Medium Chemical Peel

A medium chemical peel must reach to the papillary dermis layer of the skin, found at a depth of .45-.60mm, which accounts for the positive medium chemical peel before and after results. But, such action in the skin occurs only with higher concentrations of acids as found in a medium chemical peel solution. A medium chemical peel includes single acid preparations such as 35-40% trichloroacetic acid (TCA). A medium depth chemical peel may also be administered in a variety of acidic blends, wherein two or more peeling components are combined for a synergistic effect. Some examples of a medium chemical peel include a blend of a 35-50% TCA solution with a solution of 70% glycolic acid,5 a Jessner’s peel solution (salicylic acid, resorcinol and lactic) followed by a 35% TCA, and “mini” phenol peel containing 10% phenol with 20% TCA.

The longevity of a medium chemical peel is influenced by multiple factors, many within the control of the patient such as lifestyle, diet, use of sunscreen and skincare routine. In general, the changes seen in a medium chemical peel before and after picture will endure for 6 months to a year.

The strength of a medium chemical peel will vary depending upon multiple factors. In general, the lower the pH of an acidic solution, the higher concentration of H+ and the greater the presence of free acid. The free acid concentration of a chemical peel solution is significant when discussing a medium chemical peel because this component is more lipid soluble and therefore is better able to penetrate the skin. The ratio of free acid versus its counterpart, ionised acid, is known as the pKa of an acid. While it may seem a straight-forward conclusion that a higher concentration of acid with a lower pKa (i.e. higher presence of free acids) would be stronger, other factors such as the solvent and emulsifier used will also affect the “strength” of a medium chemical peel. The following are the most common medium depth chemical peel solutions in dermatological use:
35%-50% trichloroacetic acid (TCA)
35% TCA + 70% glycolic acid–known as the “Coleman peel”
35% TCA + Jessner’s solution (14% salicylic acid, 14% lactic acid, 14% resorcinol)--known as the “Monheit peel”)
80-88% Phenol peel Pyruvic acid, 40%-70%

A medium chemical peel is a significant inflammation and wounding event in the skin and should not be repeated for 4-6 months to allow for complete healing and reepithelialization of the skin, although for some conditions a medium chemical peel may be administered more frequently or alternated with other peels to achieve a specific action in the skin. It’s important to note that many medi-spas or other skincare locations may recommend more frequent visits, such as once a month, for a peel they refer to as a medium depth chemical peel. However, a true medium chemical peel reaches the upper layer of the dermis and should not be performed this frequently.⁷ Often, in the non-medical aesthetic space what is called a medium depth chemical peel is in fact a medium depth superficial peel, or a peel that acts only on the epidermis and does not penetrate the papillary dermis.

As the medium chemical peel before and after photos show, significant change in the skin results from a medium chemical peel that reaches the papillary dermis to the upper reticular layer of the dermis.⁸ It is only natural that this depth of treatment would be uncomfortable. Thankfully, measures are taken to alleviate patient discomfort both during and after a medium chemical peel. Painkillers are de rigeur and topical anesthesia is common. In some cases an oral sedative may be used as well. During the application of the medium chemical peel fans and other cooling techniques will be used to reduce the burning sensation. Some peels may even contain a numbing agent to reduce the discomfort during the medium chemical peel. The experience of a medium depth chemical peel will differ based on the solution used, the application technique, the skin type and the preparation of the skin. Always consult with the performing medical professional for an accurate assessment of procedure discomfort during a medium peel and the measures that may be taken to manage it.

A medium chemical peel may improve the appearance of many of the abnormal pigmentation conditions inherent in photodamage and after internal inflammation triggers such as the hyperpigmentation that may remain after an acne breakout. Conditions such as melasma that result in pigmented blotches on the skin may also benefit from a medium depth chemical peel as the various medium chemical peel before and after pictures will attest. Even freckles may be removed from the action of a medium chemical peel. But for all cases of abnormal pigment in the skin, the dark spots will return if the causal triggers, such as UV damage or an acne breakout, are repeated. To prolong the effect of a medium chemical peel it is essential to practice consistent sun safety and adhere to a healthy lifestyle and effective skincare regimen.

Medium chemical peel before and after care is very important to ensure optimal results. White petrolatum or Vaseline^® after a medium depth chemical peel is the standard recommendation as white petrolatum makes an excellent occlusive for vulnerable, healing skin. Both of these factors are important for skin healing after a medium chemical peel and the general recommendation includes the application of white petrolatum 3 times daily for the first 3 days after a medium chemical peel. After that initial period of 3 days other emollient creams may be recommended. As always, it’s important to follow the post-care prescribed by the professional performing the medium chemical peel as many factors influence both the depth of the peel and the healing process. Strict adherence to the healing protocol will ensure the best medium chemical peel before and after results.

The hot steam produced by the typical shower is not recommended for at least 1-2 weeks after a medium chemical peel. If the water temperature is tepid, it may be safe to shower after 3 days if the area where the medium chemical peel was applied is not exposed to the stream of water. However, there are many different factors that influence the strength and healing time after a medium chemical peel and the practising skin professional should be consulted about all aspects of a patient’s post-care regimen.

The onset of peeling after a medium depth chemical peel will differ according to the peel used, the application method, the reaction of the skin and the medium chemical peel before and after care practiced by the patient. For many patients, peeling begins 48-72 hours after a medium chemical peel and generally completes within 10 to 14 days.¹⁰ Peeling is a natural process that occurs as the damaged tissue is being replaced. It is important to not interfere with the process by picking the skin or removing peeling skin during recovery from a medium chemical peel. Although it may seem “helpful”, these kinds of interventions may interfere with healing and cause scarring in the skin.

The recovery period after a medium chemical peel is focused on preventing infection and expediting the healing of the skin. The healing period will vary, but generally endures 7-14 days.¹¹ Directly after the medium depth chemical peel procedure there may be swelling and discomfort that can be addressed with the use of ice packs. Gently soaking and cleansing the skin along with multiple applications of an occlusive such as white petrolatum for 3 days is often recommended to allow for reepithelialization of the skin. During these first 3 days patients should avoid all sun exposure if possible and use physical barriers such as hats and face wraps. After the skin is reepithelialized, patients may use a physical sunscreen (zinc oxide and/or titanium dioxide) along with a physical barrier such as a hat. Patients should refrain from any picking or peeling of the skin after a medium chemical peel as this may result in injury and scarring. Medium chemical peel before and after care may differ depending upon the patient and the medium chemical peel used. As always, it is important to consult with the skincare professional performing the medium chemical peel as to the proper care post a medium peel.

*Always consult your physician before undergoing this procedure