Chemical Peeling

Chemical peeling is a skin treatment in which a chemical solution is applied to the face, neck, or hands to remove the damaged outer layers of skin and reveal fresher, smoother skin underneath.

The chemical solution works by breaking down the bonds that hold dead and damaged skin cells together. Over the following days, that outer layer peels away. The body then replaces it with new skin that is typically more even in tone and texture. Depending on how deep the solution penetrates, the treatment is described as a superficial (surface-level), medium, or deep peel — and each level treats different skin concerns.

Dermatologists use chemical peeling to treat a range of skin conditions where the surface layer of skin has become damaged, discoloured, or uneven. The right depth of peel is chosen based on the specific condition and the patient's skin type.

• Acne (pimples and breakouts) and the dark marks or scars they leave behind
• Melasma (patches of brown or grey-brown discolouration, often triggered by sun or hormones)
• Post-inflammatory hyperpigmentation (dark spots left after skin inflammation or injury)
• Sun damage, including sunspots and an uneven, rough skin texture
• Fine lines and wrinkles, particularly around the eyes and mouth
• Dull or rough skin texture that has not responded to topical creams
• Mild to moderate acne scars
• Seborrhoeic keratoses (harmless, rough, wart-like skin growths) in selected cases

Chemical peeling is not suitable for everyone. A dermatologist will assess whether the treatment is appropriate. It is generally avoided in the following situations:

• Active skin infections, open wounds, or severe active acne
• A history of keloid scars (thick, raised scars that grow beyond the original wound)
• Skin that is currently being treated with certain prescription medications, such as oral retinoids (vitamin A derivatives), because they affect how the skin heals
• Pregnancy or breastfeeding, depending on the chemical agent planned
• Very dark skin tones undergoing deep or medium peels, where the risk of uneven pigmentation is higher — a dermatologist will discuss safer alternatives
• A recent history of radiation therapy to the face

Superficial peels carry very few risks and most side effects are mild and temporary; medium and deep peels carry a greater chance of more significant side effects, and a dermatologist will discuss these with you before you decide.

• Redness, tightness, and peeling of the skin — expected and normal for all peel depths, lasting days to a few weeks
• Temporary darkening or lightening of the treated skin (post-inflammatory hyperpigmentation or hypopigmentation), more likely in darker skin tones
• Prolonged redness (erythema) that may persist for several weeks after medium or deep peels
• Swelling (oedema) of the treated area, particularly around the eyes after a deep peel
• Increased sensitivity to sunlight during healing, raising the risk of new sun damage if the skin is not protected
• Reactivation of the herpes simplex virus (the cold sore virus) in people who have had cold sores before — preventive treatment is usually given
• Scarring — uncommon but possible, especially if post-procedure instructions are not followed or if deep peels are performed on unsuitable skin
• Infection of the treated skin — rare, but more likely if the skin barrier is broken
• Allergic reaction to the chemical agent — rare

Preparation for a chemical peel focuses on getting the skin ready so it heals well and responds evenly. Your dermatologist will give you a personalised plan, but the following steps are typical.

In the weeks before the procedure, your doctor may ask you to use a pre-conditioning cream — often containing a retinoid (a vitamin A compound) or a lightening agent — to prepare the skin. You will usually be asked to stop using certain skin products, including retinoids, exfoliating acids, and abrasive scrubs, for several days before the peel. Smoking and heavy alcohol use are generally discouraged because they slow healing. If you have a history of cold sores, your doctor may prescribe an antiviral (an infection-fighting medication) to take before the procedure to prevent an outbreak. For medium or deep peels, your doctor may arrange blood tests or a general health check beforehand.

Fasting (not eating or drinking) is not usually required for a superficial or medium peel. If you are having a deep peel with sedation (medication to make you relaxed and drowsy), your doctor will give you specific fasting instructions.

The procedure itself follows these general steps:

• Your skin is thoroughly cleansed to remove oil, make-up, and sunscreen.
• Your eyes and, where relevant, your lips and hairline may be protected with a barrier.
• The chemical solution — which may be a mild acid such as glycolic acid, a stronger acid such as trichloroacetic acid (TCA), or a phenol compound for deep peels — is applied evenly to the treatment area using a brush, gauze, or cotton applicator.
• You will feel a stinging or burning sensation during application. This is expected and usually settles within a few minutes.
• The solution is left on the skin for a controlled period. Your doctor watches the skin closely for the expected reaction, called frosting (a white film that indicates the peel is working).
• The solution is then neutralised or removed, depending on the type of peel used.
• A soothing cream or protective dressing is applied to calm the skin.
• For a deep peel, sedation or pain relief is usually given beforehand, and the session may take considerably longer than a superficial peel.

After a superficial peel most patients go home immediately and recovery is quick; medium and deep peels require more careful aftercare and a longer period of recovery at home, and in some cases brief monitoring in the clinic before discharge.

• Sun protection is essential during healing. Treated skin is extremely sensitive to UV radiation (ultraviolet light from the sun or tanning lamps), and sun exposure can cause permanent discolouration. Your doctor will advise on a high-SPF sunscreen and may recommend staying out of direct sun for several weeks.
• Do not pick, rub, or peel the skin yourself. Pulling off flaking skin before it is ready can cause scarring and infection.
• A gentle moisturiser recommended by your doctor should be applied regularly to keep the skin barrier intact and reduce discomfort.
• Avoid make-up until your doctor confirms the skin has healed enough to tolerate it — this is usually several days for a superficial peel and longer for deeper peels.
• Strenuous exercise and activities that cause heavy sweating are typically restricted for at least the first few days, as sweat can irritate healing skin.
• For a deep peel, your doctor may apply a protective dressing that stays in place for several days; wound care instructions will be given for cleaning and re-dressing at home.
• A follow-up appointment is usually scheduled so your doctor can check how the skin is healing and watch for any early signs of complications such as infection or abnormal pigment changes.
• A course of chemical peels is sometimes recommended for certain conditions; your dermatologist will advise whether one session is enough or whether several sessions spaced weeks apart are more appropriate for your skin.
• Maintenance skin care — such as daily sunscreen use and possibly prescription creams — is often recommended to prolong the results and protect the new skin.