Chemical peeling is the process where a chemical (usually an acid) is applied to the skin in controlled amounts to remove the top layer of the skin. This results in the generation of new skin cells and remodeling of the skin.
Generally, chemical peels are a great procedure for your skin when it is done properly and in most cases, by trained professionals. However, there are cases where things seem to go wrong, and the outcome we want is not the outcome we get.
The most common issues that you may have after a chemical peel are:
- Pain and Burning
- Persistent Redness
- Skin is darker – Hyperpigmentation
- Patchy Skin – Hypopigmentation
- skin looks more wrinkled
- Pimples and/or Cysts
- Adverse Reactions
- Chemical Burns
Now, this article will guide you on how to spot these reactions and give you some guidance on how to prevent and safely treat them.
Related Article – Can You Get a Chemical Peel When Pregnant or Breastfeeding
What Happens after a Chemical Peel
It is important to know that you will not immediately start to see peeling or changes to the skin after the application process.
Peeling of your skin is completely normal and will start to occur between 48 and 72 hours after the application and will last for about 5-7 days, depending on the type of chemical peel that you used. Citation.
Skin Looks Worse after Chemical Peel
The most common complaint that people tend to have after a chemical peel or when considering it is that their skin looks worse in the days just after the procedure rather than better – this is normal.
As the skin goes through the exfoliation and regeneration process, it will look like a peeling mess until your skin has been completely transformed. After that, your skin is expected to look much improved.
Related Article – For a safer and more gentle type of peel try an enzyme peel – you can click here to learn more.
Possible Complications of Chemical Peels
The effect of chemical peels on the skin and any resulting complications will depend on the depth of penetration of the chemical being used. The severity of complications will also depend on pre and post-procedure care.
However, complications can be grouped into Immediate and Delayed Complications, based on the time of onset.
Immediate Complications (Within minutes to hours after the procedure)
1- Pain & Burning After Chemical Peel
Pain and burning usually occur;
- In people who have very sensitive skin.
- When topical products are applied to the face cause a reactions,
- Area is exposed to the sun just after the procedure.
Topical products such as retinoid, glycolic acid or even certain types of sunscreen can result in contact or irritant dermatitis – an inflammatory condition that causes burning, pain, and itching.
This can last for as long as 2-5 days after the procedure or until regeneration and resurfacing are complete. Citation.
Treatment & Management of Pain & Burning After Chemical Peel
All treatments should be approved by your doctor before use, but they can include:
- Immediate ice application to reduce the pain and burning sensation
- Topical calamine lotion to soothe the skin
- Topical steroids such as hydrocortisone or fluticasone to reduce the inflammation
- Emollients to moisturize the skin
- Sunscreens (if you are not allergic or if no reaction occurs)
2- Persistent Redness After Chemical Peel
This means that the skin remains red and angry-looking beyond the normal expected time. Generally, redness is expected to disappear between 3-5 days in superficial peels, 15-30 days in medium peels, and 60-90 days in deep peels.
If redness lasts longer than the expected time, it is a serious indication of potential scarring. A variety of things can potentially stimulate prolonged vasodilation (dilation of the blood vessels under the skin) which can be accompanied by skin thickening and scarring.
Treatment & Management of Persistent Redness
If you are experiencing prolonged redness, you need to visit your doctor. Any treatments for this complication will be clinical and prescription-based. Citation.
Treatments can include:
- Topical (on top of the skin), systemic (given my mouth, or through injections), or intralesional (applied directly to the affected area under the skin) steroids if thickening is occurring
- Pulsed dye laser to treat the vascular factors
Video Showing You Some Tips For Healing After Chemical Peel
3- Itching After Chemical Peel
Itching mostly occurs after medium and deep peels. However, even after superficial peels, it can occur as the skin starts to scab over.
Some itching is normal but excessive itching is not and can result from dermatitis (especially if papules, pustules, or redness occur along with it), or it can result from an infection. Citation.
Treatment & Management of Itching
- The most important thing to remember is that you should not actively itch your face after a chemical peel. Not only will that damage your skin, but it may cause infections and scarring as well.
- Topical antihistamines and calamine lotion are also options that can help with itching but your doctor should be consulted before using any of these.
- Application of ice to the affected area could also help with itching and irritation.
