This column first ran in Valerie Monroe’s newsletter, How Not to F*ck Up Your Face, which you can subscribe to on Substack.
Q: I always read your blog, and I am so grateful for the information. I’m considering a peel with a plastic surgeon, which I think takes off two layers of skin. Maybe it’s called a T peel? I am interested in any feedback and learning about any risks. I am 68 and blonde. Thank you so much!
A: According to the Journal of Clinical and Aesthetic Dermatology (JCAD), a chemical peel is the third-most commonly performed noninvasive cosmetic procedure in the U.S. There’s been a paradigm shift in recent years, with lasers largely supplanting deep peels. But superficial peels have simultaneously increased in popularity, mostly because they’re relatively mild, have minimal side effects, and generally cost less compared to laser treatments.
I think what your plastic surgeon has recommended, dear reader, is a TCA peel, which is indeed a deep peel and among the strongest available. Is it right for you? I asked dermatologist Dr. Whitney Bowe to share her expertise.
“I offer superficial chemical peels in my practice” she says. “I find them to be especially beneficial for treating acne, improving skin tone and texture, and creating radiance when performed as a series of three to five peels every few weeks leading up to a big event.” Bowe says she also uses superficial peels to treat melasma, a stubborn pigment disorder that often requires a multimodal approach. Superficial peels have minimal downtime and a lower risk of complications as compared to deep peels, especially for patients with darker skin tones, she adds.
Dermatologist Dr. Mona Gohara agrees: “Peels are a dermatologic staple. Great for evening out skin tone, adding radiance, and helping with fine lines or deeper furrows in some instances, and they’re one of my favorite treatments for comedonal acne.”
However!
“Over the past decade, I’ve largely replaced my use of medium- and deep chemical peels with lasers and energy-based devices,” says Bowe. “These devices allow more precision and control, so I can more specifically target certain depths of the skin. My practice is primarily aesthetic and cosmetic, so my patients are interested in seeing the most dramatic impact with the lowest risk possible. From my experience, using these newer technologies allows for great results without much risk of infection or scarring, and with less downtime than is involved with deeper peels. They also allow me to customize the treatment, because I can adjust the laser or device to different wavelengths and intensities.”
Because Bowe is reiterating what’s reported in the JCAD, I wonder whether you should discuss with your physician why a deep peel is the preferred procedure for you rather than a laser treatment or series of treatments. Among the questions I’d ask:
- What does the peel accomplish in terms of rejuvenating the skin?
- Are the results variable depending on skin type and condition? What results might I, specifically, expect from the procedure?
- Please explain the procedure in full: What chemicals are used, how long does the procedure take, and what might I expect to feel in terms of discomfort?
- How long is the downtime, and what does it entail? What follow-up care is required and for how long?
- What are the risks involved? Is there any risk of scarring or hyper- or hypopigmentation?
- Is there another treatment (with a laser, for example) that might give me comparable results with less or no downtime?
I’d ask these questions days before the procedure, so I could decide whether to go forward without feeling rushed. The clearer you are about your expectations, the happier you’ll be with the results — no matter which treatment you choose.
Originally published on July 16.
