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When the question about a peel usually comes up
Most often when the skin has stopped responding to what used to work.
The skin looks tired despite skincare
Dull, rough to the touch, without radiance, even though the cosmetics are well chosen and used regularly. Usually it is a matter of an excess of the horny layer, which a cream alone will not remove.
Acne has left marks
The inflammatory lesions have settled, but an uneven surface and pigmentation have been left where they were.
Pores are more visible than they used to be
Most often in the T-zone, with oily and seborrhoeic skin, along with a tendency to blackheads.
Pigmentation from the summer has not gone
Spots that were meant to fade in the autumn have stayed. That is the moment to establish what kind they are, before starting to lighten them.
Active cosmetics have stopped being enough
Acids from the chemist give a refreshing effect but do not change the structure of the skin. The difference is one of concentration, pH and control over the course of the treatment.
A peel is not the answer to every one of these situations. With some of them inflammation has to be calmed first, or the cause of pigmentation established, because exfoliating at the wrong moment can make the skin look worse.
Four levels of depth
The division follows from which layer of the skin the preparation reaches. The deeper it goes, the greater the reaction and the longer the skin takes to return to its starting state.
Very superficial peels
The horny layer of the epidermis
Refreshing the skin, reducing an excessive horny layer, prompting regeneration, adding radiance.
Superficial peels
To the basal layer of the epidermis
Normalising the process of keratinisation and regulating the cycle of cell renewal. Flaking similar to that after too much sun.
Medium-depth peels
The papillary layer of the dermis
Bringing about controlled inflammation and stimulating the reconstruction of collagen and elastin fibres.
Deep peels
To the reticular layer of the dermis
The strongest reaction and the longest healing time. They require a separate assessment and particular sun protection.
The acids we work with
We work with simple, single-ingredient peels and with compound ones, that is mixtures of acids. Below are the substances used at our clinic, together with the type of skin they tend to be chosen for. Alongside alpha and beta hydroxy acids there are also ingredients that work in a way other than exfoliation, and one multi-ingredient mixture.
Glycolic acid
Every type of skin
An alpha hydroxy acid with a small molecule, which gives it a high ability to penetrate the epidermis. It works keratolytically, changing the cohesion of the corneocytes, and promotes the synthesis of glycosaminoglycans.
A description on the price list pageLactic acid
Sensitive, dry, dull skin
It breaks the protein bridges between corneocytes and reduces the thickness of an overgrown horny layer. It stimulates the synthesis of ceramides, so it strengthens the barrier function of the skin. Because it is well tolerated, it is also used on the neck and décolletage.
A description on the price list pageMandelic acid
Thick, combination, oily skin, with dyschromia
A larger molecule means gentle, gradual exfoliation. It loosens the connections between corneocytes and stimulates the synthesis of collagen and proteoglycans.
Go to the mandelic acid peelSalicylic acid
Oily, seborrhoeic skin, with acne lesions
A beta hydroxy acid with keratolytic, comedolytic, anti-inflammatory and antibacterial action. It is lipophilic, so it easily penetrates the openings of the sebaceous glands and hair follicles. Also used on the arms, back, knees and elbows.
Go to the salicylic acid peelAzelaic acid
Skin with imperfections and a tendency to inflammation
It works antibacterially, reduces how hard the sebaceous glands work and with it the amount of sebum produced. It protects the skin from free radicals.
Go to the azelaic acid peelTrichloroacetic acid, TCA
Oily skin, with post-acne changes, with signs of ageing
It acts on the proteins of the skin and causes keratocoagulation, visible as a whitening of the skin, the so-called frost. It stimulates the activity of fibroblasts. The strongest acting of the acids used to exfoliate the epidermis, which is why it requires a separate assessment.
A description on the price list pageFerulic acid
Skin with pigmentation, exposed to sun and pollution
It does not work through exfoliation but as an antioxidant. It acts more on the side of preventing pigmentation than removing it.
Ferulic acid peelTranexamic acid
Skin with pigmentation resistant to other methods, including melasma
It acts on the pathway by which pigment forms rather than by removing the horny layer. Chosen when pigmentation returns after exfoliating peels.
Tranexamic acid peelJessner peel
Oily skin, with imperfections and an uneven structure
A mixture of three substances, in which the depth is set by the number of layers applied rather than by the concentration alone.
