Chemical Peel
A chemical peel uses acidic or keratolytic agents applied to the skin to cause controlled shedding of the epidermis and, with deeper peels, part of the dermis. The treatment clears away damaged surface cells, speeds up cell turnover, and remodels the underlying connective tissue.
At Haute-Derma, we don't treat peels as a simple spa service. They are a medical treatment, and each one requires careful choice of concentration, pH, penetration depth, and contact time to get the best results for acne, pigmentation, and skin aging.
Depth Levels of Medical Chemical Peels
How deep a peel goes depends on the agent used, its concentration and pH, how long it stays on the skin, and the condition of the patient's skin barrier.
- Very superficial peel: Affects only the stratum corneum. Smooths and softens the surface and eases mild pore clogging.
- Superficial peel: Reaches from the stratum corneum through the full epidermis, down to the basal layer. Well suited to mild acne, light epidermal pigmentation, and minimizing pores.
- Medium-depth peel: Passes through the basement membrane into the papillary dermis. Strongly stimulates collagen and treats fine wrinkles, stubborn melasma, and shallow scars.
- Deep peel: Reaches the reticular dermis. Produces extensive tissue renewal but requires a very strict protocol because of the risk of scarring and systemic toxicity.
Peeling Agents Used in Clinical Practice
| Agent | Properties & Mechanism | Preferred Uses at Haute-Derma |
|---|---|---|
| Salicylic acid (BHA) | Oil-soluble; breaks down desmosome connections; anti-inflammatory; controls oil | Inflammatory and non-inflammatory acne, oily congested skin, folliculitis |
| Glycolic acid (AHA) | Small water-soluble molecule; keratolytic; boosts dermal collagen | Skin aging, fine wrinkles, hyperpigmentation, rough texture |
| Trichloroacetic acid (TCA) | Coagulates proteins (frosting); deep tissue remodeling | Icepick scars, boxcar scars, sun damage |
| Jessner's solution | Combination of 14% salicylic acid + 14% lactic acid + 14% resorcinol | Mixed hyperpigmentation, persistent acne, priming before laser |
| Mandelic acid / lactic acid | Large-molecule AHAs; gentle action with little irritation | Sensitive skin, skin recovering from steroid damage, darker skin (Fitzpatrick IV–V) |
Clinical Procedure & Reaction Control at Haute-Derma
- Pre-Peel Skin Conditioning For 2–4 weeks before the procedure, patients use products containing a mild AHA, tretinoin, or tranexamic acid. This evens out the stratum corneum so the peel penetrates uniformly, and it lowers the risk of post-inflammatory hyperpigmentation (PIH).
- Application Technique & Reading the "Frost" The doctor watches for protein coagulation, called frosting (a white film on the skin), to judge how deep the peel has gone:
- Pseudofrosting: A white film from the acid itself crystallizing on the skin (typical of BHA).
- Speckled frosting: Light redness with patchy white flecks of coagulated protein, showing that the peel has reached the deeper epidermis.
- Solid white frosting: An even, opaque white layer, showing that the peel has reached the papillary dermis (a medium-depth peel).
- Neutralization & Post-Procedure Recovery For acids that need neutralizing (such as glycolic acid), the doctor applies 10% sodium bicarbonate solution to stop the reaction. The skin is then cooled with cold compresses and treated with a moisturizer containing ceramides and vitamin B5, followed by a broad-spectrum mineral sunscreen.
Managing Complications & Clinical Safety
- Post-inflammatory hyperpigmentation (PIH): The most common complication in Asian skin, caused by excessive inflammation or by peeling off flakes before they are ready. It is managed by stopping strong acids, using a barrier-repair cream, and applying 2–4% hydroquinone or tranexamic acid from the third week after the peel.
- Acne flare-up: Caused by natural purging or low-grade inflammation. It must be told apart from contact dermatitis and is treated with a mild BHA or a topical antibiotic.
- Secondary infection: Most often a herpes simplex reactivation. Patients with a history of herpes should take preventive acyclovir before a medium-depth or deep peel.
