Practitioners discuss using chemical peels to enhance skin quality
While injectables can give patients the volume, structure and smoothness they desire, they may not provide the ‘glow’ that treatments like chemical peels can produce. Sex and the City’s Samantha Jones’ experience of a burnt face with flaking skin gave chemical peels a bad reputation 20 or so years ago1, but, these days, patients can see big improvements with minimal downtime.
Aesthetic practitioners Dr Beatriz Martín Hernández, Dr Amiee Vyas and nurse prescriber Susan Young share their advice on investing in chemical peels and getting patients on board with treatment protocols.
“The first thing I would say is that optimised skin health is the absolute key component of any treatment within medical aesthetics,” says Young. She explains, “If you haven’t got your patient’s skin concerns under control, then you’re not going to get the best results from injectable treatments. Skin health is the first thing we should be looking at.”
Dr Vyas highlights that chemical peels are a low-investment treatment option for clinics. “If you’re just starting out and have less of a budget, you can provide your patients with significant skin health benefits through chemical peeling,” she says.
Dr Vyas explains that peels can be a great option for those who are nervous of more invasive treatment, as well as those who want to level up on the results they’re already seeing with injectables.
For Dr Martín Hernández, the fact that peels are a non-invasive therapy and can treat so many indications is extremely appealing. “As well as enhancing dull, tired skin, you can address pigmentation, acne, rosacea, skin ageing, scarring and so much more,” she says.
Dr Vyas adds that they can also significantly improve skin laxity, particularly if patients are using them alongside home skincare routines. “At the end of the day, if you’re treating the canvas – the skin – and that is looking fantastic, then everything else is going to look better as well,” she says.
The terminology associated with this treatment can instill fear in some patients, says Young, explaining, ‘chemical’ can be inferred as being dangerous, while ‘peel’, of course, suggests that your skin will peel. While this is the case, the peeling isn’t always that drastic. “If patients undergo a superficial peel, which is always the starting point, they might just have a couple days of flaking,” she says, continuing, “They’re more than likely going to get lovely results, and really quite quickly as well.”
To ease concerns, a thorough consultation, whereby you take a detailed medical history and go through all of the contraindications, side effects and potential complications, is key.
Depending on the patient’s level of concern, peels can feature different ingredients and be applied in varying strengths. Dr Vyas explains superficial peels will work on the stratum corneum and epidermal layers of the skin, so patients won’t see excessive skin shedding. “Depending on the ingredients, these peels can also impact oil control and even skin tone as melanocytes sit in this area,” she says.
Alternatively, a medium depth peel works on the full epidermis and papillary dermis, which will increase skin shedding and patients may leave looking fairly red and swollen, while deep peels, which induce controlled tissue injury further into the reticular dermis, will leave patients experiencing more severe side effects for longer, the practitioners advise.
“Peels that contain alpha hydroxy acids (AHAs) such as lactic and glycolic acid, as well as beta hydroxy acids (BHAs) with ingredients such as salicylic acid, are great for treating acne,” says Dr Vyas. She explains that these are good starting points, as they’ll exfoliate and brighten skin, while tightening pores. “Mandelic acid is a fantastic ingredient for treating acne in dehydrated skin and skin of colour, as it’s more gentle on the skin,” she adds.
Only when you become confident in superficial peeling, should you move to deeper peels, the practitioners advise. “There are different types of trichloroacetic acids (TCAs) available, which will give you more or less peeling depending on what is suitable for the patient,” says Dr Vyas.
When choosing a brand to invest in, Dr Vyas recommends researching the clinical evidence each has and considering whether they would best treat your demographic’s concerns. She says it’s also worth investigating how much training and support is on offer from the provider. “Even with peels, it’s important you optimise the skin quality through skincare prior to treatment,” she says, adding, “Look for those brands offering the supportive preparatory skincare and you’ll then be able to create protocols alongside your peel treatments.”
It is vital that practitioners also pay due consideration to treating skin of colour with peels, as it can be more challenging. Dr Martín Hernández says, “You can cause more damage by worsening hyperpigmentation, for example. Do your research and ensure the products you invest in have been tested on darker skin types.”
Dr Vyas uses the NeoStrata ProSystem as she appreciates the safety data of the range, and the fact that the peels have been tested on multiple skin types. “The retinol peels do result in some shedding, but this is relatively short-lived and results are equivalent to those I have seen with medium peels,” she says, adding that with the NeoStrata ProSystem peels, there is no shedding and patients can go straight back to work or to a special event.
For deeper peeling, Dr Vyas recommends the Obagi Blue Peel that uses TCA to tackle acne scarring, deeper pigmentation, skin laxity and wrinkles. With downtime lasting up to two weeks, she says this is better for patients who don’t have work commitments or are happy to accommodate longer, more aggressive side effects.
