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A chemical peel is a dermatological procedure in which a medical acid solution is applied to the skin for a carefully timed period, removing defined layers of surface cells and prompting the skin to renew itself. Peels are classified by the depth they reach — superficial, medium and deep — and the type of acid, its strength and how long it stays on the skin are chosen according to the problem, the skin type and tone, and the previous treatment history, rather than according to a wish for a faster result. Peels are commonly used for acne and its superficial marks, for surface pigmentation, for melasma as one part of a wider plan rather than a stand-alone cure, for fine lines, for rough texture and enlarged-looking pores, and for darkening of areas such as the neck and underarms. Superficial peels are usually given as a course of closely spaced sessions, while medium-depth peels involve a longer recovery period and are spaced much further apart. The limits of a peel deserve to be stated plainly. A peel does not tighten sagging skin and does not lift facial contours. It does not fully remove deep depressed or ice-pick scars. It does not stop dynamic wrinkles produced by muscle movement. It does not cure melasma permanently, because melasma is a chronic, relapsing condition driven by sun exposure and hormones. And it never replaces daily sun protection — in fact, neglecting sunscreen after a peel can leave the skin darker than it was before. The most important risk to understand is post-inflammatory hyperpigmentation, which is more likely in brown and easily tanning skin and becomes more likely with an inappropriate depth or with sun exposure afterwards. Other risks include stinging, prolonged redness, reactivation of cold sores and, rarely, scarring. For these reasons both suitability and depth are decided by clinical examination and skin-type assessment, and the procedure is postponed when there is an active infection, a wound, or recent use of certain medications that the doctor will ask about.
The doctor examines the skin, determines the skin type and its tendency to pigment, reviews medications, medical history and any history of cold sores, then selects the solution and the peel depth appropriate for your case specifically.
You may be asked to use priming topical preparations for a period before the session and to stop exfoliating products or vitamin A derivatives some days beforehand, while using sunscreen consistently, to lower the risk of pigmentation afterwards.
The skin is thoroughly cleansed and surface oils and make-up are removed so the solution spreads evenly, and sensitive areas such as the corners of the eyes, the nostrils and the corners of the mouth are protected with a barrier.
The solution is applied in layers while the skin reaction is watched moment by moment; application is stopped or neutralised once the intended end point is reached. You may feel stinging or burning that eases with cooling and a fan.
The skin is soothed with a barrier moisturiser and sunscreen, the expected stages and duration of peeling and the warning signs are explained, and the next session is scheduled according to the depth used and the skin response.
Tell the doctor if you use topical or oral vitamin A derivatives, exfoliating products, lightening agents or any prescribed medication, and do not stop a prescribed medicine on your own. Mention pregnancy or breastfeeding, any history of cold sores, keloid or thickened scarring, immune disease, or recent cosmetic procedures in the same area. Stop waxing, depilatory creams and laser hair removal in the treatment area for the period your doctor specifies, and avoid sun exposure and tanning beforehand. Use sunscreen daily in the weeks before the peel, arrive with a clean face and no make-up, and do not schedule the session close to an important event, since redness and flaking are an expected stage rather than a complication.
Do not peel or pull flaking skin with your fingers — this is the commonest cause of dark marks and scarring after a peel. Wash with a gentle cleanser and lukewarm water, use the barrier moisturiser your doctor prescribed generously, apply sunscreen every day and reapply it, and avoid direct sun, sauna, steam, swimming pools and strenuous exercise until peeling is complete. Stop all exfoliating products and vitamin A derivatives until your doctor allows you to restart them. **Seek review immediately if you develop: severe burning that persists after the session, blisters or erosions, spreading redness with skin that feels hot, yellow crusting, pus or fever, painful clustered blisters resembling cold sores, or areas that stay very pale or painful and do not heal.** These should not be waited out or self-treated.
A superficial peel usually takes 15 to 30 minutes to apply and is often given as a course of four to six sessions two to four weeks apart, while medium-depth peels need longer intervals and a longer recovery.
Dr Huda Al Qudah is a consultant dermatologist and venereologist, a Jordan University of Science and Technology graduate and holder of the Jordanian Board. Her …
Dr Reem Mahmoud Al Awadi is a dermatologist and venereologist with the Jordanian Board in the specialty. At her Shmeisani practice, she assesses skin and hair c…
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