A combination of life-long ultraviolet damage (UVA and UVB) from sunlight, plus age-related changes in the skin, can lead to fine lines (rhytids) in the facial skin and many different issues with pigmentation or discoloration (dyschromias). Fine lines are frequently prominent in the area around the eyes (crow’s feet) and may become more obvious with facial movement (such as smiling, laughing, etc.). In mild cases and younger patients, Botox cosmetic may be sufficient to treat this issue. In more advanced cases, however, these lines are visible at rest and may extend into the cheek area. For these patients, skin resurfacing is required, and Dr. Ransom offers a variety of chemical peels to suit all skin types and specific needs.
In some patients, a similar issue arises in the area around the mouth (perioral), causing fine lines (rhytids) that radiate away from the lips like the spokes of a wheel. These are sometimes referred to as “lipstick bleed lines” because they may permit small amounts of lipstick or lip liner to run onto the face. Lines around the mouth are of variable depth – many are shallow, like those around the eyes, but others may be very deep (particularly in smokers). Treatment of lines in this area often requires multiple modalities and sometimes multiple treatment sessions, depending on each patient’s unique anatomy.
Chemical peels can also treat some pigmentation issues, including brown or purple-colored spots (dyschromia) and visible, tiny blood vessels (telangiectasias). By removing the top layer of the skin (epidermis), the peel can take away these spots, replacing them with a smoother, more uniform skin color and texture. An added benefit of chemical peels is the ability to remove some precancerous skin lesions, such as actinic keratoses. Because the epidermis sloughs off after the peel, areas that may have turned into skin cancer (i.e., those with cancerous potential but that have not penetrated into the deeper layers) are removed. Healthy new skin then heals from below!
Facial resurfacing is a category of procedures including chemical peels, and ablative lasers. Each of these approaches removes variable amounts of the epidermis (the superficial or outside layer of the skin) and the dermis (the deeper or inside layer of the skin). There are many types and strengths of chemical peels available, but the most effective formulas must be administered under the direct supervision of a doctor. Dr. Ransom most commonly uses TCA (trichloroacetic acid), glycolic acid, or Jessner’s solution. He personally administers your peel, making sure that you achieve the best results with the quickest and easiest recovery possible.
Chemical peels can be performed on anyone who has skin surface irregularities, fine lines (rhytids), and/or pigmentary dyschromia (colored spots, freckles, telangiectasias, etc.). Different formulations and strengths may be used, depending on the innate properties of the skin (such as skin pigmentation, sensitivity, etc.). For patients with medium to dark skin, less aggressive peeling is performed in order to avoid unwanted changes in the skin color after the procedure. In some cases, it is necessary to perform a “test spot” (placing a small amount of the peeling solution on an area that is easily hidden) to see how the skin reacts. Chemical peels are contraindicated for people with certain skin or connective tissue disorders, and for women who are nursing. Finally, there are special considerations for patients who have been taking Accutane (isotretinoin).
There are a variety of approaches to skin resurfacing, and Dr. Ransom will work with you to make the best plan to suit your needs and skin type!
Please note that all patients are different and individual healing times and results may vary. The statements regarding procedures and recovery made here are general rules.
Recovery after a chemical peel varies according to the type of peel used, the depth of the desired effect, and each person’s unique skin characteristics and healing capacity. Most medium-depth peels cause some skin irritation over the first couple days, followed by slough (flaking off, like dry skin) over a few more days. The new skin below is very sensitive as it heels, but patients are able to go out and can use make up. This process takes about a week. For superficial peels, the recovery is even shorter.
Dr. Ransom will work with you to get your skin ready for the peel. Depending on your skin type and history, this may begin up to two weeks before the peel is scheduled. Treatments may include topical creams to strengthen the skin (such as retinoic acids, or Retin A) or tone down the pigments (bleaching agents, such as hydroquinone). You should avoid excessive exposure to UV (direct sunlight) and make sure that the area to be peeled is not sunburned. If you have a history of cold sores, an antiviral medication will be given for prophylaxis. A gentle daily cleanser is important as well, but harsh treatments should be avoided.
Dr. Ransom will work with you in your consultation to identify the best peeling strategy and formula for your goals and skin type. Commonly used peels are glycolic acid (mild), Jessner’s formula (medium), and TCA (different strengths). These peels may be used alone or in combination to adjust the depth of the desired peel. For more information, please schedule a consultation today!
Dr. Evan Ransom is an Ivy League-educated and Ivy League trained Facial Plastic and Reconstructive Surgeon. He is a Double Board Certified Head and Neck Surgeon and Facial Plastic and Reconstructive Surgery and fellowship-trained in facial plastic, reconstructive, and laser surgery. His practice is in the San Francisco Bay Area, serving patients from San Francisco, Oakland, Marin County, Palo Alto, Silicon Valley, Walnut Creek, the East Bay, and all over Northern California.