Women in cosmetology

 

Doctor Kachiu Lee

Cosmetic and Laser Dermatologist
Director of the Laser and Aesthetic Clinic at Brown University
Boston, USA

tells us why Chemical Peelings are back “in Vogue” and are an “Art of Individualization”.

 

About your career and the people who inspired you

 

Early in my career, I became fascinated by the results that chemical peels could produce. I am a fellowship-trained cosmetic and laser dermatologist. I did my Laser and Photomedicine Fellowship with Rox Anderson, MD  and Mathew Avram, MD at Massachusetts General Hospital in Boston.

However, when it came time to set up my practice, I realized that I could not afford laser equipment.  I started looking in the literature to see what I could do that would provide amazing results. This led me to meet some leaders from the International Peeling Society like Harold Brody, Peter Rullan, and Gregory Hetter, all of whom are pioneers in chemical peels.  I was fortunate to learn from them and observe the results that they could get with deep chemical peels versus what I knew how to do by training with a CO2 laser.

When I saw what they had been doing for the past 20-30 years and the results they could get, I was so impressed that I started doing Chemical Peels and never stopped.

INDUSTRY ZOOM:
CHEMICAL PEELS ARE BACK “IN VOGUE”
As consumers and humans, we are always looking for the next new thing. Even as a laser trained dermatologist, we keep looking for the next device, the next tool that will further help improve our appearance. These days, we are looking back again at chemical peels because we see the limits of what devices can do; we see the limits of what neuromodulators or fillers can do.  We are finally reviving the art of chemical peels to get long lasting and amazing results.

Recent changes in patients’ concerns about chemical peels

Superficial chemical peels have become very popular among  millennials who buy them on internet and visit forum-based websites where users teach each other how to do chemical peels. This is driving some level of confusion among my patients who want to know the difference between the chemical peels on internet and the ones I offer in my practice. I always remind them that it is difficult to know about the purity of the peels bought on line and that they should be careful as peels are chemical agents that can cause deep scarring1, severe PIH(2) and other severe side effects if not performed properly. With my internet-savvy millennials, it is all about education and helping them understand that chemical peels can cause severe side effects if improperly used.

My non-millennial population are also interested in chemical peels, but might not be as familiar with them as they are with neuromodulators, fillers, and lasers. With this population, it is about demonstrating the benefits of peelings as adjunctive or complementary aesthetic treatments.

What kind of benefits can you expect from chemical peels

There are 3 types of chemical peels which are categorized in terms of depth of penetration: superficial, medium and deep. I am a big advocate of doing deep chemical peels for people who have deeply aged wrinkles and discolorations. Some histological studies have shown in the literature  that chemical peels can rebuild collagen and elastin and regenerate the skin(3) The photo-rejuvenation benefits of deep chemical peels are seen even 15-20 years after the initial peel(4).


Instead of injecting fillers to enhance the volume of the skin, I can use chemical peels harness your skin’s own ability to regenerate collagen and do it naturally for a long lasting effect. Fillers will only last you a couple of years. Comparatively, when you use chemical peels to stimulate production of new collagen, this result will last 15 to 20 years(4). I think the old is new and the new is old again. We see the limits of what our laser and light-based technologies can do and we are reaching back to our armamentarium to rediscover effective treatments like chemical peels.


About recent innovations in chemical peels  

1. Major skincare brands and companies are finally recognizing the consumer demands for superficial chemical peels. They are finally formulating safe over the counter superficial peels. Instead of buying products from online forums, patients can now get superficial chemical peels from reputable skincare lines. These products are safer and have advanced cosmetic formulations to minimize side effects..

2. From a medium to deep chemical peels’ perspective, I am really excited that there is finally more evidence-based research being done to support what clinicians have seen for years. Chemical peels do work and evidence-based studies have shown that they are effective for acne, melasma, acne scaring as well as for multiple other conditions(6). I am very pleased to now have the evidence to present to my patients and to be able to reference it to support my observations.

