From superficial to deep chemical peeling, you have to learn about your options…
In this article:
- 3 Types of Chemical Peels
- Glycolic & Salicylic Acid
- Jessner’s Chemical Peel
- TCA Peel
- Medium-Depth & Deep Chemical Peeling
- What to Prepare
- How Much Does It Cost?
How effective are chemical peels for acne scars? First of all, chemical peeling is actually a chemical exfoliation. It is one of the many skin resurfacing techniques that utilizes exfoliating chemical agents. Once these agents are applied to the skin surface, they will work by encouraging epidermal or dermal damage.
There are 3 types of chemical peels for acne scars:
- Superficial chemical peels
- Medium-depth chemical peels
- Deep chemical peels
Superficial chemical peels work on superficial acne scarring (experts call it hyperpigmentation though) and the last 2 types of chemical peels (medium-depth and deep) show more promising results in treating acne scars.
Best results can be seen in rolling and boxcar scars. As for ice pick scars, chemical peeling has to be combined with another treatment such as punch excision. Another interesting fact is that chemical peels show better results in treating acne scars on older patients. This is due to the less-elastic condition of the skin in older individuals.
Superficial Chemical Peels
Just like the name describes, chemical peeling using superficial chemical peel agents is a superficial exfoliation that aims for the stratum corneum down to the papillary dermis of the skin. Several chemical peels that belong to this category are:
- Jessner’s solution
- Glycolic acid 40-70% (belongs to the AHAs group)
- Trichloroacetic acid (TCA) 10-20%
- Salicylic acid (belongs to the BHAs group)
Note: Please read explanations about AHAs (Alpha Hydroxy Acids) and BHAs (Beta Hydroxy Acids) in our article about acne scar cream.
Each of these peels has its own qualities and method of peeling, with Jessner’s solution as the most inflammatory and TCA as the least inflammatory. Glycolic acid is considered as medium inflammatory and salicylic acid is completely non-inflammatory. All of these superficial peels are safe for dark-skinned individuals.
Glycolic Acid Chemical Peel
This is one of the most popular AHAs used as peeling agents. Others include: lactic acid, mandelic acid and pyruvic acid. All of them are natural ingredients. Patients can use these chemical peels for face and almost any area of the body. A 2 week interval is usually needed between treatments.
Salicylic Acid Chemical Peel
It is considered as the safest chemical peel for acne scars (hyperpigmentation) due to its anti-inflammatory and anti-microbial properties. It never shows any significant side effects nor complications. The peeling is performed at 2-4 week intervals with 3-6 treatments to achieve maximum results.
Jessner’s Chemical Peel
Jessner’s solution represents a combination of salicyclic acid, resorcinol and lactic acid.
TCA is the most flexible of all acne scars chemical peels. It is used in a variety of concentrations, starting from 10% to 50%. The higher the concentration is, the bigger the ablative injury, yet the greater the rejuvenative achievements.
TCA peels with concentrations greater than 30% can have an effect on the dermis and epidermis of the skin and therefore are classified as medium-depth or deep chemical peels.
In the past, 40-60% TCA peels was used for acne scarring treatments, but there were too many complications like scarring and post-inflammatory hyperpigmentaion. Consequently, these highly-concentrated TCA peels are not in use anymore.
Currently, most physicians combine 2 less-inflammatory chemical peels for acne scars; the first one is a superficial peeling agent and then followed with 35% TCA application. This can be done as a single procedure and the recovery time is normally 7-10 days.
Medium-depth Chemical Peels
Medium-depth chemical peels aim for the epidermis, papillary dermis, down to the upper reticular dermis of the skin. Unlike superficial chemical peeling, this kind of treatment should be used cautiously for dark-skinned individuals, because of the greater risk of post-inflammtory hyperpigmentation.
Acne scar chemical peels which belong to this category include:
- TCA 30-50%
- Glycolic acid 70% – applied 3-30 minutes
- Glycolic acid 70% + 35% TCA
- Jessner’s solution + 35% TCA
- CO2 snow + 35% TCA
- Phenol 88%
Deep Chemical Peels
Deep chemical peeling is a superb treatment for acne scarring – it can generate remarkable improvements within a single procedure that can last for a long time. However, this treatment is more aggressive and therefore has some inconveniences:
- Requires a long time to heal
- Uncomfortable conditions such as swelling, peeling, oozing and possible erythema for a minimum of 1 week
- The skin appears sunburned for 2-3 months
Chemical peels in this category are:
- Phenol 88%
- Baker-Gordon phenol formula
Chemical Peeling for Acne Scars – Preparations & Post-Treatment Hints
- Preparations depend on each patient’s health and scarring conditions
- Patients who are on isotretinoin (Accutane, Roaccutane) are normally delayed for 6-12 months until chemical peeling is performed
- Patients with a history of hypertrophic/keloid scar formation are normally treated carefully
- The same goes for pregnant women and patients with heart disease
- For combination treatments of acne scars, punch excision or elevations are usually performed 4-6 weeks before chemical peeling. Subcision is usually performed at the same session with the acne scars peel
- Usage of topical retinoids (tretinoin, tazarotene, retinol formulations) can increase the penetration and depth of chemical peeling
- Retinoic acid is commonly used in superficial and medium-depth chemical peeling, because it helps texture, tone and smooth the skin
- After chemical peeling, sometimes topical bleaching agents such as azelaic acid, kojic acid, arbutin and licorice can be used
- Sunscreen is a must for post-treatment application
- After the peeling, use sunscreen daily and choose the right type of sunscreen, depending on the type of chemical peeling experienced and the type of the skin. Use UVA filters, UVB filters, or inorganic sunscreens
- After experiencing chemical peeling for acne scars, isotretinoin may be needed to avoid acne flare and scar reformation
How Much Is the Cost of Chemical Peels?
Depending on where you live, the types of the acne scars and the area that will be treated, on average it will cost you from $50 to $1,500.
Chemical peels for acne scars before and after
- After 5 sessions of salicyclic acid peels for acne scars -