Chemical Peels : Depth of Peel Penetration
There are many physical factors that will affect the depth of penetration of your chemical peel: pre-treatment with retinoids, glycolic acid, or other strong AHA products; previous peels; variances in skin density; and thickness of the stratum corneum, and the number of layers of the peel solution applied, to name a few.
We require our clients complete our Patient Profile prior to treatment to ensure we have a full understanding of these factors for each individual client. The information we collect here is used to ensure your treatment may penetrate much deeper than you might have anticipated.
Medium-depth and deeper chemical peels have long been used and can cause blanching (white protein coagulation) that will stimulate a healing response in the skin, which will reveal new skin. Blanching can be the expected and desired end point of higher percentage trichloroacetic acid (TCA) and phenol peels that are performed by physicians. Superficial frosting is a crystal residue of salicylic acid that accumulates on the surface of the skin during treatment. Blanching and frosting are terms that are often used interchangeably and neither are incorrect.
Chemical peels are divided into three categories, depending on the depth of the wound created by the peel. Superficial peels penetrate the epidermis only, medium-depth peels affect the entire epidermis and papillary dermis, and deep peels allow for controlled tissue injury to the level of the midreticular dermis (and sometimes subcutis, if not used properly
Peel depth is typically characterized by the type and concentration of acid contained in the chemical peel solution. The illustration above identifies the general depth of different acid solutions. The penetration of superficial solutions is primarily based on the state of the patient’s skin and the number of layers applied.
Monolayer application chemical peels allow for a more superficial level of anticipated exfoliation, with subsequent multiple layers or “passes” resulting in additive deeper peeling. However, multiple applications or layers of a superficial peel are not the same as a monolayer or single application of a medium-depth chemical peel. Furthermore, time of exposure is inversely proportional to concentration. For example, higher concentrations achieve targeted depth of keratocoagulation in shorter exposure times.
In addition, the associated downtime, healing rate, and potential for side effects are directly proportional to the depth of the peel and inversely proportional to the cosmetic outcome; deeper peels will have longer recovery times and pose greater risks of scarring and dyspigmentation; however, they will also result in more dramatic improvements in skin tone and texture.
If full blanching is achieved, it is likely penetrating to the deeper epidermis and maybe the upper papillary dermis, depending on the patient. The more prominent the white appearance is, the deeper the solution has penetrated (e.g. light grayish appearance is not as deep as a solid white appearance).
The deeper the peel, the more critical post-procedure care becomes. An occlusive barrier product needs to be applied following ablative treatments until the skin is re-epithelialized when the post-procedure kit can be utilized.
The post-procedure kit should be used immediately following superficial treatments. Using The Post-Procedure Solution, Hyaluronic Acid Boosting Serum, and Dual Action Redness Relief for the first three to five days or until flaking has resolved (longer with a medium-depth peel), will ensure optimal outcomes.
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