3. Last but not least, as a physician, one of the most important thing is to individualize treatment for each patient. When I look at a patient to see if they are an appropriate candidate for peelings, I look at a diversity of factors. I look at what they are trying to treat, I look at what their skin type is ( if they are fair or have dark skin), I assess their risk factor when it comes to healing. Each individual approach is personalized to not only that person’s skin color and skin type but to the condition they are trying to treat, to the oiliness of their skin, to the texture of their skin and the location that we are trying to treat on their skin. Chemical Peeling is an Art of individualization.

What is on the Horizon

  • Chemical peels have been scary to many physicians, because it is an old art that a lot of people are not taught anymore. It is really an art because even if I am applying the same solution, the same peel to a person face, the technic I use to apply the medicine under the eye is going to be different from the technique I am using on the cheeks, or on the nose for example. It is exciting that Chemical Peels are finally having a resurgence and that people are taught these skills again. It is exciting that Chemical Peels are finally having a resurgence and that people are taught these skills again.
  • Over the past few years, a lot of the major skincare brands have started commercializing some peels into formulations that are easier for physicians to use. I am motivated to see that more types of superficial chemical peels are being made available to physicians like specific peels for skin of color for example. By 2020, more than half of the children in the USA will be part of a non-caucasian racial or ethnic group(6). We need better options for these patients and future patients. We need to reach back to our chemical peel armentarium and relearn the skills to use them for this population to offer them something for their skin concerns. We also need to further develop the evidence on Chemical Peels in Skin of Color. Most of the date comes from India and it is important to have a diversity of ethnic and cultural background because there are unique aspects for skin of color all around the country and around the world.
  • Finally, to me the biggest downside of chemical peels remains the downtime (healing time) of medium and deep peels.  For my ideal specification, I would want something safe, effective, and with minimal side effects. We still have a lot of research to do on how to formulate the best product to maximize results while minimizing side effects and downtime

What is your definition of Skin Health?

Skin Health is restoring your skin back to its best and most natural state. I really believe that by using your body own’s ability to rejuvenate, you can become your ideal self. Chemical peels harness the wound healing power of your body to regenerate collagen, leaving you with a natural, healthy, and long lasting result.

What are your secrets about Chemical Peelings?

I love combining different types of chemical agents with other aesthetic procedures. As such, I often layer my peels or I often do a series of peels combining different agents(7) like using salicylic acid, lactic acid or mandelic acid for pigments. A lot of our industry partners are catching on and are making multi-steps peels that are made up of different ingredients harnessing the benefits of different molecules.

Now that chemical peels are in Vogue again, I’m excited at the possibility of combination treatments with lasers, microneedling, and other injectables. By doing innovative combinations like microneedling and then performing a chemical peel over it, we can potential have improved penetration of the peel and thus produce better results with fewer treatments and less downtime.

The future of Chemical Peeling is brighter than ever.

BIBLIOGRAPHY:
1. Shaw DJ, Higgins HW 2nd, Lee LC. Development of a hypertrophic scar after application of an over-the-counter chemical peel.  Dermatol Surg. 2017 Jan;43 Suppl 1:S91-S93.
2. Beylot C, Raimbault-Gérard C. Post-Inflammatory hyperpigmentation occurring after cosmetic procedures. Ann Dermatol Venereol 2016 Dec- 143 Suppl 2:S33-S42
3. Yardy Tse MD et al. Clinical and histologic evaluation of two medium-depth peels. Dermatologic Surgery. 2016 Sept; volume 22, Issue 9
4. Kligman AM, Baker TJ, Gordon HL. Long-term histologic follow-up of phenol face peels. Plast Reconstr Surg. 1985 May;75(5):652-9.
5. Vemula S et al. Assessing the safety of superficial chemical peelings in darker skin: A retrospective study. J Am Acad Dermatol 2018, Mar 5
6. 2018 American Academy of Dermatology Meeting – Daily Publication- Proper Care for all skin colors
7. Sarkar R et al. Chemical peels in melasma: a review with consensus recommendations by Indian pigmentary expert group. Indian J Dermatol. 2017 Nov-Dec; 62(6):578-584