May 9, 2000 -- Ellena Smith, 34, of Cincinnati is not aging as quickly as most of her friends. At least, she looks that way.
Her secret? She has been getting chemical peels once a month for the past six years. Such peels, available in several different strengths, use a chemical solution to improve and smooth the texture of the facial skin by removing its damaged outer layers.
"It lightens and brightens skin, takes away fine lines, and lessens wrinkles. I'm not aging like my friends," she tells WebMD. "Your skin just looks so much better, and you look so much younger."
According to a survey by the American Society of Aesthetic Plastic Surgery (ASAPS), more than 840,000 chemical peels were performed last year, making the peel the most popular cosmetic procedure performed in the U.S. The next most popular were Botox injections -- a procedure in which doctors inject a small amount of the botulism toxin into a wrinkled area to paralyze the muscle that creates the wrinkle -- and laser hair removal. Nearly 500,000 Botox injections and more than 480,000 laser hair-removal procedures were performed in 1999.
Chemical peels come in three strengths: mild, medium, and deep, Devinder Mangat, MD, president of the American Association of Facial Plastic Surgery and a facial plastic surgeon in Cincinnati, tells WebMD.
The mild peels are the most popular, he says. They cost from $150 to $300, and people often need to have a series of them to see a significant improvement in their skin.
"That improvement will range from a glow to actually eliminating some brown spots. At best, a patient may see some improvement in very fine wrinkles," Mangat says. He adds that some young people are getting the mild peels in an effort to reverse early sun damage.
Mild peels can be performed on any type of skin and take no more than 60 minutes, Mangat says. Skin may be somewhat painful for the first few hours following the procedure.
"These peels use either alpha hydroxy acid, such as glycolic acid, beta hydroxy or lactic acid, or salicylic acid in different strengths from 20% to 70% to produce a very superficial peel," he says. "You don't necessarily see skin peeling off, but you may see some redness or flaking."
Medium strength peels, which are usually reserved for fair skinned people, use such chemicals as trichloroacetic acid (TCA) and take about one week to heal, Mangat says.
"These peels will get rid of brown spots and roughened scaly skin, improve fine lines, and it tends to tighten skin a little bit, but skin will be pink for about four weeks afterward," he says.
Deep peels use a chemical called phenol. These peels, which can remove the damaged top layer of skin, are only for people with very deep lines, extremely leathery skin, or acne scars, Mangat says. "They take about 10 days to heal, and a patient has more extreme redness in the face that takes four to six months to completely go away," he says. These peels cannot be performed on people with olive skin, because they can cause discoloration.
Whatever strength peel you need, it's important to choose an experienced doctor, says David J. Leffell, MD, a professor of dermatology at the Yale University School of Medicine in New Haven, Conn., and the author of "Total Skin: The Definitive Guide to Whole Skin Care for Life."
"As more and more doctors get involved in doing cosmetic procedures outside their original area of training, it is important to ascertain where your doctor learned to do peels and what kind of experience he or she has had," he tells WebMD. "The degree to which your doctor can answer your questions specifically will be an indication of degree of expertise. In general, board certified dermatologists are the most highly trained in these procedures."
For referral to a cosmetic surgeon in your area, call ASAPS at (888) 272-7711 or visit its web site at http://www.surgery.org.