Chemical peels in aesthetic dermatology: an update 2009

Peelings are among the oldest and most widespread aesthetic procedures used in aesthetic dermatology worldwide. More than 50 commercial peelings are currently available on the European market.

In the present review, we summarise the current knowledge on chemical peels.

A state-of-the-art peeling procedure will take into account the depth of the targeted structure and the skin condition of the patient to choose carefully among the variables such as chemical class of the peeling agent, concentration, frequency and pressure of the application. The usual classification of chemical peels comprises superficial, medium and deep peels. For superficial peels alpha-hydroxy-acids and most recently lipo-hydroxy acid are used to induce an exfoliation of the epidermis. Medium-depth agents such as trichloroacetic acid (<50%) cause an epidermal to papillary dermal peel and regeneration. Deep peels using trichloroacetic acid (>50%) or phenol based formulations reach the reticular dermis to induce dermal regeneration. The success of any peel is crucially dependent on the physicians understanding of the chemical and biological processes, as well as of indications, clinical effectiveness and side effects of the procedures.