Deep Chemical Peel

The most powerful deep chemical peel is often referred to as the Baker Gordon phenol peel. This peel containing phenol, croton oil, septisol and water was the standard up until 2000 when a plastic surgeon named GP Hetter published a suite of academic papers revealing a remarkable discovery. Through extensive research Hetter was able to show that in fact, croton oil was the active agent creating dermal change, not phenol. With a seemingly simple innovation, Hetter lowered the concentration of phenol of the classic Baker Gorden phenol peel and varied the concentration of croton oil giving physicians more control and precision. The Hetter formulations, along with high concentration (≥50%) TCA (trichloroacetic acid), are the new standard deep chemical peel formulations.⁴⁵ It’s important to note that a deep chemical peel is not always the appropriate or most effective way to treat an unwanted skin condition, and clients considering a treatment such as a phenol peel should consult with a trusted skincare practitioner before proceeding with a deep chemical peel.

Deep chemical peel recovery time is extensive, but will vary due to factors ranging from the peeling solution used, contact duration, and an individual’s healing response. Commonly, cool compresses are applied to the treated areas followed by the application of a bland ointment. Patients may be instructed to wash the peeled areas with a mild soap three to four times daily, each time reapplying the ointment. This regimen is usually continued for the next 4 to 5 days post-procedure, by which time peeling will likely have begun.⁶ For some cases, a deep chemical peel will be completed with the application of occlusive tape (generally a zinc oxide tape) that remains on the skin for 24-48 hours and is removed by the physician. Then begins a two week healing process with peeling, irritation, crusting and discomfort. In some cases, swelling may persist for up to 3 months after a deep chemical peel, or “phenol peel”,⁷ and atypical flushing may accompany exercise for up to a year.

A deep chemical peel is a medical procedure to be performed only by an experienced physician who has taken the proper precautions to vet the patient before the procedure. Performed correctly on the right patient, a deep chemical peel is intense, but safe. However, there are serious possible complications if performed incorrectly, even as severe as cardiac arrest, and although it is now possible to find deep chemical peel solutions such as phenol peels on the internet, a deep chemical peel should only be administered by trained medical professionals.

A deep chemical peel reaches a depth of .60-.80mm in the skin, which translates to the lowest layer of the dermis, the reticular dermis. A deep chemical peel, most commonly a high-concentration TCA or phenol peel, is capable of creating changes in the skin that persist for 15-20 years. Although healing may take months, the deep chemical peel before and after photos reveal a remarkable difference after just one peel and the results can last up to 10 years.⁸

The deep action of a phenol peel comes at the expense of a very significant inflammation event in the skin and should not be repeated for at least 2-3 years. Most patients that have opted for the dramatic results of a phenol peel or deep chemical peel do not repeat the procedure at all, choosing to focus on other modalities that address factors a deep chemical peel cannot, such as sagging of the skin. Of course, there are some factors, such as severe scarring or very deep rhytids, that may benefit from a repeated deep chemical peel. A qualified and experienced physician should decide if a repeated deep chemical peel is advisable or not. But, as the before and after photos of a phenol peel or other deep chemical peel can attest, a single treatment is often sufficient.

A true deep chemical peel includes solutions of phenol with croton oil or trichloroacetic acid (TCA) in concentrations of 50% or higher.⁹ These peels reach the reticular dermis, the lowest layer of the dermis and will cause significant erythema (redness) and peeling. However, when the peeling occurs after a deep chemical peel will depend upon many factors such as the health of the skin at the time of the deep peel, the technique used to apply the deep chemical peel or phenol peel, and the post-treatment care. While some patients may begin peeling within a few days after a deep chemical peel or phenol peel, for others the onset of peeling may occur later and/or endure longer.

Pre and post procedure care are extremely important in the overall success of a deep chemical peel. Because the deep chemical peel or “phenol peel” reaches deep into the dermis, there is a significant downtime usually lasting around 2 weeks during which time skincare may be limited to a gentle cleanser, simple moisturizer or ointment and sunscreen. After this acute period, skin actives such as vitamin C may be suggested by the performing physician to aid the recovery of the skin, but it’s important to consult with the physician for specific post-procedural instructions after a deep chemical peel and adhere assiduously to their recommendations.

A deep chemical peel or phenol peel is not performed on patients with darker skin tones due to a very significant risk of adverse effects such as scarring and pigmentation. Other factors such as roaccutane or isotretinoin use within the past 6 months, any active inflammation or wound in the peel area, any warts on the face or active herpes breakout will also preclude a patient from receiving a deep chemical peel. Anyone with a history of keloid scarring or skin disorders such as psoriasis and atopic radiation should also forego a deep chemical peel. Finally, patients that are pregnant or breastfeeding should also forego a deep chemical peel procedure.¹⁰

A deep chemical peel is a significant medical procedure with significant discomfort. Different measures to control the level of discomfort always accompany a deep chemical peel. Although it’s up to the practicing physician to determine the proper pain control, oral sedation and pain relievers are common.¹¹ Another factor that influences the discomfort of a deep chemical peel or phenol peel is the time required to perform the “phenol peel.” Multiple safety pauses occur during the procedure to moderate the skin response and ensure that the patient is enduring the deep chemical peel procedure safely. A deep chemical peel on the full face may take up to 90 minutes to perform because of these factors.

Because of the long-standing misconceptions about phenol peel solutions discussed above in “What is the deepest chemical peel?” phenol is often used in stronger deep chemical peel solutions. However, the true peeling agent in a deep chemical peel is croton oil which is capable of reaching the deepest layers of the skin. Although trichloroacetic acid (TCA) peels may come in various concentrations, 50-75% being standard for delivering a deep chemical peel, they are not as predictable in their ablative depth as a phenol peel and have become less utilized due to this unreliability and potential complications.¹² It’s important to note that in certain formulations or with lower concentrations, a TCA peel solution may also deliver results similar to a superficial or medium-depth peel.

A deep chemical peel is capable of reaching the lowest level of the dermis, the reticular dermis. This means that a deep chemical peel or phenol peel, can potentially remove 6 layers of the skin. This explains the longer deep chemical peel recovery time but also the dramatic deep chemical peel before and after photos. Other factors influence the depth reached by any deep chemical peel such as the peel concentration, the patient’s skin type, the preparation of the skin, and the application technique. For example, the reason a deep chemical peel is preceded by a cleanse and the application of acetone is to ensure deeper penetration and even results.

The deep chemical peel recovery time is significant and the judicious application of the prescribed after-care is supremely important to ensure the best possible outcome. The first 24-48 hours the skin will be bandaged and the patient will be using prescribed pain medication to manage the throbbing and burning sensations that are common after a deep chemical peel or phenol peel. In some cases a topical anesthetic may also be prescribed as well as antibiotic to minimize the risk of infection. After a follow-up appointment with the performing physician, the bandages will be removed and specific instructions given for the care of the skin during the deep chemical peel recovery time. The prescribed care may differ depending upon the deep chemical peel used and the intensity, but it general the skin care after a deep chemical peel or phenol peel includes very gentle cleansing of the skin and the application of an ointment (most commonly vaseline) to soften crusting of the skin and provide an occlusive barrier. The total time needed to heal after a deep chemical peel will vary, but patients can generally expect a healing period of 14-21 days.¹³

*Always consult your physician before undergoing this procedure