Jessner peelThe final decision about the type of peel and its concentration is made by the cosmetologist during the consultation, after assessing the skin and taking a medical history.
Peels with compound preparations
Alongside single acids we work with three ready preparations, in which the acid occurs together with ingredients that change how it acts. Each has its own description, because they differ not in strength but in what happens to the skin afterwards.
What decides the intensity of the treatment
The same acid can act differently in two clinics. Five variables decide this, and the cosmetologist sets them before every session.
The type and condition of the skin
The thickness of the skin, its sensitivity, the continuity of the epidermal barrier, the activity of the sebaceous glands, the size and location of the treatment area and the history of previous treatments.
Type of substance
AHA and BHA acids, alpha keto acids and TCA act differently and reach a different depth.
The concentration and pH of the solution
The two most often adjusted variables. It is they that decide whether the treatment will be a refresh or a remodelling.
The technique of application
The amount of product, the number of layers applied and the time it is left on the skin.
The formula of the preparation
Water and alcohol formulas penetrate faster and irritate more, gel ones act more slowly and more evenly.
The formula matters too. Water, alcohol and hydroalcoholic peels penetrate faster and irritate more, and their intensity is measured by the number of layers applied. Gel peels penetrate more slowly and more evenly, and their intensity follows from the time they are left on the skin.
Indications
A peel acts on the epidermis and, at greater depths, on the dermis. It does not add volume, does not tighten lax skin and does not replace diagnosis. A pigmented lesion of unclear character needs a medical assessment first, not lightening.
A medical peel and a cosmetic peel
The difference concerns the depth of action. A cosmetic peel removes the outer, keratinised layers of the epidermis. A medical peel reaches the whole epidermis, and at stronger concentrations the dermis as well, where it prompts fibroblasts to synthesise collagen fibres.
A different assessment follows from that difference too. A medical peel requires a medical history, an assessment of the phototype and a plan for sun protection, because if it is chosen wrongly it can leave pigmentation after the treatment.
How it goes and the course of treatments
We carry out peels in courses, usually of four to six treatments, and a course can be repeated within a year. The frequency within a course and the interval between courses depend on how the skin tolerates them, which is why we write the plan down and adjust it after the first sessions.
After superficial peels the skin can be smoother and more radiant after the first treatment, because the keratinised layer of the epidermis is removed. Changes in tone, in post-acne marks and in the firmness of the skin require the whole course, and their scale depends on the starting state of the skin.
Before and after the treatment
Before the treatment
Use cosmetics that prepare the skin, as recommended by the cosmetologist. With recurrent cold sores antiviral prevention is needed.
The first hours
Redness and slight stinging usually pass within one to two hours. We do not rub the skin or cool it with anything the cosmetologist has not indicated.
Sauna and swimming pool
Out of the question for a week after the treatment, because of the temperature, sweat and chlorine.
Sun protection
For three weeks after the treatment high-factor UVA and UVB filters are essential. That is a condition, not a recommendation: without it the risk of pigmentation after the treatment rises.
Active cosmetics
Retinol, strong acids and other irritating ingredients come back into skincare only once the flaking has settled and after agreeing it with the cosmetologist.
Immediately after the treatment the skin may be red, with a slight stinging sensation. The discomfort usually passes within one to two hours of the treatment, and at the end the cosmetologist applies a moisturising and protective preparation.
Contraindications to chemical peels and medicines
Oral therapy with vitamin A derivatives requires a break of 6 to 12 months after the end of treatment. A separate group is medicines that increase the skin's sensitivity to light: oral contraceptives, hormone medicines and antibiotics from the tetracycline group, including doxycycline and minocycline. Report them before the treatment, and any change of treatment is decided solely by the doctor treating you.
Combining with other treatments
Peels are sometimes a therapy on their own and sometimes an element of a plan in which they improve the conditions for later procedures. At our clinic we combine them with needle and microneedle mesotherapy, depigmenting courses, electroporation, iontophoresis, radiofrequency and phototherapy.
A peel is also sometimes a stage of preparation before aesthetic medicine treatments: an orderly epidermis and a working barrier make better conditions for injections and energy-based treatments. They are not, however, done on the same day or on freshly exfoliated skin, and if you are planning a treatment with a doctor it is worth saying so at the cosmetology consultation, so that the order can be arranged rather than repaired.
