In 1958 two renegade plastic surgeons in Miami, Florida, noticed that people with flash burns to their faces healed with fewer wrinkles. At the same time, they learned of women in Hollywood salons who painted the faces of their clients with a chemical that erased wrinkles.The young physicians experimented with deep chemical peeling on animals and then on themselves. Twenty-nine years later, when I was Dr. Thomas Baker’s cosmetic surgery fellow, he still illustrated that story by showing the spot on his arm where he bravely performed the first deep chemical peel.The results were so dramatic and so revolutionary that other plastic surgeons refused to believe them. It wasn’t until the doctors brought a patient to the annual meeting of the American Society of Plastic Surgeons that other plastic surgeons accepted the technique. Baker and Dr. Howard Gordon opened up an entire field of plastic surgery that culminated in 556,000 chemical peels in the United States in 2005!Peels and Lasers Are Methods of Fooling the Skin into HealingVirtually all methods of nonsurgical wrinkle control have one thing in common: they wound the skin. This starts a complex series of events, which ultimately leads to healing. The skin heals by making new epidermis and shrinking the dermis. The body races to close the wound before bacteria can enter and cause infection.Shrinking skin, however, can lead to deformities. But the body values life before function. When surgeons injure the skin to decrease wrinkles, it responds by pumping out new collagen and elastin. Virtually every known chemical and almost every known electronic device that decreases wrinkling injures the skin and fools it into healing and shrinking. And so, the science of wrinkle reduction is the science of wound healing.Deep Chemical PeelsDeep chemical peels use a solution containing phenol (the substance in Chloraseptic sore-throat spray) mixed with water, the caustic agent croton oil, and soap. The mixture is applied to the face slowly, because rapid peeling can cause irregular heart rhythms.The peel is painless because the phenol numbs the skin in much the same way that Chloraseptic soothes a sore throat. Phenol is actually carbolic acid, an antiseptic that was first used by Joseph Lister. It causes the upper layers of skin to peel off. The face swells like a pumpkin for about a week. But when the skin finally heals, it is remarkably smoother. Not only does this peel shrink the skin, it also causes the body to make new, healthy-looking collagen. For nearly three decades, the Baker-Gordon deep chemical peel was the best method to lessen wrinkles. As an added benefit, the peel decreases the chance of future skin cancers by removing sun-damaged cells. Profound skin lightening makes this peel less useful on people with any degree of brown color in their skin.The terminology is a little confusing, because skilled doctors can alter the depth of the peel. Deep peels can be performed lightly and, as you’ll learn, light peels can be performed deeply.Deep Chemical Peels Are the ‘‘Two-Week Peels’’Before the peel, the skin is treated with tretinoin to make the skin more uniform, and with hydroquinone to decrease brown pigment. Peels are performed in the operating room, with an anesthesiologist present to administer sedation or general anesthesia.After the skin is cleaned with acetone, the peel is applied slowly. The skin immediately turns a stark white color, a process called ‘‘frosting’’ by surgeons. A thick layer of moisturizer is placed on the skin. If the peel is performed while the patient is awake, it is not necessary to numb the skin.While the deep peel does not hurt when it is applied, it does cause enormous swelling of the face. Within minutes, the skin starts oozing blister fluid. Repeated cleaning of the skin, with either a hydrogen peroxide solution or a weak vinegar (acetic acid) solution, is necessary to dissolve the crusts and keep the skin soft. If crusts are allowed to form, the patient’s misery level will be even greater. The crusts crack when she is speaking or eating, causing bleeding and delaying healing.After cleaning, a thick layer of a moisturizer is applied. I prefer Crisco shortening, made with all-vegetable oil. It is gentle on the skin, inexpensive, and has a low chance of allergic reactions. (And if there is any left over after you heal, you can bake with it!) Alternatively, a lighter moisturizer, squalene, made from olives, can be used.The face heals in seven to fourteen days, leaving the skin beet red. Until the skin is healed, there is a significant amount of pain, requiring narcotics such as codeine. Makeup can be applied very gently after healing has occurred. The healed skin is dull, while skin that has not yet healed is shiny. The redness of the face lasts for nearly three months, requiring a relatively opaque makeup. For this reason, deep peels are uncommon in men. When healing is complete, the skin tone is more uniform. Brown pigmentation and wrinkles are significantly reduced. Fine and even coarse wrinkles are immediately decreased; further improvement is seen in the first three months, as the skin continues to shrink.Everyone’s skin lightens after a deep peel. Depending on your skin color, this might be a major issue. And a line may be visible where the peel ends at the jaw, despite ‘‘feathering’’ of the peel. The neck cannot be peeled because there is too high a chance of scarring. The face can also scar, but this is rare unless infection occurs.The deep chemical peel, while not extinct, is certainly much less popular than it was two decades ago. Even Dr. Baker, its inventor, says, ‘‘I still do an occasional phenol peel . . . but public demand is for the laser.’’ The more sophisticated and expensive laser peels have many drawbacks, however, and the phenol peel seems to be making a comeback.
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