closely for about three months. For instance, some post-op patients feel tightness around the mouth which can be relieved with some special creams.”

Moreover, deep peel patients are often treated with antibiotics and an antiviral medication to help prevent infections and fever blister formation.

In most cases, a deep peel can only be done once. After application, the skin will peel for about 14 days. The treated area will remain very red and raw for up to two weeks with some severe swelling possible.

“However, the deep peel will not take out the oft-maligned nasolabial lines, those folds of skin that run from the corner of the nose to the corner of the mouth,” says Dr. Russo. “To treat those, I usually use a filler such as Radiesse which will last for one to two years, or the solid implants, Advanta which are permanent.”

Some surgeons do a combined procedure, first performing a classic facelift or eyebrow lift and then doing a chemical peel a short time later. All post-peel patients must use sun block and stay out of the sun as much as possible.

Possible risks include infection, scarring, color and pigment changes in the skin -- which are the same perils involved with any deep resurfacing procedure of facial skin.

Is it all worth it? Just ask Arlene Howard’s 58 year-old-husband, Bryce, who, after admiring his trophy bride for a year, underwent his own enhancements -- a face and neck lift, along with eyelid surgery -- to take about ten years off his own apparent age.

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