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  • Improvement in skin quality and texture may be seen with the use of chemical peels, laser and light devices, dermabrasion, and skin needling.

  • All approaches share the common mechanism of controlled wounding and stimulation of a healing response in the skin.

image Beginner Tips

  • Use a pre-peel regimen of either topical tretinoin or hydroquinone cream to improve efficacy and outcomes.

  • Be consistent in application technique and document all the parameters of the treatment process (pre-peel regimen, degreasing regimen, and peel regimen) to achieve consistency and predictability in results.

  • Feather the peels around the hairline and the chin to prevent a sharp demarcation, particularly with medium and deep peels.

image Expert Tips

  • Medium-depth chemical peels are an excellent modality for the treatment of diffuse actinic keratoses.

  • Multiple studies have shown that a combination approach using a topical regimen with serial chemical peels can improve melasma.

  • Phenol peels have also been used as an adjunct to, or a less invasive alternative to, blepharoplasty.

image Don’t Forget!

  • When applying the peel, numerous parameters such as the pretreatment regimen, degreasing regimen, type of application, length of peel application, and end-point should all be considered and documented.

  • Pretreatment with topical tretinoin daily for 2 weeks prior to the procedure results in a more rapid, uniform, and even frosting of the skin compared to no pretreatment.

image Pitfalls and Cautions

  • Evaluate for any areas of inflamed skin on the day of treatment. These regions will have greater uptake of the peel solution and may create a deeper than intended reaction.

  • Be cautious when using newly opened chemical solution bottle for the first time. The clinician should be particularly vigilant about clinical endpoints. On rare occasions, the concentration advertised on the label may not be accurate.

image Patient Education Points

  • The consultation appointment is key in establishing rapport and realistic expectations, including that a series of treatments may be needed.

  • Patient selection is critical given the discomfort, extensive healing process, and potential for adverse events associated with phenol peels.


Chemical peels are a fast, reliable, effective, and inexpensive method of wounding the skin under controlled conditions to induce skin regeneration.1 In trained hands, chemical peel solutions can be used to treat a diverse array of concerns including acne vulgaris, actinic keratosis, melasma, and photodamage. Scientific research on the effect of these peels is challenging given the cosmetic nature of these procedures and difficulty with obtaining biopsy samples from facial locations. The number of peels on the market also increases annually with new concentrations, formulations, and combination agents available. In addition, variations in application technique between clinicians and variations in patients’ response to wounding make extrapolation of results unreliable.

Chemical peels are generally classified according to the relative depth of wounding (Table 26-1). Very ...

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