Chemical peel: what to expect from the day, the flaking and the following weeks

"Will I be peeling for a week?", "Can I go to work the next day?", "What if my skin gets darker?". These are the most frequent questions before a chemical peel, and they all have the same answer: it depends on the depth of the peel and on your skin.

The chemical peel is one of the oldest and most studied aesthetic treatments. Used with judgement, it improves tone, texture, some dark spots and acne. Poorly indicated or poorly cared for afterwards, it may irritate, cause dark marks or, with deeper peels, leave a scar. The difference between the two scenarios lies almost entirely in the preparation and the aftercare, that is, largely in your hands. This guide describes the whole journey: the assessment, the day of treatment, the peeling day by day and the following weeks.

What a chemical peel is

A chemical peel consists of applying one or more acidic substances to the skin, in a controlled way, to cause the removal of surface cells and stimulate renewal. The skin reacts as to a small, controlled injury: it flakes, regenerates and, with deeper peels, produces some new collagen.

The factor that most determines everything else (effect, recovery time and risks) is the depth:

The same acid can give peels of different depths depending on the concentration, pH, contact time, number of layers, skin preparation and area of the face. That is why two "glycolic" peels can have very different recoveries.

This article focuses on superficial and medium peels, which are the ones used in facial aesthetics. Deep peels are a medical procedure with their own monitoring and fall outside the scope of this guide.

Before the peel: assessment and preparation

The assessment

A good peel begins before the bottle is opened. In the prior assessment, the professional should find out:

• The goal: dark spots, acne, texture, fine lines. The type of peel is chosen from the problem, not the other way round.
• Your phototype: darker skin has a higher risk of post-inflammatory hyperpigmentation and calls for gentler peels and careful preparation.
• History of cold sores: peels can reactivate the virus. With medium peels, or in people with frequent outbreaks, the doctor may prescribe a preventive antiviral.
• Medication: oral isotretinoin (current or recent), topical retinoids, photosensitising medicines, anticoagulants.
• Tendency towards keloid scars or dark marks after minor wounds.
• Current state of the skin: wounds, active eczema, inflamed rosacea, recent sunburn.

Contraindications and situations that call for postponement

• Active infection in the area (herpes, impetigo, warts).
• Open wounds, active dermatitis, sunburn.
• Pregnancy and breastfeeding: some acids are not recommended at these stages; the decision, if any, is medical and restricted to very superficial options.
• Intense sun exposure planned in the following weeks (beach holidays, outdoor sports).
• Unrealistic expectations: a peel does not eliminate deep wrinkles or sagging.
• Oral isotretinoin: for decades, it was recommended to wait 6 to 12 months after the end of treatment. A 2017 expert consensus concluded that the evidence does not support postponing superficial peels, but the decision should be medical and prudent, especially with medium peels (Waldman et al., 2017).

Preparing the skin

In many cases it is recommended to prepare the skin for 2 to 4 weeks beforehand, for example with a topical retinoid, a gentle acid or a depigmenting agent, especially on skin prone to dark spots. The aim is to even out the penetration of the acid and reduce the risk of pigmentation. The evidence for this preparation is mainly practical and consensus-based, but it is widely used.

In the days immediately before, the usual advice is:

• Stop retinoids and exfoliants 3 to 7 days beforehand, as advised.
• Do not wax, use laser hair removal or use depilatory creams on the area in the week before.
• Avoid the sun and use sunscreen daily.
• Arrive with clean skin, without make-up.

On the day: how the session goes

A superficial peel session typically takes between 30 and 45 minutes. The usual steps:

1. Cleansing and degreasingThe skin is cleansed and degreased so that the acid penetrates evenly.
2. Protection of sensitive areasThe corners of the eyes, the sides of the nose and the corners of the mouth can be protected with an occlusive ointment, because the product accumulates there more easily.
3. Application of the acidWith a brush, compress or cotton bud, area by area, in a defined order.
4. Contact time and observationThe professional observes the skin continuously: redness, and with TCA peels a whitening (the so-called "frosting"), indicate the depth reached.
5. Neutralisation or removalSome acids (such as glycolic) have to be neutralised or removed after a certain time; others (such as salicylic, Jessner and TCA) are self-limiting.
6. Soothing product and sunscreenAt the end, a soothing cream is applied and, if it is daytime, sunscreen.