4- Swelling After Chemical Peel
Swelling is normally expected within 24-72 hours after a medium or deep peel. However, it can also occur in superficial peels when the person has thin, dry, or damaged skin, especially under the eyes.
Swelling usually resolves on its own, but sometimes people opt to treat it to maximize comfort and speed up the healing process. Citation.
Treatment of Swelling
- Ice application is the first and most common treatment
- If swelling does not resolve, even with the application of ice, then you need to consult your doctor as this can be a sign of an ongoing inflammatory process.
- In some cases, your doctor may prescribe a short term course of steroid medications for you to take.
5- Blisters After Chemical Peel
Blisters are more common in younger people and those with loose skin around the eyes. Blisters can also occur around the nose and on the skin around the mouth, which can be thinner and more sensitive. Citation.
Treatment of Blisters
- In general, petroleum jelly or vaseline can be used in the most prone area before the procedure to prevent blisters
- If blisters do occur, they are expected to crust over and heal. If they do not, your doctor may need to apply surgical tape over the areas or prescribe gentle solutions to help with healing.
Delayed Complications (within a few days to weeks after the procedure)
6- Hyperpigmentation After Chemical Peel
Hyperpigmentation is the overproduction of color in spots or patches in the skin. People with darker skin tones are more at risk for hyperpigmentation and it is a common side effect of chemical peels that use TCA (trichloroacetic acid). If not properly treated, it can be persistent. Citation.
People at the highest risk for developing hyperpigmentation after a chemical people are:
- Those with darker skin tones
- Those with skin types III-VI
- Those with skin types I and II who have intense exposure to sunlight or tanning
- Those who use drugs like Non-steroidal anti-inflammatory drugs, oral contraceptives, other hormone replacement therapy, etc.
- Those who expose their skin to the sun early after the procedure without adequate sunscreen protection
How to Treat Hyperpigmentation After Chemical Peel
Any treatments for hyperpigmentation after a chemical peel will need to be prescribed by your doctor to be safe and effective.
Treatments may include:
- Use of sunscreen with a Sun protection factor 30 or higher.
- Retinoic acid, 0.05% cream in combination with 4% hydroquinone, which can be used once or twice daily for 3 weeks or longer if necessary
- Hydrocortisone cream, which can be used for several weeks as needed if redness from irritation due to the retinoic acid occurs
Prevention of Hyperpigmentation
- Having a good, suitable skincare regimen will help the effects of the peel to last longer and to prevent hyperpigmentation
- Try to avoid sun exposure and always use broad-spectrum sunscreens before and after your peels
- When doing superficial peels, start at low strengths and increase slowly
- Temporarily stop the use of birth control pills before your peel procedure and after to prevent hormonal stimulation of the melanocytes (pigment-producing cells).
7- Patchy Skin After Chemical Peel – Hypopigmentation
Sometimes hypopigmentation can occur after a peel due to the removal of the top layer of the skin and/or the removal of excessive amounts of melanin from the skin.
More extensive hypopigmentation can occur with medium and deep peels because of the deeper penetration into the skin, so deeper layers and more melanin are removed. Citation.
Hypopigmentation is where certain areas of your skin have a lighter shade – giving it a patchy look.
Prevention & Treatment of Hypopigmentation
There is no specific way to prevent hypopigmentation. However, after the treatment, the surrounding skin can be treated after healing, and with professional guidance, using a skin-lightening agent, to make the spots of hypopigmentation less obvious. The lighter surrounding skin will make the skin blend in.
8- Skin looks more Wrinkled After Chemical Peel
Please keep in mind that chemical peels are not expected to completely get rid of wrinkles and lines, especially not after one treatment. However, they are expected to make them less apparent.
The opposite may occur in people with darker skin tones who have undergone medium and deep peels. The lines in the skin sometimes appear more obvious.
Prevention and Treatment of Wrinkled Skin
Increased lines of demarcation in the skin or wrinkles can be prevented by using the feathering technique on the edges and by using a lower concentration to merge with the surrounding skin.
9- Breakouts After Chemical Peel (Millia)
Milia are tiny white bumps that look like cysts or pimples that can break out on your face or any other part of your body.
They are not all that common after chemical peels, but they can occur during the first few weeks of the healing period. Usually, people with thicker skins are more at risk since the major cause of milia is occlusion (blocking of pores).
