What is skin peeling?
Peeling is a technique for improving the appearance when fine wrinkles of the skin are present. Surgery can correct sagging excess skin and bulges, but a peel is required to treat wrinkles. Here is an example of the kind of changes that a chemical peel can make:
How is the peel done? I've heard of a laser, and I've heard of chemical peeling, too.
The peel is accomplished by removing the top layers of skin, and when the new skin heals, it doesn't wrinkle like the old skin did. There are different ways to remove the top layers of skin. In a chemical peel, a solution is placed on the skin that damages the top layers, which then fall off like sunburned skin. In a laser peel, the heat energy of the laser damages the top layers of skin, which are then usually wiped off. A dermabrasion can also accomplish the same results. In a dermabrasion, or skin sanding, the top layers are sanded off by the rough material that is used in the sanding process.
There are advantages and disadvantages of any of these techniques of skin peeling. The laser has been marketed very heavily in recent times, not because it is better than the other techniques, but because much of the public looks on anything done with the laser as being magical and new age and better somehow. It is not. It is just a tool in the plastic surgeon's toolbox, and a good plastic surgeon will select the best method of accomplishing the peel based on the skin color and type, the amount of wrinkling, the age of the patient, and other factors. The chemical peel is the strongest, and generally gives the best results.
What areas are helped by the peel?
The lower eyelids: Especially after eyelid surgery, a peel can improve some of the very fine "crepe paper" wrinkles that remain on the lower eyelids. The crow’s feet, which are not helped by eyelid surgery, are peeled at the same time.
Around the mouth: Small vertical lines that radiate from the mouth and lips can be improved with a peel. The "laugh lines" which go from the side of your nose to the corner of your mouth are peeled at the same time. Many patients have the peel around the mouth at the same time as their face lift.
Those are the two areas most commonly peeled. Some people also have very fine wrinkles of the skin over the entire face and cheeks, giving them a "weathered" appearance. These fine spider-web wrinkles, which may be hereditary or the result of excessive sun exposure, are only slightly improved by a face lift, and a full-face peel can greatly benefit such individuals.
Horizontal creases on the forehead and vertical frown lines between the eyebrows may also be softened by a peel, although they will not be eradicated.
In general, surgery removes sags, bulges, and extra skin, while the peel is used to tighten the skin surface and smooth its wrinkled texture. Many people require both procedures for optimum results.
Can I have both my surgery and peel at the same time?
It is best not to peel an area of skin at the same time as an operation on that same area of skin. For example, if you require a peel only around your mouth, that peel can be done at the same time as your face lift. However, a full-face peel must wait until two to three months after a face lift, and a peel of your lower eyelids is usually postponed until about a month after lower eyelid surgery.
Some of my wrinkles are deeper than others.
The deeper wrinkles will not be totally eliminated by a peel. Sometimes a touch-up peel is needed to achieve further improvement. That is quite optional, though, and most people are quite pleased with their results, even if there are a few wrinkles left over.
What else should I consider?
Deciding on a peel is not a matter of vanity. Caring deeply about one’s physical appearance is not a prerogative only of the young. Our bodies age, but our minds stay youthful. Cosmetic surgery is an attempt to let us see in the mirror a face that better reflects the way we feel.
Keep in mind that this operation is for you. Though a good result may have a pleasing effect on a spouse, friend, or employer, do not expect praise or notice from everyone. You are not doing it for them. They are not paying the fees and incurring the minor inconveniences and risks of surgery. If the changes are more subtle than dramatic, other people may not even notice. Your friends might not be as observant as you are. Cosmetic surgery that is undertaken with the purpose of affecting others nearly always fails to produce the desired results.
Remember that the goal is improvement, not perfection. Strive to look good for your age, not to look twenty years younger than you are. The patient most pleased with surgery is the one whose expectations are realistic and whose motivations are internal--you should want to feel better about yourself.
Improvement in the appearance of the face can also enhance self-esteem, imparting a psychological benefit that cannot be measured in a photograph.
Will there be scars?
Scarring from a peel is extremely rare if the postoperative instructions are followed closely.
What problems are not helped by a peel?
Large pores will not be changed by a peel, and scarring from acne is usually more effectively treated with a dermabrasion than with a chemical or laser peel.