What it feels like: stinging, prickling or heat, more intense in the first minutes, which are usually well tolerated with superficial peels. A small fan helps. With medium peels the stinging is stronger and may justify pain relief. Always tell the professional if the discomfort is much greater than expected, because it may be a sign of uneven penetration.

On leaving: with superficial peels, the skin is pink, as after a windy day, and may be slightly shiny or tight. Most people resume their activities the same day. With medium peels the skin is red, sometimes swollen, and starts to darken the next day.

Day by day: the peeling

Peeling is the most visible part, and the one that causes most concern. It is important to know two things: the absence of peeling does not mean the peel did not work (especially with very superficial ones), and flaking more does not mean better results.

Superficial peel (the most common)

Medium peel

With medium peels, plan your week: most people prefer to have no social engagements until the peeling has finished.

Itching

Some itching during peeling is common and a sign of healing. Moisturising and applying cold compresses helps. Intense itching, with spots or increasing redness, should be reported to the clinic: it may be a contact dermatitis to a product applied afterwards.

Aftercare for peels: what to do and what to avoid

In the following days, the skin is rebuilding the skin barrier. Anything that irritates it or exposes it to the sun slows this process and increases the risk of dark marks.

To do

• Cleanse gently, with lukewarm water and a mild cleansing gel or milk, without rubbing. Dry with dabs of a clean towel.
• Moisturise frequently, with a simple cream, fragrance-free and without actives, as often as the skin asks. With medium peels, a more occlusive ointment may be advised in the first few days.
• Protect your skin from the sun every day, with a broad-spectrum sunscreen of SPF 50, reapplied every two hours if you are outdoors. A hat and shade complete the protection. On skin prone to dark spots, a tinted sunscreen adds protection against visible light. See Tinted sunscreen: how to choose and how to apply.
• Sleep on your back for the first nights after a medium peel, with a clean pillowcase.
• Follow the schedule given to resume your usual routine.

Avoid

• Pulling, picking or scratching off the flaking skin. It is the most common mistake and the one that most often causes dark marks and, with medium peels, scars. If a piece of loose skin bothers you, cut it with small, clean scissors, without pulling.
• Retinoids, acids, pure vitamin C, exfoliants and brushes until advised otherwise (usually one week for superficial peels, longer for medium ones).
• Direct sun, sunbeds, sauna, steam bath and chlorinated pool during the peeling.
• Intense exercise in the first 24 to 48 hours, because heat and sweat increase stinging and redness.
• Make-up in the first 24 hours after superficial peels, and until the peeling has finished after medium ones.
• Hair removal and other treatments in the area until the skin has fully recovered.
• New products at this stage: it is not the time to experiment.

The following weeks: results and number of sessions

When the results show

When the flaking from a superficial peel ends, the skin usually looks smoother and more radiant. It is a real but partial effect: dark spots, acne and texture improve progressively, over several sessions. With medium peels, the improvement in sun spots and texture is more noticeable in a single session, but can only be properly appreciated when the redness disappears, after weeks.

How many sessions

• Superficial peels: generally series of 3 to 6 sessions, 2 to 4 weeks apart, depending on the indication and tolerance.
• Medium peels: one session, possibly repeated months later.
• Maintenance: in chronic conditions such as melasma or acne, results depend on the routine at home and sun protection. Without them, the improvements fade.

What a peel does and does not do

The best time of year

Autumn and winter are traditionally the preferred seasons, because there is less intense sun exposure. But with rigorous protection, very superficial peels can be done throughout the year. What should be avoided is having a peel before a beach or snow holiday.

Complications and warning signs

With well-indicated superficial peels, complications are uncommon and usually mild. The risk increases with depth, on darker skin and when aftercare is not followed.

Possible complications:

• Post-inflammatory hyperpigmentation: the most frequent, especially in darker phototypes or with early sun exposure. It can usually be treated, but requires patience.
• Prolonged redness, more with medium peels and on sensitive skin.
• Reactivation of herpes, with small clustered, painful blisters.
• Bacterial infection, rare: yellowish crusts, increasing pain, pus.
• Contact dermatitis to products applied afterwards.
• Acne-like eruption or milia (small white cysts), usually temporary.
• Hypopigmentation and scarring: rare with superficial peels, more associated with medium and deep ones or with infections and picking.

At Luxmed, each peel begins with an assessment of the skin and the goal, with the acid and depth chosen to suit your phototype. You receive written instructions for the following days and a direct contact if you have questions during the peeling.

This article is for information purposes and does not replace a medical consultation. The results of any treatment vary from person to person.

Frequently asked questions