How to treat Breakouts after Chemical Peel
To prevent breakouts, you can stick to more gentle and superficial procedures of exfoliation or you can ask your doctor about using tretinoin before and after the peel.
In regards to treatment, breakouts usually resolve on their own. However, in some cases, gentle and sterile extraction may be necessary (popping the pimples using sterile tools).
10- Adverse Reaction After Chemical Peel
Adverse reactions after chemical peels, if they occur, usually come in the form of an allergic reaction or the form of persistent irritation.
Allergic dermatitis, although rare, is most likely to occur with peels like resorcinol, salicylic acid, kojic acid, lactic acid, hydroquinone, etc.
On the other hand, irritant contact dermatitis mostly occurs with glycolic acid, but it can be caused by any peel that is used too often, in too high concentrations, or with too intense skin preparation.
Both forms of contact dermatitis can be recognized by itching, swelling, blistering, hive-like breakouts, pain, burning or stinging in the skin.
Prevention of Adverse Reactions
- Your doctor should closely examine the condition of your skin before a peel
- Ensure that you provide your doctor with information about previous experiences with peels and skin treatments
- Ensure that the correct peel selection is made
- Ensure that the skin is primed properly
- Ensure to follow post-peel care and sun protection instructions
- Avoid picking at your skin as nails contain all sorts of bacteria
Treatment of Adverse Reactions
Depending on the severity of your allergic reaction, your doctor will recommend topical steroids such as hydrocortisone or fluticasone to reduce inflammation. If the reaction is very bad, they may also prescribe oral medication for you to take.
Do not try to treat allergic reactions at home or by yourself. This can make reactions worse and may result in permanent skin damage.
11- Chemical Burns After Chemical Peel
A chemical burn is the destruction of one or more layers of the skin which results in inflammation and irritation.
You may experience redness, irritation, pain, numbness or burning at the site of contact. Severe symptoms include the formation of blisters or black dead skin at the contact site, vision changes if the chemical gets into your eyes, or even coughing or shortness of breath if strong fumes are inhaled.
A chemical burn can result from:
- Using a chemical peeling solution that is too strong or unsuitable for your skin
- Leaving the solution on your skin too long
- Prepping your skin before the chemical peel too aggressively
- Not having proper skincare and sun protection routine before a chemical peel
I have an entire article where I go in-depth into how to spot, treat and prevent chemical burns from chemical peels. You can click here to read it.
General Precautions to take before a chemical peel
You and your doctor/dermatologist/aesthetician should discuss skin priming. This means the treatment and care of the skin to prepare it for the chemical peel procedure.
This is sometimes done for a duration of 2-4 weeks and then stopped about 3-5 days before the day of the peel.
Do not bleach, wax, scrub, massage, or use depilatories or scrubs, or schedule any important event 1 week before the peel and stop retinoid use 3 days before the peel. Citation.
General Precautions to Take During a Chemical Peel
- While doing a chemical peel, it is very important to select the right peeling agent at the right concentration.
- Always discuss the kind of peel, strength and expiry date of the peeling solution with your doctor and/or the person applying the peel.
- It is always better to under peel than over peel in the initial stages.
- Always do patch tests.
- Makes sure that your eyes and other sensitive areas of your skin are protected.
- If you start to feel pain, burning, stinging, dizziness or any other “strange” way, tell the person applying the peel immediately, even if you are not sure whether it is normal or not. Citation.
General Precautions to take After a Chemical Peel
- Immediately after the peel, mild soap or non-soap cleanser should be used.
- If there is crusting, your doctor may recommend a topical antibiotic ointment which should be used to prevent bacterial infection and enhance wound healing.
- Sun exposure should be avoided and broad-spectrum sunscreen should be used religiously.
- Calamine lotion in a moisturizing base can be used for any stinging sensation as recommended by your doctor.
- Peeling agents like glycolic acid and retinoids should be avoided until the actual skin peeling process is complete.
- You should avoid picking, peeling, scratching, rubbing or scrubbing the skin.
You should have a conversation with your doctor about how to recognize complications like excessive redness, swelling, burning or pain, crusts, oozing, pus formation, or blisters.
And what to do so that preventive or treatment actions can be taken as fast as possible. Citation