Chemical peels explained: types, strengths and downtime

Key takeaways

• Peels are graded by how deep they reach. Depth decides both results and risk.
• Indian guidelines consider superficial peels safe in Indian patients. Medium peels need great caution in darker skin, and deep peels are not recommended for skin types IV to VI.
• Common uses include acne, dark marks, melasma, tan, dull skin, fine lines and shallow scars.
• Preparing the skin for two to four weeks before a peel reduces the risk of darkening.
• Most people need a series of sessions. One peel rarely gives the full result.

How does a chemical peel work?

See, what happens is, the acid loosens the bonds between the dead and damaged cells on the surface. Over the next few days those layers shed, sometimes visibly, sometimes not. The skin underneath is fresher, and over repeated sessions, pigment in the surface layer reduces, pores look cleaner and texture improves.

Deeper peels also cause a controlled injury to the second layer of the skin, the dermis, which prompts collagen remodelling. That is where the stronger effect on lines and scars comes from, and also where the risk rises.

What are the different types of peels?

The Indian standard guidelines of care for chemical peels, published in IJDVL, classify them by depth:

Some common acids, in plain words: - Glycolic acid: the most studied alpha-hydroxy acid. Good for dullness, tan, pigment and fine lines. - Salicylic acid: oil-soluble, so it gets into pores. Useful for acne, blackheads and oily skin. - Lactic acid: gentler, often suits sensitive or dry skin. - TCA: used at low strengths for pigment and, focally, at high strength for deep pitted scars. - Jessner's solution: a combination of salicylic acid, lactic acid and resorcinol.

What can a chemical peel treat?

The Indian guidelines list these indications: - Pigment: melasma, dark marks after pimples (post-inflammatory hyperpigmentation), freckles, sun spots - Acne: mild to moderate acne, post-acne marks, superficial acne scars - Ageing and texture: photo-ageing, fine wrinkles, dilated pores - Surface growths: some keratoses, warts and milia

What peels do not do well: deep scars, deep (dermal) pigment, sagging skin or deep wrinkles. For those, other treatments fit better. See acne scar treatments compared.

Is a chemical peel safe for Indian skin?

Yes, when the right peel is chosen and the skin is prepared. That is very important to understand. Brown skin reacts to injury by making pigment, so the main risk is post-inflammatory darkening.

The American Academy of Dermatology says people with darker skin can safely have peels, but should see a doctor experienced with darker skin, because permanent pigment changes can occur otherwise. DermNet notes that Fitzpatrick IV to VI skin has a higher risk of blotchy pigmentation and raised scarring, and that lighter peels are preferred.

How I reduce that risk: - Choose depth carefully. Superficial peels for almost all my Indian patients. - Prime the skin. The Indian guidelines recommend starting two to four weeks before with broad-spectrum sunscreen, a low-strength retinoid at home and, for people prone to pigment, a hydroquinone cream. - Check for reasons to wait. Active infection, cold sores, open wounds, active eczema or psoriasis, photosensitising medicines, and, for medium and deep peels, isotretinoin within the last six months or a history of keloids. - Start low. The first peel is gentle. We build up if your skin tolerates it.

How many peel sessions will I need?

Normally a series. The Indian guidelines suggest very superficial peels every one to two weeks and superficial peels every two to four weeks. The American Academy of Dermatology says the lightest peels often need three to five treatments, repeated every two to five weeks. Maintenance peels afterwards help hold the result.

DermNet also notes that the first superficial peel may show little visible effect. That is normal. Peels work cumulatively.

What does a peel session feel like?

1. Skin is cleansed and degreased.
2. The peel is applied in an even layer, sometimes in coats.
3. You feel warmth, tingling or stinging for a few minutes. A fan helps.
4. The peel is neutralised or removed after a set time, depending on the acid.
5. A soothing layer and sunscreen go on.

A superficial peel takes about half an hour in total.

How much downtime is there?

• Superficial peels: DermNet says redness and mild swelling usually settle within 48 hours, and most people return to normal activities, with makeup possible after a few hours. Some people see light flaking for a few days. The American Academy of Dermatology gives one to seven days for healing of refreshing peels.
• Medium peels: around a week of swelling, peeling and redness, with mild redness for longer. Most people take a week off work.
• Deep peels: weeks of recovery. Not used for Indian skin types IV to VI.

Basically, plan a superficial peel so that the next two days are not your best friend's wedding.

My chemical peel aftercare guide explains what to do afterwards.

How we approach this at Dr Tvacha

Chemical peels are one of the treatments available at our centres in Thane, Andheri, Bandra and Dahisar. I decide whether a peel suits you, which acid and what depth, only after a skin consultation, and I usually prime the skin first. The Rs 499 skin consultation is the starting point, and the plan, number of sessions and fees are written down before you pay. Read about the Second Layer Skin Plan or find your nearest centre.

Written by

Dr Amit KarkhanisAesthetic Physician · MBBS, Dip. Dermatology (UK) · Reg. No. 2001/02/1124

Founder of Dr Tvacha, practising in Thane since 2005. Leads the weight loss and hair programmes.