It depends entirely on depth. Many superficial peels produce no visible flaking at all. A medium-depth peel will peel visibly for several days, and we will tell you exactly what to expect before you book.
Overview
Prescribed, not bought
An old technology, still unbeaten for certain problems — provided the depth is chosen by someone who knows your skin type.
A chemical peel removes a controlled thickness of skin and lets it regenerate. Superficial peels work within the epidermis and produce brightening, smoother texture and less congestion with little or no visible peeling. Medium-depth peels reach the upper dermis and address pigmentation, fine lines and sun damage — with a week of visible recovery.
In acne, peels have a specific role: they clear the follicular obstruction that starts the process, reduce comedones and improve the penetration of topical treatment. In pigmentation, they can be extremely effective — or, at the wrong depth in the wrong skin type, they can make matters considerably worse.
That is the whole argument for having a peel prescribed rather than bought. The agent, the concentration, the number of coats and the preparation of the skin beforehand are all clinical decisions.
At a glance
- Treatment time20–40 minutes
- AnaestheticNone; a warm stinging sensation during application
- DowntimeNone to seven days depending on depth
- SessionsA course of 3–6 for superficial peels
- ResultsBrightening within days; pigment change over weeks
- Combines withMedical acne therapy, bio-stimulation, laser
How it works
Controlled removal, controlled regeneration
Different acids reach different depths and do different things. Alpha-hydroxy acids such as glycolic loosen the bonds between surface cells; they must be neutralised, because depth is governed by time as much as by concentration. Salicylic acid is lipid-soluble, concentrates in the follicle and stops itself — it precipitates as a white crystalline film as the solvent evaporates, which is why it is forgiving. Trichloroacetic acid denatures protein outright; the white frost is the clinical gauge of depth, and it cannot be neutralised once applied.
Depth is the whole decision. A superficial peel reaches roughly sixty microns — the epidermis and no further — and is appropriate for every skin type. A medium-depth peel reaches around four hundred and fifty microns, into the upper reticular dermis, which is where genuine collagen change begins and also where scarring and pigmentary disturbance become real. The histology after a medium-depth peel is well described: full-thickness epidermal loss by day three, resurfaced by day seven, new collagen at thirty days, thickened collagen bundles at ninety.
Skin is usually prepared for several weeks beforehand — often with a retinoid and a pigment-inhibiting agent — which improves the result and reduces the risk of post-inflammatory pigmentation.
The same acid is also used, in a completely different way, to reconstruct individual deep scars: see TCA CROSS.
Indications
Suited to
- Dull, uneven skin tone
- Comedonal and inflammatory acne
- Congestion and enlarged pores
- Sun-induced pigmentation and freckling
- Melasma, at carefully chosen depths
- Fine surface lines
- Rough texture on the back, chest and shoulders
- Melasma treated with a medium-depth peel — the inflammation frequently makes it worse
- Deep atrophic scarring, tethered scarring or laxity, none of which a peel can reach
- Active herpes simplex or any infection in the field
- Recent facial surgery or resurfacing
- Skin that cannot be kept out of the sun afterwards
- Fitzpatrick IV to VI at medium depth without several weeks of priming first
In the clinic
Step by step
Preparation
Several weeks of prescribed home preparation for most medium-depth peels, particularly in skin prone to pigmentation.
Cleansing and degreasing
The skin is thoroughly prepared so that the agent penetrates evenly.
Application
The agent is applied in controlled coats and monitored. You feel warmth and stinging, eased with a fan.
Neutralisation
Where the agent requires it, the peel is neutralised at the endpoint chosen for your skin.
Recovery
Superficial peels: flaking for a few days or none at all. Medium-depth: visible peeling for up to a week, then pinkness. SPF 30+ daily throughout.
Recovery
Downtime, honestly
Superficial peel, days nought to two
Redness and mild stinging for a few hours, then fine flaking. There is effectively no social downtime, which is why these are given as a course rather than as an event.
Medium peel, day nought
Burning during application, frost, then redness and swelling. The skin feels tight.
Medium peel, days one to two
Deepening redness, oedema and a bronzed appearance. This is the point at which patients who were not warned become alarmed.
Medium peel, days three to six
Peeling in sheets, dark and unmistakable. Do not pull it; let it release.
Medium peel, day seven onwards
The surface has re-epithelialised. Residual redness fades over two to six weeks, and the dermal benefit continues to mature for about three months.
Risks
What can go wrong
Expected
Stinging during application, redness, flaking. At medium depth, a week of visible peeling and several weeks of residual pinkness.
Uncommon
Post-inflammatory hyperpigmentation — the commonest meaningful complication, and the one that priming is designed to prevent. Prolonged erythema. Milia. A visible demarcation line at the jaw if the peel is not feathered.
Rare but serious
Infection, bacterial or herpetic. Hypopigmentation. Scarring, which at medium depth follows from pushing to a solid white frost in skin that should not have been taken that far.
Priming is not a formality. Two to four weeks of a retinoid, with a pigment-inhibiting agent in anyone at risk, thins the stratum corneum so the acid penetrates evenly and markedly reduces the pigmentary risk afterwards. In darker skin the retinoid is stopped about a week before the peel itself.
Evidence
What the evidence shows
Adequate for acne, weak for scarringFor acne, twelve randomised trials covering 387 patients found almost no difference between agents: trichloroacetic against salicylic, glycolic against salicylic, glycolic against Jessner’s — all statistically indistinguishable. Glycolic acid beat placebo. The honest reading is that the choice of acid matters far less than the depth, the preparation and the skin it is used on, and that the trials are too weak to prove either superiority or equivalence.
For melasma and pigmentation in darker skin the evidence is better than most people expect: in a meta-analysis of thirteen studies, both trichloroacetic acid and Jessner’s peels outperformed topical hydroquinone, and glycolic acid outperformed trichloroacetic.
For acne scarring, peels performed similarly to fractional laser — but Cochrane adds a caution we will repeat rather than hide: because the comparisons were all between active treatments with no sham arm, finding no difference between two treatments could also mean that neither of them works.
If you are travelling
A superficial peel has no travel consequence; you can fly the same day and nobody will know.
A medium-depth peel does. Plan seven days before you want to be seen, and do not book one before a wedding, a conference or a photograph.
Sun is the Marbella problem, and it is not a small one. A medium peel should be avoided in high summer, and in any season requires rigorous photoprotection for weeks afterwards — which, in practice, means it is often better done at home in winter than here in July. We would rather tell you that than take the booking.
Questions
Good to know
If your question is not here, ask it in the enquiry form — Dr. Henningsen answers these personally.
Ask a question- Will my skin peel visibly?
- Are peels safe in darker skin?
Superficial peels, yes, and they are widely used. Deeper peels carry a real risk of post-inflammatory hyperpigmentation in darker skin types, and are approached with preparation, caution and often a preference for a different modality altogether.
- Can I have a peel for melasma?
Sometimes, as part of a broader plan. Melasma is a chronic condition that relapses with sun and hormonal exposure, and treating it aggressively with the wrong depth can worsen it. Diagnosis first.
- How is this different from TCA CROSS?
Same acid, opposite intention. A peel treats the surface of a wide area at a shallow depth. CROSS puts a small volume at high concentration into the base of one scar at a time, and never touches the skin between them.
Consultation
Ready to talk about your skin?
Consultations with Dr. Henningsen are arranged individually. Tell us what you would like to change and we will come back to you with the options, the honest downtime and the realistic result.