October 5, 2012
Dear Mayo Clinic:
Are wrinkle treatments like dermabrasion and chemical peels safe? Do they actually work?
Chemical peels and dermabrasion work by removing layers of skin. The skin that grows back is often smoother, with fewer wrinkles and less discoloration. Chemical peels and dermabrasion can cause side effects. In general, however, when performed by experienced and knowledgeable providers, they are safe.
Your skin has three layers. The outer coating is the epidermis. Its main purpose is to serve as waterproofing for your skin. On your face, this skin layer is very thin. The second layer, called the dermis, is thicker. The connective tissue and collagen that gives skin its strength is located in the dermis. The third and deepest layer of skin, known as the subcutaneous layer, contains fatty tissue, muscles and blood vessels.
Chemical peels involve putting acid on the skin. The goal is to cause a controlled first- or second-degree burn that makes the skin peel. When the old skin comes off, new tissue forms that is tighter and smoother.
Mild chemical peels include salicylic acid peels or glycolic peels. These are the kind of chemical peels done at a salon or spa, and sometimes in a dermatologist's office. They typically take off the epidermis, and results are not as long-lasting. Side effects are usually skin reddening and some skin peeling.
Medium-depth peels are applied in a dermatologist's office. The most common contains trichloroacetic acid. These chemical peels not only remove the top layer, they also remodel the second layer of skin. As that second layer heals, new collagen forms and the old collagen tightens.
Recovery following medium-depth chemical peels usually takes several weeks. During that time, the old layers shed and the new skin looks badly sunburned. People with moderate wrinkling and some sagging often see considerable improvement in the appearance of their skin following a medium-depth chemical peel. In general, those results can last from several months to several years. Skin discoloration may reappear more quickly, though, with some darkening coming back within six months.
Stronger chemical peels are available, too. For example, a peel using phenol is very strong and causes an even deeper chemical burn. These peels can be helpful for severe acne scars or deep wrinkles. But they are not widely used because recovery time is longer, and side effects can be more serious, including permanent skin discoloration, and an increased risk of heart rhythm problems.
In general, chemical peels work best for people with mild to moderate wrinkles and sagging. Usually included in that group are those in their 30s, 40s or 50s. For someone 60 or older who has deeper wrinkles or more sagging, a chemical peel may not be as effective. That's because, in addition to skin damage, at that age many people also have some loss of skin's underlying soft tissue that a chemical peel cannot fix.
As with a chemical peel, the purpose of dermabrasion is to remove layers of skin. The difference is that in dermabrasion, the skin is sanded away, usually with a small tool that looks like an electric toothbrush.
A benefit of dermabrasion is that the depth of its effect can be precisely controlled. Dermabrasion is most helpful for correcting isolated irregularities in the skin, such as a single, raised scar, acne scars or other abnormalities that require delicate changes in a small area.
Before you decide to get a chemical peel or dermabrasion, talk to a dermatologist about the possible risks and benefits. Be aware that people who are prone to keloids — an overgrowth of scar tissue — or skin discoloration, as well as those who bruise or bleed easily, may not be good candidates for these procedures.
Make sure your health care provider understands what you are hoping to achieve. When expectations are reasonable and people are screened carefully, these procedures often provide pleasing results.
— Christopher Arpey, M.D., Dermatology, Mayo Clinic, Rochester, Minn.