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Chemical Peel and Its Implications

Article  in  International Journal of Innovative Research in Medical Science · January 2020

DOI: 10.23958/ijirms/vol04-i12/817

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International Journal of Innovative Research in Medical Science (IJIRMS)
Volume 04, Issue 12, December 2019,
https://doi.org/10.23958/ijirms/vol04-i12/817

Original article

Chemical Peel and Its Implications

Dr Munir Alam
MBBS (KE), FRCS (Ire), FRCS (Ed), FCPS (Plastic Surgery)
International/European Board of Cosmetic Surgery
Associate Professor and HOD Plastic Surgery, Independent Medical College, Faisalabad, Pakistan
Consultant Plastic Surgeon, Faisal Hospital, Faisalabad, Pakistan

Corresponding author: Dr Munir Alam; [email protected]

Received 09 December 2019; Accepted 17 December 2019; Published 31 December 2019

Abstract
Background/Objectives: The chemical peels may be used to help ameliorate the scars, to destroy premalignant and /or malignant lesions,
unsightly pigmentation etc. The treatment modalities used to produce a controlled injury are dermabrasion, chemical peels and photoepilation
(LASER and IPL). Only if the injury is in the proper tissue plane can the desired result be achieved. If too superficial, the results will be
disappointing. If too deep, the results can be catastrophic. Material and Methods: The author has introduced newer formula into the world of
chemical peeling according to the depth of peeling agent penetration.
Superficial Medium Deep
TCA 15 gm TCA 10 gm TCA 35 gm
Croton oil Mandelic acid 5 gm Septisol
Sesame oil Salicylic acid 15 gm Glyserine
Distill water Sesame oil Croton oil
Croton oil Distill water
Distill water
PAKPEEL
This is a prospective study of 3 years from Aug 2016 to Aug 2019. In this study, total number of 216 consecutive chemical peels on 54 patients
over a 3-year period were performed. Age distribution ranges from 20 years to 55 years. Results: The results achieved with these newer
chemical formula are highly satisfactory (80-90%) for almost all skin conditions treated. Conclusion: In our office setting practice, we perform
approximately four sessions of chemical peel weekly and continue skin lightening/spot protection creams and sun protection. This study
corroborate evidence superiority of our selected chemical formula.

Keywords: Chemical, Peel, Munir, skin, resurfacing, scars, pigmentation

Introduction Chemical peels can be done at different depths from light or

superficial to deep depending on desired results (Chart 3). Each
A chemical peel is a skin-resurfacing procedure in which a peel uses a different chemical solution. Deeper chemical peels
chemical solution is applied to the skin to peel away the produce more-dramatic results and deeper skin rejuvenation but
accumulation of dead cells and pigment (melanin) on the surface of also involve longer recovery times (Picture 2,3)[3,4].
the skin, enhancing cell renewal and increasing the moisture The author has introduced newer formula into the world of
content of the skin[1,2]. It also helps to stimulate collagen chemical peeling according to the depth of peeling agent
regeneration making skin healthier. The skin can peel or flake off a penetration.
few days after the peel revealing healthier, smoother and more
radiant skin. Recommended home care products help to stimulate Superficial Medium Deep
skin renewal and sun protection[3,11]. TCA15 gm TCA10 gm TCA35 gm
Chemical peels are used to treat fine lines and wrinkles, skin Croton oil Mandelic acid 5 gm Septisol
discoloration usually on the face but also on the neck, trunk and Sesame oil Salicylic acid 15 gm Glyserine
hands. A chemical peel can be performed alone or in combination Distill water Sesame oil Croton oil
with other cosmetic procedures and results are enhanced if the Croton oil Distill water
correct pre-treatment and post-treatment products are used[11]. Distill water

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International Journal of Innovative Research in Medical Science (IJIRMS

The most common indication includes for superficial PAKPEEL

are melasma, post inflammatory hyperpigmentation, superficial
scars, freckles and ageing spots. The medium PAKPEEL with its
ingredient Salicylic acid indications are mild to severe acne,
freckles, sun spots and blemishes. The deep PAKPEEL commonly
used for deep hyperpigmentary spots, scars, resistant melasma,
chloasma, post-inflammatory hyperpigmentation, freckles, resistant
ageing spots.

