Chemical peels have been used in dermatology and plastic surgery for many decades. These peels can be classified as either light peel, medium-depth peels, or deep peels.

Light peels are sometimes referred to as the so-called lunchtime peel, in which a patient can be treated by the physician on a lunch break.

Generally, a buffered hydroxy acid peel of different concentrations is applied to the skin, sometimes in combination with different agents such as salicylic acid or Jessner's solution, which is a combination of salicylic acid, lactic acid, and resorcinol. Depending on the particular combination used, the patient can often return to the office or a social engagement with only very slight or moderate redness.

On the other hand, medium depth chemical peels can take a week or more for the recovery period.

Finally, the deepest peels will take several weeks for recovery, and before undergoing a deep peel, the patient should carefully ask the physician to explain the risks and benefits.

The deepest chemical peel generally used is the phenol peel. Phenol peels can give the most dramatic results, but complications can also be the most dramatic. At the very worst, facial scarring can occur. In almost every case, significant lightening of the skin, which may even require cover up make-up, will occur. Most importantly, phenol has to be applied carefully to the face, one small section at a time by the operating surgeon.

Because phenol may be absorbed into the skin and go into the circulatory system, there is always the risk of disturbance in the rhythm of the heart, and the patient having a phenol peel should always be hooked up to a cardiac monitor during the procedure.

As with laser resurfacing, the beneficial effect of any one chemical peel will often correlate with the depth of damage done to the skin, and for this reason, deeper peels will always result in a longer recovery time and chance of complications.

Every physician has techniques that work best in his or her hands, and should encourage the prospective patient to understand the various peels which can be used, with the risks and benefits of each.

For many years, trichloroacetic acid, alone or combined with other agents, has been the most commonly used agent for facial peeling. Trichloroacetic acid is used in various concentrations. Depending upon the concentration in combination with other agents, the number of coats applied to the skin, and the length of time the peel is left on the skin prior to neutralization, as well as the degree of reaction of the individual patient's skin, the outcome will vary.

In recent years, as time pressures at work and social obligations have increased, many patients require techniques with less recovery time. For this reason, alpha-hydroxy acid peels have gained in popularity.

Alpha-hydroxy acids originally were derived from food and fruit acids. This includes lactic acid present in milk, and glycolic acid, present in many fruits. Alpha-hydroxy acids can be applied to the skin as either buffered alpha-hydroxy acids, in which case the reaction tends to be milder but produces less visible peeling, or unbuffered alpha-hydroxy acid peels, which produce a more visible and immediate reaction.

Alpha-hydroxy acid peels can be used in combination with beta-hydroxy or salicylic acid peels, or the Jessner peel. These combination peels will usually result in some delayed scaling and peeling of the skin, persisting for approximately four days to a week.

In every case, the patient should discuss with the physician the risk of scarring, pigmentary changes, and anticipated recovery time. Before undergoing either trichloroacetic acid peels, Obagi peels, or the phenol peel, the physician should make certain that the patient has not been treated with Accutane for at least one year prior to the peel, since Accutane can produce significant scarring in surgically treated skin.

As with laser resurfacing, all of the peels can produce sensitivity, and for that reason, it is essential that patients take precautions against significant sun exposure for several weeks after the peel.

Again, as with facial resurfacing, any of the stronger facial peels should be preceded by the use of appropriate facial conditioning. This will often include the use of alpha-hydroxy acids or retinoic acids and its derivatives, such as Differin, or Tazorac. Moreover, it appears that the concurrent use of topical Vitamin-C may be helpful in bringing about improved facial texture, and amelioration of facial lines.

Presently, some physicians question the true value of using topical Vitamin-C. It is important to remember that Vitamin-C is an unstable chemical which can break down following exposure to oxygen. For this reason, any topical Vitamin-C solution should be discarded when there is change in the color solution.