For Young, PCA Skin is her brand of choice. She says, “They offer peels for all skin conditions, so we can create bespoke treatment plans for all patients.” Young highlights that the NoPeel Peel is a good starting point, explaining, “It’s got a high level of lactic acids, which bind to arginine creating a slow release, rather than blasting the skin with a strong acid. It also contains gluconolactone, which increases cell turnover, and salicylic acid, which is great for acne and oily skin.”
For more advanced peeling, Young recommends a Sensi Peel. “This is really good for patients with particularly sensitive skin,” she says, explaining, “It’s a 6% TCA blended peel, with lactic acid that helps to inhibit melanogenesis. Silymarin and emblica are also included, which are powerful antioxidants that help manage inflammation and discolouration.”
Going deeper, Young notes that the Ultra Peel is a great option. With the same ingredients as the Sensi but double the strength, this peel can really tackle more advanced ageing concerns and scarring, she says.
Prescription-only peels could also be an option, with Young highlighting that these are her favourite. “In the prescription range we have 4% and 6% pure retinol peels. Of course they are blended, so we can flood the skin with beneficial actives such as marigold, silymarin, olive fruit oil and vitamin E, as well as tackling skin concerns with this high-strength protocol,” she explains.
Dr Martín Hernández offers the V-Carbon Peel System to her patients. “I like it because of its unique properties,” she says, explaining, “It’s carbon activated, which purifies and detoxes the skin, while its active peeling ingredients – ferulic acid, mandelic acid and lactic acid – work to brighten, regenerate and reduce inflammation of the skin.”
This enables the peel to treat open pores, acne and pigmentation, notes Dr Martín Hernández, highlighting that patients find it is almost like having a facial. She says, “This is a really nice thing to say about a peel because, yes, there will be flaking and a bit of dryness, but the immediate effects are brightened, detoxified skin that satisfies patients!”
Some practitioners recommend avoiding peeling in the summer months, however Young says, “We can use any of the peels, particularly the more gentle peels as long as patients are educated around the ‘non-negotiable’ use of SPF and keeping out of the sun as much as they can due to the possibility of pigmentation.”
Before you administer a peel, the practitioners advise investigating your patient’s current skincare regime. Young says, “We will tell patients to avoid using actives such as retinols or AHAs prior to treatment, and may also get them on a redness-reducing serum or a really good cleanser such as Dual Action Redness Relief, which is high in niacinamide to help improve the barrier function and reduce transepidermal water loss, along with InflaShield, which is a patented ingredient that reduces sub-clinical inflammation. This product is great to help prep the skin for a peel,” she says.
Dr Vyas also recommends finding out more about any cultural products or practices patients engage in, which is particularly common amongst those with skin of colour. Questions she suggests asking are, “Do you do a lot of exfoliation/scrubbing of your skin? Do you use lemon juice? Do you use any products that I may not be familiar with?” It’s also advisable to consider the use of hair dye and how often patients are dying their hair or using treatment on it, as the ingredients could negatively react with the peel. Dr Vyas says, “This is of course relevant for everyone, but we find that in patients with skin of colour there is a lot more usage.”
Skin should be prepped for a couple of weeks prior to the peel, with Dr Vyas highlighting that she adds two weeks more for skin of colour patients, which she says can make a significant difference. “Putting your patients on products that contain poly hydroxy acids will help strengthen the skin barrier, ahead of adding stronger or more exfoliating ingredients, which is particularly important in darker skin as it’s more prone to dermatitis,” she adds.
When it comes to performing the peel, the practitioners highlight how important it is to always follow the product’s protocol, no matter how many treatments you’ve performed with other brands. “Protocols from one brand won’t be the same as others, so do not mix them up,” says Dr Vyas, adding, “A patient’s skin may also have gone through a change since the last time they saw you, so it’s always important to start at the lowest strength and follow the protocol to avoid unwanted side effects.”
So how often should you peel patients’ skin? “It depends on the type but, usually, one superficial peel isn’t going to solve all of your patient’s skincare problems,” says Dr Vyas. Young agrees, emphasising that she would never recommend a singular peel unless it was deep, and will offer more treatments if a patient has significant ageing concerns, and fewer to those with sensitive skin. They agree that educating patients on what to expect is essential, as it isn’t an overnight treatment.
The practitioners advise spacing superficial peels about one month apart and offering a course of between three and six, depending on the patient’s concern and budget, with a maintenance peel every three months. “You would normally start to see a glow and improved hydration after the first couple, but patients will need to wait approximately three months to see improvement in specific skin conditions such as hyperpigmentation or acne,” explains Dr Vyas, noting that this will, of course, be improved if patients stick to their home skincare routine.