Material and Methods

This is a prospective study of three years from Aug 2016 to Aug
2019 and this study was conducted at Faisal Hospital, Faisalabad, Chart 2: Gender
Pakistan. The inclusion criteria were clients with aging rhytides[7],
pigmentation, acne scarring, ageing spots, premalignant lesions etc. Forty six patients had successful treatment and eight cases were
The exclusion criteria includes noncompliant clients, pregnancy & treated with combined radio frequency (RF) intense pulsed light
breast feeding, if the patient has recently waxed, recent surgery, (IPL) therapy microdermabrasion and chemical peel for acne
recent use of systemic isotretinoine, recent radiation, herpes virus scarring.
infection, allergies to chemicals.
As in all cosmetic procedures, a detailed discussion with the Results
patient emphasizing realistic expectation is critical. Patients should
be explained that skin will not be “perfect” following a chemical This is a prospective study in which fifty four patients were treated,
peel (Picture 2). A modest improvement of 50% to 60% can be out of which 46 patients were treated with various chemical peel
achieved though some may improve more. A careful detailed treatment and eight patients were treated with chemical peel
history should include previous episodes of herpes simplex, prior combined with IPL microdermabrasion for acne scarring. Although
surgeries in the area, cold intolerance, present and prior statistical analysis show the comparison between these two groups
medications, pigmentary problems, a history of wound healing is nonsignificant (p value 0.106), however, clinically satisfactory
following previous surgery and of course realistic expectations, results achieved in the second group of patients.
thorough physical examination and relevant investigation In our office setting practice, the author perform
performed where indicated. approximately four sessions of chemical peel weekly and continue
In this study, total number of two-hundred and sixteen skin lightening/spot protection creams and sun protection. The
consecutive chemical peels on 54 patients over a 3-year period results achieved with these new innovative PAKPEEL are highly
were performed from Aug 2016 to Aug 2019. Age distribution satisfactory (80-100%) for almost all skin conditions treated by
ranges from 20 years to 55 years with a mean age 29 years SD ± using visual analogue scoring system.
7.4 (chart 1).
Discussion
There were 42 females and 12 males patients (Chart 2).
A new patented technology allows Easy Trichloracetic Acid (TCA)
Controls pain to safely give results comparable to a papillary
dermis depth, with a very discreet burning sensation only. Efficacy
has increased especially on pigment problems. As the skin is
dynamic structure, the session of peeling may require a repeat
session almost every six months or yearly to maintain the desired
results[2,4,6].
In comparison to PAKPEEL, the Skin Tech brand is the most
famous and internationally known medium depth chemical peel for
skin regeneration, considered as one of the safest, the most
effective and the easiest peeling. The Easy TCA is used to treat
facial fine lines, photo-ageing, acne problems, acne scars, pigment
problems (hyperpigmentation), melasma, chloasma, keratosis of
hands, forearm and body stretch marks, “ageing spots”, etc[5]
Chart 1: Age Distribution

Chart 3: Depth of Penetration

Agent Superficial Epidermis Deep Epidermis Papillary Dermis Reticular Dermis

1. Superficial

2. Medium

3. Deep

4.Combination of IPL Microdermabrasion

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International Journal of Innovative Research in Medical Science (IJIRMS

Among the superficial chemical peels, the glycolic acid is a natural pigmentation, superficial scars, freckles, age spots etc. It is useful
constituent of cane sugar and the smallest molecule of the alpha- on dyschromia, photoaging, seborrheic keratosis, increases tonicity
hydroxy (AHA) family. and elasticity, increases brightness, and is by far safer and less
In practice, Combined use of Glycolic and Lactic acids to aggressive
exfoliate surface cells and hydrate the skin. This peel revitalises the Medium PAKPEEL contains salicylic acid which is
appearance of photodamaged skin. antiseptic and keratolytic help ameliorate the acne scarring.
Skin ceuticals gel peel SM are formulated to address pore Mandelic acid is non-comedogenic, anti-microbial and soothing
congestion, wrinkles, other signs of ageing. This peel combines effect and is smoothing to skin restoration. Mandelic acid is
Salicylic and Mandelic acids to manage problematic skin and epidermal reactivator, moisturizer with a firming effect.
promote exfoliation. Trichloroacetic acid (TCA) has exfoliating and antibacterial action.
Obagi Radiance Peel is a gentle chemical peel for a healthy, Acne treatment with medium PAKPEEL is a highly advance
bright complexion with a blend of 20% Salicylic Acid, Lactic and therapy for acne. It has been introduced recently, but has done
Glycolic Acid. Nevertheless, chemical peels may result in drastic wonders for the acne issue. It is the most effective treatment ever
complication such as toxic shock syndrome[8]. invented for acne problems and kicks out acne from your skin
Our PAKPEEL Superficial peel contain low dose quicker than any other traditional treatments! In this process, each
trichloroacetic acid (15%) which is a soft peeling continuous and pimple of acne is treated individually for the best and enduring
non invasive cutaneous renewal and is indicated for results.
melasma/chloasma (Picture 1,2), post inflammatory hyper

Picture 1:

A: Before Peeling B: 3 Months after Peeling

C: Before Peeling D: 3 Months after Peeling

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International Journal of Innovative Research in Medical Science (IJIRMS

E: Before Peeling F: 3 Months after Peeling

Deep peel contain high concentration of TCA (35%) is a intensive Deep peeling guarantees a strong and long-lasting cutaneous
peeling, with a whitening and hypopigmenting action. This is renewal with a lifting effect. This is highly indicated for thick skin,
recommended for skin with visibly dilated pores. It is antibacterial, resistant melasma and/or skin with deep hyperpigmented post-
keratolytic action. It has whitening and brightening effect. Sesame burns cars (Picture 3).
oil exfoliate the skin, enhance collagen and elastin
synthesis/remodelling.

