Since the days of ancient Egypt, people have been using chemoexfoliation methods, also known as chemical peeling, to rejuvenate skin. The original chemoexfoliant was lactic acid, an active ingredient of sour milk that was used topically by the nobles as part of an ancient skin rejuvenation regimen.
In the Middle Ages, old wine with tartaric acid as its active ingredient was used for the same purpose. Today, these historical chemoexfoliants are known to contain alpha hydroxy acids, which are the active ingredients responsible for the skin exfoliation.
The chemical peel produces a controlled partial thickness injury to the skin. Following the insult to the skin, a wound healing process ensues that can regenerate epidermis from surrounding epithelium and adnexal structures, decrease solar elastosis, and replace and reorient the new dermal connective tissue. The result is an improved clinical appearance of the skin, with fewer rhytides and decreased pigmentary dyschromia.
Modern day chemical peeling originally was promoted by dermatologists, such as P.G. Unna, who first described the properties of salicylic acid, resorcinol, phenol, and trichloroacetic acid (TCA). Slowly, the early practitioners of chemical peels began to develop other peeling agents for varying depths of penetration.
In the 1960s, Baker and Gordon developed a deep peeling agent, which was able to smooth deeper furrows, especially around the mouth. From the 1980s to the present, an explosion has occurred in the mass of research on this subject, with the elucidation of many different types of peels, each for a specific range of problems.
Collagen remodeling is the main reason that chemical peels are able to reduce wrinkles. The process of remodeling involves a reorientation of the collagen in a parallel fashion and begins as collagen is formed following the peel.
The process of performing a chemical peel
An evaluation of the patient by the clinician is necessary to determine the appropriate treatment based on the dermal defect. If it is determined that a chemical peel is warranted, the appropriate agent is selected based on the patient's Fitzpatrick skin type and Glogau's photoaging group, as well as other variables that may affect peel penetration.
The skin should be defatted properly with acetone. Delicate areas that need to be protected should have petroleum jelly applied to the lips, inside the nose, and optionally in the nasolabial fold, medial canthus, and lateral canthus. The correct peeling agent then is applied for the appropriate amount of time.
When performing a combination peel, pouring one agent at a time is advisable because of the ease in which the agents may be confused when poured into similar cups. Then, the peeled area should be neutralized, and the patient should be sent home with proper instructions along with advice to call should any complications arise.
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