When aging, acne, or sun exposure leave the face with blotches, scars, wrinkles, or lines, skin resurfacing may help the skin look younger and healthier.
With "peel" (from English “to peel”), it’s defined some procedures that induce the destruction of epidermal areas and/or layers of the dermis and the subsequent tissue regeneration process, in order to treat some skin conditions and/or resolve or improve the clinical-aesthetic aspects.(1)
The peel is mainly used in the clinical-aesthetic field(1) and it is possible to draw up a list of the most common cases in which the aesthetic doctor adopts this type of treatment; in particular, among others, we can mention keratosis and stretch marks, dyschromia, acne, seborrheic dermatitis, skin laxity.(2)
The peeling procedure is also a valuable method for the aged skin, photo aging, acne scars and melasma and to improve the skin vitality, tonus and texture.(3)
Peeling procedures to obtain the exfoliation are:
- chemical peels
- mechanical peels
- physical peels
The aim is to remove excess corneocyte buildup, which in turn stimulates cell turnover, resulting in a more polished, smoother, translucent surface(4).
Skin resurfacing a powerful tool that can restore a more youthful and rested appearance to the aging face. It is also used to manage other skin conditions with the aim of homogenizing pigmentation and reducing textural unevenness. Skin resurfacing ultimately aims to enhance a patient's appearance and thus, self-esteem.(5)
The quest to preserve a youthful appearance has persisted for centuries, and recent advances in dermatology have catalyzed the re-emergence of noninvasive techniques. Noninvasive modalities such as lasers, chemical peels, and microdermabrasion remain viable alternatives to successful noninvasive facial rejuvenation.(6)
(1) Labrini G. et al. Peeling chimici: Linee guida. Aprile – Giugno Numero 2.
(2) Molinari P. et al. L’utilizzo del peeling chimico nello studio del medico estetico. L’ambulatorio medico, settembre 2017.
(3) Merita Grajqevci-Kotori and Allma Kocinaj Exfoliative Skin-peeling, Benefits from This Procedure and Our Experience Med Arch. 2015 Dec; 69(6): 414–416. doi: 10.5455/medarh.2015.69.414-416
(4) Katie Rodan, MD, Kathy Fields, MD, George Majewski, and Timothy Falla, PhD Skincare Bootcamp: The Evolving Role of Skincare Plast Reconstr Surg Glob Open. 2016 Dec; 4(12 Suppl): e1152. Published online 2016 Dec 14. doi: 10.1097/GOX.0000000000001152
(5) Kouris A, Platsidaki E, Christodoulou C, Efstathiou V, Markantoni V, Armyra K, Potouridou I, Rigopoulos D, Kontochristopoulos G. Patients' self-esteem before and after chemical peeling procedure. J Cosmet Laser Ther. 2018 Aug;20(4):220-222.
(6) Meaike JD et al. Noninvasive Facial Rejuvenation. Part 3: Physician-Directed-Lasers, Chemical Peels, and Other Noninvasive Modalities. Semin Plast Surg. 2016 Aug; 30(3): 143-50.
There are three different levels of implementation the peeling procedures. Depth of peeling and the concentration of the substance used are based on the level of damage or photo damage and what is expected by the patient. There are three levels of chemical peels: superficial, medium, and deep.
- Superficial peel eliminates the superficial cells of the epidermis by causing the necrosis of the epidermis from granulose to basal layer. These peels stimulate a rapid regeneration of epidermis, eliminate the spots, eliminate the fine lines and improve the wrinkles through the promotions of fibroblasts and regeneration of fibers of elastin and collagen.
- Medium peel is recommended for the skin that is more damaged by radiation to penetrate deeper the product and the improvement to be seen in the middle layers of the skin.
- Deep peel: this procedure is implemented to eliminate deep wrinkles, acne scars and signs of actinic keratosis. Today the application of lasers and dermabrasion procedures are most frequent and eliminate side effects. Since the deep peeling can cause hypo pigmentation or skin whitening and skin changes it is recommended to use combinations of deep and medium peeling.(9)
(1) Rendon MI, Berson DS, Cohen JL, Roberts WE, Starker I, Wang B. Evidence and considerations in the application of chemical peels in skin disorders and aesthetic resurfacing. J Clin Aesthet Dermatol. 2010 Jul;3(7):32-43.
(2) Alicia A O'Connor, Patricia M Lowe, Stephen Shumack, Adrian C Lim Chemical peels: A review of current practiceFirst published:24 October 2017 https://doi.org/10.1111/ajd.12715
(3) Labrini G. et al.Peeling chimici: Linee guida. Aprile – Giugno Numero 2.
(4) Weissler JM, Carney MJ, Carreras Tartak JA, Bensimon RH, Percec I. The Evolution of Chemical Peeling and Modern-Day Applications. Plast. Reconstr. Surg. 2017 Nov;140(5):920-929.
(5) Reserva J, Champlain A, Soon SL, Tung R. Chemical Peels: Indications and Special Considerations for the Male Patient. Dermatol Surg. 2017 Nov;43 Suppl 2:S163-S173. [PubMed]
(6) Chen X, Wang S, Yang M, Li L. Chemical peels for acne vulgaris: a systematic review of randomised controlled trials. BMJ Open. 2018 Apr 28;8(4):e019607. [PMC free article] [PubMed]
(7) Castillo DE, Keri JE. Chemical peels in the treatment of acne: patient selection and perspectives. Clin Cosmet Investig Dermatol. 2018;11:365-372.
(8) Kaminaka C, Yamamoto Y, Yonei N, Kishioka A, Kondo T, Furukawa F. Phenol peels as a novel therapeutic approach for actinic keratosis and Bowen disease: prospective pilot trial with assessment of clinical, histologic, and immunohistochemical correlations. J. Am. Acad. Dermatol. 2009 Apr;60(4):615-25.
(9) Merita Grajqevci-Kotori and Allma Kocinaj Exfoliative Skin-peeling, Benefits from This Procedure and Our Experience Med Arch. 2015 Dec; 69(6): 414–416. doi: 10.5455/medarh.2015.69.414-416