Picture 2:

A: Before Peeling B: 3 - 4 weeks after Peeling

C: 5 Months after Peeling

In my experience, we have not encountered with problems such as for hyperpigmentation should be treated aggressively both before
wound infection, this risk may be reduced due to appropriate and after chemical peeling with agents such as retinoic acid,
postpeel wound care. Pigmentary problems are common especially glycolic acid, hydroquinone, kojic acid, or other similar
hyperpigmentation. Hyperpigmentation is inflammatory in nature. compounds. If the hyperpigmentation is deep in the dermis,
It is possible as a result of melanocyte overstimulation secondary to conservative treatment with the listed agents and “tincture of time”
trauma and can develop from acne, chronic dermatitis eruptions, proven the most prudent.
and trauma to the skin by the use of chemical peels. Patients at risk

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International Journal of Innovative Research in Medical Science (IJIRMS

Picture 3:

A: Before Peeling B: 4 Months after peeling

C: Before Peeling D: 4 months after peeling

Perhaps the most dreaded complication of chemical peeling is satisfactory results with the most modern technique of RF IPL
scarring. The deeper the peel the higher the risk of scarring. To combined with newer PAKPEELs.
avoid these complication due to chemical peeling, I prefer to Complications are also more likely with darker skin types,
perform four sessions of peeling weekly taking into consideration certain peeling agents, and sun exposure. They can range from
the response of skin to chemicals and achieving the desired minor irritations, uneven pigmentation to permanent scarring. In
results[12]. However, the deep peeling may result in resurfacing very rare cases, complications can be life-threatening[14,15,16,17,18].
upto the deeper dermal layer. Only the tincture of time and To combat this difficult situation, we have been able to use with
soothing/moisturising lotion and sun protection is necessary to success, combination of RF Intense Pulse Light therapy with
achieve the desired results after the episode of acid burn (Picture microdermabrasion and 35% TCA in a controlled manner with
2). excellent results.
Acne scarring is caused by the body effectively putting “too
much effort” into healing the wounds caused by acne, meaning that Conclusion
there is an excess of collagen built up in the dermis. This collagen
may stay in place permanently creating acne scars. Traditional The art of chemical peel require a well trained and experienced
dermabrasion have been combined with other techniques such as person. The patient should be informed about possible post peel
punch grafting of deeper, wider, ice picks scars trephined using expectation and the time frame to achieve the desired results.
various-sized punches. The tissue is discarded and replaced with Although postpeel wound care responsibility will lie with the
similarly sized punch grafts from normal skin and subsequently patient, the direction comes from the treating doctor. It is important
dermabraded. The results achieved using these techniques are to remember that the skin has been wounded and is in a vulnerable
unpredictable[9]. state. Like any wound healing, it requires careful wound treatment
Dermabrasion was first introduced by Dr Abner Kurtin in and camouflage with temporary make ups for upto three months
1953, a New York dermatologist[13]. This traditional technique post peel recuperative phase. As the skin is a dynamic structure, the
combines a hand engine with either diamond-studded fraises or session of peeling may require every six months or yearly to
wire brushes. It is indicated for scarring especially the acne maintain the desired results.
scarring or photodamage skin. Dermabrasion is extremely
technique dependent. The art of dermabrasion is knowing how Abbreviations
deep to go. If one goes too deeply, scarring will be created, If one
does not go deeply enough, the results will be suboptimal. Light amplification of stimulated emission of radiation (LASER),
However, these complications are most likely encountered with the Intense pulse light therapy (IPL), Trichloroacetic acid (TCA).
use of traditional dermabrader, we have achieved highly

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International Journal of Innovative Research in Medical Science (IJIRMS

Conflicts of Interest [7] Thomas J B, Chemical Face Peeling and Rhytidectomy:

A combined approach for facial rejuvenation, Plastic &
None Reconstructive Surgery: Feb 1962 - Vol 29 (2) 199-207
[8] LoVerme, William E. Drapkin, Mark S et al; Plastic &
Funding Statement Reconstructive Surgery: July 1987 Vol 80(1)115-118.
[9] Grabb and Smith’s Plastic Surgery, 5th Edition pp605,
No financial interest Philadelphia 1997.
[10] Phillip R L, Mark M, Robert Y, Comparison of the Laser
Acknowledgments and Phenol Chemical Peel in Facial Skin Resurfacing,
Arch Otolaryngol Head Neck Surg. 2000;126(10):1195-
DERMASCIENCE pharmaceutical company, Lahore, Pakistan. 1199.
Manufacturer and sole distributor of PAKPEEL. [11] Brian P M, Brad M, Gary M, Gaylon M, The Etiology of
Prolonged Erythema after Chemical Peel, Dermatologic
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