The intervals between methods matter, because skin after a peel needs time to rebuild its barrier. The cosmetologist sets the order, and with treatments carried out by a doctor, both people set it together.
Situations that change the plan
Four circumstances in which the standard protocol does not apply and something else has to be agreed.
Acne in the inflammatory phase
Active pustular and papular-pustular lesions in the treatment area are a contraindication. Exfoliating irritated, inflamed skin increases the risk of the lesions spreading and of post-inflammatory pigmentation.
First we calm the inflammation, usually with home care, and with more severe lesions with a doctor's help. We come back to peels when the skin is calm, and then they become part of a plan rather than a rescue.
A darker phototype and a tendency to pigmentation
The higher the phototype, the greater the risk of post-inflammatory pigmentation after the treatment. The risk also rises in people who have been left with dark marks after earlier irritation.
We work more shallowly, more slowly and usually for longer. Preparing the skin before a course and consistent sun protection afterwards matter more in this group than the choice of acid itself.
Retinoids and strong acids in home care
Skin used to retinol and acids reacts differently from unprepared skin, and applying two stimuli in a short time ends in irritation rather than a better result.
Active preparations are stopped before the treatment, and you come back to them once the flaking has settled. The cosmetologist sets the dates, because they depend on the preparation and the depth of the peel. Oral vitamin A derivatives are a separate situation and require a break of 6 to 12 months after the end of treatment.
Pigmentation: peel or laser
That depends on the type of lesion and the depth at which the pigment is deposited. With superficial changes and uneven tone, peels are sometimes enough. With pigment lying deeper, exfoliation alone will not reach where it needs to.
What settles it is the assessment of the lesion, not the patient's preference. It also happens that both directions are combined in one plan, in an order set after assessing the skin. With a lesion of unclear character a medical assessment is needed first.
The questions we are asked most often
Will the skin flake and for how long?
It depends on the depth of the treatment. After superficial peels the flaking can be slight and resembles the reaction after too much sun. After medium-depth ones it is clearer and lasts longer, which is why before an important event we plan the treatment with time to spare.
Can a peel be done in summer?
The best period is autumn and winter. Stable preparations make it possible to run the therapy in summer as well, but then sun protection stops being a recommendation and becomes a condition of having the treatment.
How many treatments do I need?
Usually a course of four to six treatments, which can be repeated within a year. The cosmetologist matches the exact number and intervals to how the skin tolerates them, and adjusts the plan after the first sessions.
How does a peel at a clinic differ from an acid from the chemist?
In concentration, pH and control over the course. Clinic preparations reach deeper and require the skin's reaction to be watched and, with some acids, neutralised. Home cosmetics work on the surface of the epidermis and serve rather to maintain the result between treatments.
Will a peel help with post-acne scars?
Peels are sometimes used with superficial scars and post-acne changes, as part of a plan. Deeper, indented scars usually require other methods, for example microneedling or laser therapy. We say what makes sense in a particular case at the consultation.
I take isotretinoin; when can I have a peel?
Oral therapy with vitamin A derivatives is a contraindication. The break after the end of treatment should be 6 to 12 months, and the date is agreed with the doctor treating you.
Does the treatment hurt?
Anaesthesia is not required. During the application a stinging or warm sensation usually appears, which fades once the preparation is removed. If the sensation is unpleasantly strong, say so, because the cosmetologist can shorten the exposure time.
Can I wear make-up after the treatment?
Immediately after the treatment the skin is irritated, so we leave make-up until the next day. We come back to it with light, non-comedogenic formulas and clean brushes.
I have sensitive, couperose skin; is a peel for me?
It can be, but the choice of acid and concentration has to be careful. With such skin we more often choose acids that are well tolerated and a shorter exposure time. The cosmetologist makes the decision after assessing the skin.
How much does it cost?
The price depends on the type of acid and the area, which is why we keep one current price list for cosmetology treatments rather than scattered amounts on separate pages. We discuss the cost of the whole course at the consultation, before the first treatment.
Before you decide
Consultation with a cosmetologist
The cosmetologist assesses the skin, chooses the acid and the concentration and says how many sessions make sense in your case. The conversation does not commit you to having the treatment. A consultation with an aesthetic medicine doctor is paid for in line with the price list, as is preparing a home care plan, which requires a separate appointment.
This material is for information and does not replace a consultation or an assessment of suitability for the treatment.