A Peek into Peels

By Rebecca Jones

Originally published in Body Sense, Spring/Summer 2009.

Nineteen-year-old Lindsay Burks admits she is just a little scared as she reclines on the treatment table and Colorado esthetician Niki Manion’s hands begin working their magic on her face.

“I’m excited, but I’m worried about what this is going to feel like,” Burks says, as she prepares to get her first skin peel.
Manion warns Burks to expect a little stinging and itching. But Burks figures the potential discomfort is just a temporary state of affairs, while freckles and uneven skin tone can last a lifetime. She thinks she can put up with a few minutes of minor irritation in exchange for a better complexion.
Burks is not alone in that assessment. Chemical peels have become increasingly popular over the past few years, with more than 558,000 performed in doctor’s offices in 2007, untold numbers more performed in salons and spas by estheticians, and still more performed by women on themselves in their own homes.
Once a strictly medical procedure, peels entered the beauty industry in the 1980s as a way to rejuvenate aging skin, smooth lines, even out skin tone and fade dark spots, minimize enlarged pores, improve acne, and generally promote overall healthier skin.
“We can’t work miracles with just one treatment,” Manion says. “We recommend a series of six treatments. Even though we don’t do the serious stuff that a dermatologist would do, with a series of treatments we can help you see amazing results.”

So What is It?

Chemical peels involve applying one or more acids to facial skin to remove the outermost layer, called the epidermis. Deeper peels, which involve stronger chemicals that penetrate farther down into the deeper layers of skin called the dermis, are still considered a medical procedure that estheticians may not perform. Technically speaking, the peels that take place in spas and salons across the country aren’t really peels but are a kind of resurfacing.
“Resurfacing is treating the skin so it will speed up the development of cells in the lower layers, and they will come to the surface younger and more healthy-looking,” says Janet McCormick, a Florida esthetician and Comite International Desthetique de Cosmetologie (CIDESCO) diplomate who has written widely on skin care. “Back in the ’80s, people started calling these ‘peels’ because doctors were peeling people. But what estheticians are doing is resurfacing.”
As Manion notes, salon peels are usually done in a series of six to eight treatments every one to two weeks, followed by monthly maintenance treatments. Costs vary according to the amenities of the salon or spa, but typically range from $50 to $75 per treatment, with discounts for multi-treatment packages.
Deeper peels done by medical providers will use more potent chemicals and are substantially more expensive, costing several hundred dollars. The results can also be more pronounced.
In general, peels involve the use of alpha hydroxy acids, which are naturally occurring acids found in fruits and other foods. The most common are glycolic acid, derived from sugar cane, and lactic acid, which comes from sour milk. These acids have a long track record in treating dry skin, hyperpigmentation, and reversing the look of aging, Manion says.
Another frequently used substance, salicylic acid, derived from the bark of the willow tree, is an oil-grabber that helps unclog pores.
Manion uses lactic acid on Burks, who is much too young to be concerned about lines and wrinkles, but could benefit from lactic acid’s tendency to rehydrate the skin, as well as even out skin tone and lighten dark spots.

Common Considerations

Before touching Burks’ face, Manion evaluates her skin type to ascertain which product would do the most good and makes sure Burks has no conditions that would make a chemical peel risky.
And there are certain risks, Manion acknowledges. The chief risk is post-peel hyperpigmentation. If care isn’t taken in the days following the procedure, clients may find themselves developing dark patches on their skin. The skin will be especially sensitive to sunburn for about a week after the peel, and Manion insists that clients agree to wear sunscreen during that time. “We’re opening up the skin and making it sensitive,” she says. “It could be cloudy outside, but the sun can still get through to the skin. That can cause brown spots to develop, and that’s what we’re trying to get rid of.”
Other potential side effects include flaking or scabbing, and clients who are prone to cold sores may experience an outbreak.
Not everyone is a good candidate for chemical peels. Dark-skinned individuals—including olive-toned Hispanics and Asians—are at greater risk for scarring and ought not consider peels, Manion says. “You also want to look out for die-hard sun-tanners, people who want to be outside every day,” she says.
Others for whom chemical peels are not recommended include women who are pregnant or lactating, those who have taken the acne medication Accutane within the past year, those who have used Retin-A or any other form of Retinoic acid recently, those who have had laser resurfacing performed within the past year, diabetics who do not heal quickly, or those who have an autoimmune disease.

Peels at Work

Burks’ treatment begins with a good skin scrubbing to exfoliate and remove all the makeup and oils. That’s followed by a degreasing solution slathered on her face. “We want to make sure her face is a clean slate to put that chemical on,” Manion says. “The degreaser will pick up any leftover oil or makeup.”
Proper skin preparation is critical, says McCormick. “If you’re not careful, it can lead to hot spots,” she says. “That’s where the acid goes too deep, and that can lead to redness and peeling. You want the acid application to be even all over.”
At last, Manion coats Burks’ face with the lactic acid itself, which is a gel consistency Manion brushes on with a fan brush. As it works its way into the skin, it stimulates fibroblasts that produce collagen. The collagen will plump up the skin.
“See how pink she’s getting?” says Manion, two minutes into the acid application. “That’s her skin sending messages saying, ‘I’m wounded! What’s going on? Better send some blood to the surface.’ I’m watching the clock closely. We won’t leave this on for more than five minutes.”
And yes, it itches, Burks says. But it’s not unbearable. On a scale of 1 to 10—with 1 being barely noticeable and 10 being I-want-to-scratch-my-face-off intolerable—Burks puts the sensation at about a 3.
Three minutes later, Manion lays a towel, soaked in cold water, atop Burks’ face and begins to wipe off the acid. The towel is followed by a cooling mask of oatmeal and water, followed by the application of a light moisturizer and sunscreen.

“In the coming week, treat your skin gently,” she warns Burks. “Keep it simple. Use a gentle, mild moisturizing cleanser; nothing that will put more stress on your skin. No acids, no exfoliants. Just moisturizer and sunscreen.”
She also suggests Burks avoid makeup that contains chemical preservatives for a day or so. After that, she can go back to her regular cosmetic routines.
Burks rises from the treatment table with a faint red glow to her skin. The entire process has taken less than 45 minutes and she’s ready to return to work with absolutely no downtime.
“Be prepared for flaky skin for a few days,” Manion warns her. “Things always get worse before they get better. You won’t get rid of all the discoloration with just one treatment, but I think you’ll definitely see a difference in your skin texture, and you’ll have a nice glow.”