For this type of peel, I sedate all patients. The use of topical anaesthesia, chilled air, nerve blocks (in some cases) & sedation makes this peel well tolerated by all. Post procedure recovery is painless.

Some patients experience mild to moderate itching around day 3 to day 7 post peeling. This itch is due to a combination of new skin formation as well as sweat gland occlusion. The use of saline soaks & antihistamines can alleviate the itch.

Jessner TCA is a medium to deep chemical peel which consists of two peels in the one session. Jessner contains AHA & BHA (lactic & salicylic acid) with another keratolytic known as resorcinol. The first step of the peel primes the skin for the second peel, namely TCA. This allows more uniform & deeper penetration without the risks of employing a higher TCA concentration. In the context of TCA, I perform 1-4 coats depending on clinical features.

The majority of my medium to deep peels are conducted under mild sedation. In some cases I employ the use of lasers to treat deeper areas of pathology; around the lip or eyes for example. The entire procedure takes approximately 20- 40 minutes to perform.

Medium to deep chemical peels can treat certain forms of acne scarring, classically ice pick & box car scars. This type of chemical peel is called ‘focal or regional’ peels, as the peeling agent is applied to the skin scars with little or no collateral damage to normal skin. CROSS or Chemical Reconstruction of Skin Scars is an example of this peel. I use both TCA (80 to 100%) as well as Phenol (88%) Croton Oil to treat suitable scars.

No. In the past, dermatologists employed medium to deep peels for the management of melasma. The results from week 2 to 4 were spectacular! The downside was that the majority of patients rebounded, with melasma coming back equally as severe, and in some cases worse than the pigmentation pre-peel.

The only exception I make to this rule is potentially dermal melasma resistant to conventional therapy. Dermal melasma is resistant to all forms of treatment. Careful consideration and consent will be taken if deep peels are contemplated as the chances of rebound & post inflammatory hyperpigmentation is significant. I prefer to employ novel peels for melasma.

In some situations, chemical peels are actually better than laser resurfacing, hence why all procedural dermatologists will have the knowledge and skill sets to perform medium to deep chemical peels.

In the context of on label fractional lasers such as Fraxel & Clear & Brilliant, deep peels will give better results compared to lasers. Even if one takes into consideration cumulative downtime & sessions required with fractional lasers. The flipside is that the risks of post inflammatory hyperpigmentation is higher with medium to deep peels.

Medium to deep peels give much better results than microneedling, even RFM or radiofrequency based microneedling. Peels treat the entire surface of skin, unlike microneedling, which can be classed as a fractional procedure. Scientific papers have shown that peels generate more collagen than lasers or microneedling.

For patients with lighter skin type (Type 1 or 2) with skin quality-textural issues I firmly believe that medium depth chemical peels can give much better results in one treatment compared to pico lasers. For patients who have olive skin-ethnic skin, Pico lasers can give better results with less risks compared to chemical peels.

The main risk is post peeling skin colour changes known as post inflammatory hyperpigmentation. This is more common in ethnic skin types and can be mitigated with strict sun protection & in some cases the use of bleaching creams pre & post peel.

Infection risks can be markedly reduced with post-peel skin care in addition to antiviral medications (if you have a history of cold sores).

Scarring is extremely rare. In most cases it is secondary to cold sore infections or abnormal production of collagen.This can be slowed down with vascular lasers, silicone gel & dilute anti-inflammatory injections. Scars are more common if deep peels are used on the neck, chest & decolletage areas.

Maintaining the result is equally as important as achieving the result. My top 3 tips are-

1. Sunscreen, Sunscreen, Sunscreen. Twice a day, regardless of sun exposure. Once before work, another reapplication at midday or before travelling home in the afternoon. Hats as adjunctive UV protection.
2. Retinol post peel can help maintain collagen as well as reduce skin pigmentation. Start off with a good over the counter retinol before prescription retinoids.
3.  Antioxidants can reduce UV induced damage. Depending on your skin sensitivities, skin care actives such as tocopherol, ascorbic acid & ferulic acid should be used post peel. In some cases I prescribe skin care acids including glycolic, citric, mandelic or lactic acid.