How to Prepare for Intermediate to Deeper Facial Peels

Prior to facial peels, patients may be asked to treat their faces with Retin A, Renova, and/or skin bleaches or creams for two to four weeks. Because dark skinned people can sometimes darken further after the procedure, they are frequently advised to treat their skin before surgery to prevent this or not to have the procedure at all. We require our patients to take an anti-viral medication such as Valtrex® or Acyclovir® to prevent cold sores, which can be stimulated by the treatment. Cold sores can spread all over the face and may cause scarring if they occur after treatment when the skin is raw. Also due to its effects on healing skin, Accutane® cannot be taken for one year prior to facial laser or dermabrasion surgeries. You also don't want to undergo a surgical procedure if you are ill or if you have unstable medical problems. Your doctor will counsel you about any limitations.

I believe that preparing for your recovery is the most important element to consider when it comes to facial peeling. Patients should be given an accurate picture of what to expect during this period, because frankly, a newly peeled face is not a pretty sight. Most patients may stay in the house for a week after the procedure, as their faces are either bandaged, or if exposed, raw and swollen. Recovery from deep peels is, on average, the toughest of any procedure we do. The dressings are claustrophobic for some people. So plan to take adequate time off from work, and don't book any important social engagements until at least two weeks after your deep peel. Let your family and friends know what to expect.

How It's Done

When you arrive at your doctor's office, you'll be given a sedative. I usually give my patients a light anesthetic drip to allow them to sleep. While you're relaxing, the doctor may draw on your face to mark the areas to be treated. Your face will then be washed with an antiseptic solution and the tumescent solution, if used, is injected with a tiny needle to numb the face. If the doctor is not using tumescent, he may alternatively have an anesthesiologist put you in a heavy sleep. For lighter peels, some patients can tolerate the discomfort without anesthetic.

By the time the doctor begins working, you shouldn't feel anything at all. If a laser is use, it "zaps" small areas on the face as the doctor moves carefully from one area to the next, treating each in turn, using his skill to blend everything evenly.

In theory, the laser doesn't actually burn the skin because there's very little heat transfer involved. Instead, it vaporizes the skin surface by making the water boil inside the skin. During the process, the treated skin changes in a way that allows the doctor to wipe off the top layers with a wet gauze pad. With each zap of the laser, the doctor can see new, fresh skin appear. Very little bleeding occurs. Each laser zap lasts a fraction of a second, and if you're awake (but sleepy) during the procedure, you'll hear it working — zip, zip, zip — and you may hear the doctor and staff talking and working around you. The whole process usually lasts about half an hour.

If acid peeling is performed, usually the face is cleaned with alcohol or even acetone, then the peeling solution is applied with a gauze sponge over at least 10 minutes and sometimes as long as a half-hour.