Many of the wrinkles on your face are accentuated by facial expressions--your crow’s feet when you squint, the small vertical lines around your mouth when you pucker, the horizontal lines on your forehead when you raise your eyebrows, the vertical lines between your eyebrows when you scowl, and the laugh lines which go from the sides of your nose to the corners of your mouth when you smile. These lines are accentuated during facial expression because as a muscle tightens underneath the skin, the muscle shortens. The skin cannot shorten as much as the muscle can, so the skin is pulled into folds.
A peel can soften the lines that are present when your face is at rest, but it cannot prevent the accentuation of those lines with movement.
How long does the peel last?
The chemical peel is one of the most long-lasting facial plastic procedures. In many cases the peeled areas continue to show their improvement for decades. Laser peels are felt to last about three to five years. Dermabrasion peels can last as long as chemical peels.
How long will I have to hide out at home after a peel?
Usually about ten to fourteen days. At that time the skin will still be quite pink. It is new, young, fragile skin, and over the next three to four months the redness will subside, more slowly under the eyes.
Once the initial healing is done, about two weeks after the peel, you can start wearing makeup to cover the redness. Most of the swelling will be gone by then too, so you should look much better and will be more comfortable being seen socially.
What if I’m a man and I don’t use makeup?
Ah, good question. We'll answer that by talking about how to decide how much of the face to peel. One of the small disadvantages of a peel is that it can lighten the skin color somewhat. On most people, it is hardly noticeable, but if you have freckles, or darker-than-average skin color, it is possible that you'll be able to tell that the skin is lighter in color after healing. The skin lightening can occur after any kind of a peel: chemical, laser, or dermabrasion.
Women who can hide the color difference with makeup usually don't care about that minor hassle, especially if they received a large improvement from the peel. (See the pictures at the top of this page.) However, someone who doesn't have very much wrinkling can't get a large improvement from the peel, because there isn't a lot of wrinkling to improve, and that person might not think that the small hassles after the operation are worth the improvement. For example, a woman with darker skin, but lots of vertical wrinkles around her lips, might put up with some skin color differences to get a very large improvement in the wrinkling. But a woman with lots of freckles and just a few faint wrinkles around her eyes might not be a good candidate for a peel yet, because she would only get a very small improvement from the peel (because the wrinkles were so faint to start with), and the peeled areas would lose their freckles, making it obvious that the peel was done. That's one of the reasons that Dr. Denenberg doesn't just go ahead and peel everyone who comes in asking for the procedure. He wants to make sure that the patient is happy with the overall results.
Men, at least nowadays, don't have the option of hiding minor differences with makeup, so we usually recommend a full-face peel for men. If the entire face is peeled, it is very hard to discern slight skin color changes, because there aren't areas of peeled skin adjacent to areas of skin that weren't peeled, so no makeup is needed. In the early healing period, when the newly-peeled skin is still pink, it just looks like the person got too much sun.
A chemical peel can significantly help older men who have many of the raised, scaly, brownish lesions called actinic keratoses which come from many years of sun exposure. The rough growths are lifted off while the peel heals, and they frequently do not return. Dark age spots of the skin, usually present on the forehead, can also be improved with a chemical peel.
Does the peel hurt?
In most cases you will be given twilight sleep sedation or a local anesthetic so the peel itself will not hurt. After the sedation or local wears off, your face may ache like it's been sunburned for about eight hours. After that there is usually no pain. The new skin is not tender, and the crusting and after care are not uncomfortable.
What about my age?
There is no upper limit to the age at which you may have a peel, as long as you are in relatively good health and can care for the peel after surgery.
When will I be able to go home?
The peeled skin is quite swollen for a couple days, and you probably wouldn't be comfortable using public transportation for about 10 days after a full-face peel, somewhat less if only a small part of the face was peeled. If you live out of town, we can help in making arrangements and figuring out when you would feel good about going home.
When can I return to work?
The care of your peel and its appearance in the first week or two will probably keep you off work for that time. You may be able to go back to work earlier if you had only a small area peeled and your work involves no physical exertion or public exposure.
You may want to remain home for longer than a week depending on how long it takes for all of your crusting to resolve and how comfortable you are being seen in public with the healing peel.
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