Chemical Peels, Exfoliation, and Advanced Treatments
Chemical Peels, Exfoliation, and Advanced Treatments tests how acids work, why pH and free acid matter more than the percentage on the label, which peels fall in esthetic scope, and how to prevent complications. In North Dakota, estheticians perform superficial peels; medium and deep peels belong to medical professionals.
Classification
- Very superficial: 10–30% glycolic or lactic, 20–30% salicylic, Jessner solution - act on the stratum corneum.
- Superficial: higher-strength AHA or low-percentage TCA - reach the granulosum.
- Medium (TCA 35%) and deep (phenol) - medical only.
- Mechanical options: microdermabrasion, dermaplaning, enzyme peels.
The chemistry that drives results
AHA effectiveness depends on concentration, pH, free acid value and contact time. Glycolic has the smallest molecule and penetrates fastest; lactic is gentler; salicylic is lipid-soluble and targets follicles; TCA self-neutralizes and produces frosting (protein coagulation) as its endpoint. AHAs must be neutralized or removed on schedule; salicylic and TCA do not require neutralization.
Screening and protocol
Avoid with pregnancy and breastfeeding (salicylic), isotretinoin, active infection, recent waxing or laser, photosensitivity and a compromised barrier. Pretreat 2–4 weeks with a mild acid and daily SPF. Degrease, protect eyes and lips with ointment, apply evenly and quickly, watch clock and skin, neutralize, cool, moisturize, apply SPF; no sun, picking, scrubbing or retinoids for about a week.
Worked example
A Fitzpatrick V client with melasma requests 30% glycolic. Reasoning: high PIH risk - use a lower strength, pretreat, patch test, enforce strict SPF, and explain that peels can worsen melasma.
Traps that cost marks
- Assuming higher percentage always means a deeper peel - pH decides.
- Expecting frosting with AHAs; frosting belongs to TCA.
- Skipping neutralization of an AHA.
- Peeling over a compromised barrier.