Skin Peels, Part 1

Dr. Furnas (00:12):
Skin peels. According to the US Sun, celebrities swear by them. Gwyneth Paltrow sells her own Goop Glow Microderm Instant Glow Exfoliator for $58. So why pay more to have a professional peel? Welcome to Skintuition. I'm Heather Furnas. 

Dr. Korman (00:34):
And I'm Josh Korman. As two plastic surgeons, we lay aside our scalpels and explore the non-surgical world to bring you what's new, what's safe, and what to look for when you're ready to hit refresh. 

Dr. Furnas (00:47):
This week we're answering questions that have been sent in from people from around the country. Thank you for taking the interest. And I'm going to start with Susan from Modesto, California who asks, what home peels are there for my face? And what do they do? 

Dr. Korman (01:07):
Well, yeah, I think home peels. Does that mean in your home? Does that mean in your medicine cabinet? Where is home anyway? I guess home is where your visa bill comes to. But anyway, the home peels, I mean, I think they're break down to a lot of several different ones. There's chemical peels, there's enzyme peels, there's physical peels. The question is what does that really mean? So I think first we got to figure out peels are not all the same things. So what do you think? 

Dr. Furnas (01:36):
Yeah, just the word peel kind of sounds, if you think about it, a little creepy. But I think what peels do, the common thing that peels do is they exfoliate. So in some way, whether it's chemically or abrasively, they will get off those top layer of dead cells. And there's really three main classes, chemical peels, enzyme peels, and physical peels. 

Dr. Korman (02:06):
So wait a second. So first, before we get to the different kind of peels, when you say they peels off, so why do we want to get rid of the dead skin cells? The skin is always regenerating. And when people have tans, if you exfoliate, the tans going to go away. Why do we want to get rid of those dead skin cells anyway? 

Dr. Furnas (02:27):
Yeah, that's a good question. I think a lot of people find that their skin looks dull and if they use a peel, it kind of brightens the skin. And that's one commonality. Even with the most gentle peel, it just gives a more refreshed look. 

Dr. Korman (02:47):
I think some of it is also that brightening, there's so many brightening products on the market, and I think one of the things that does happen as we age is that that very wonderful glow that you see in children starts to go away. What's the sign of someone who looks good or doesn't look good or looks older? Is that the brightening? And I think we won't get into all the cellular parts of it, but I think part of the reason to exfoliate is to bring out the glow beneath and to get the newer skin cells that have more youthful, literally energy to the surface. 

Dr. Furnas (03:30):
Exactly. And some of the things we've talked about in other episodes have dealt with increasing the cell turnover, you know like Retin-A, Retinoid, tretinoin, all really in that same vitamin A derivative really kick up the cell turnover. And so at the very top, you've got all those dead cells kind of piling off. And that's why with Retin-A, your skin can be flaky and it can look dry. And so when those dead cells accumulate, it does give that dry look, dry skin, flaky, dull, not bright, and you want those really bright living cells to peek through. And because the dead cells can exaggerate fine lines and wrinkles, the wrinkles and fine lines actually look better. Even though it's not really doing anything to the deeper layer of the skin, they can still look better with home peels and with any peel. 

Dr. Korman (04:30):
So it sounds like the first thing we have to do and really need to answer Susan's question because all we're do is talking instead of answering Susan's question. But I think the first thing we have to do is take off the dead skin. That's what they exfoliate before we get to the deeper layers to make things better. So the chemical peels, they use acids to take off the skin, and obviously we want acid that works, but not too much. You obviously don't want to burn the skin to a point where it cause a problem, but you have to. Part of the reason all these peels make you pink or red is because that's exactly what they're doing. They're causing reactions to take off the layers of the dead skin or even the cells that have been exposed to sun damage. And the chemical peels can be effective in treating conditions like acne, wrinkles and sun damage. 

Dr. Furnas (05:29):
We'll get a little bit more into some of those acids, alpha-hydroxy acids and beta-hydroxy acids as we go through this. But yes, they're mainly acids and then they're also enzyme peels because not everyone tolerates the acid peels. And so enzyme peels are a little bit more gentle, but they still help exfoliate and then the physical peels, you know, likes. 

Dr. Korman (05:57):
Before you go to physical peels, maybe we should kind of break down a little, what is enzyme anyway? What does an enzyme do? 

Dr. Furnas (06:03):
Yeah, so an enzyme is actually a protein. It's not an acid, and it speeds up a chemical reaction and we call it a catalyst. And so it can break down some of the bonds that are attaching the skin cells, and in that way it helps speed up the exfoliation. 

Dr. Korman (06:26):
So we know about chemical peels and enzyme peels right now, back to the physical peels, what do they do? 

Dr. Furnas (06:32):
So it's just a mechanical way of exfoliating the skin. So they may have little abrasive granules that feel kind of like sand, and it's just another way of really getting a good scrub and essentially scraping off the cells. 

Dr. Korman (06:49):
So why can't I go to the hardware store and get some sandpaper? 

Dr. Furnas (06:53):
Well, you could and then you'd be doing, if you get into the dermis, a dermabrasion, and that's a surgical procedure. But yeah, that is not so gentle for the skin though. 

Dr. Korman (07:06):
Yeah, I think that's actually the point. It's like one of the questions is like, well, since there are a lot of things you can buy in the market and buy online, why not just do everything at home? And I think, I mean the sandpaper is sort of an example of, yeah, you can use sandpaper, but you can get yourself into a little bit of trouble that you didn't really want to. And so I think part of the reason the DIY for your face is a little bit and why there's a great big industry of practitioners and products is because DIY may not be so helpful. And then getting yourself out of trouble is a little bit can be problematic. 

Dr. Furnas (07:46):
And that kind of gets us to Alicia's question, Alicia from Savannah, Georgia. What is the difference between home peels and professional peels? So you touched on it. You want to expand Josh? 

Dr. Korman (08:01):
Yeah. Well, I think the benefits of home peels is they do the remove dead skin. You can do it at home. It's pretty inexpensive from the product and it can improve the appearance of fine lines and wrinkles and sun damage. Although I'll tell you, if you look at any of those bottles that you buy in the store or online, they never say it is shown to improve. It shows, it always says it's shown to improve the appearance of, that's kind of the lingo that the government allows people to say without saying, oh, it does something. So be careful what you read. But then also home peels that unclogs pores and reduces the appearance of blackheads and whiteheads, although I think going to pick at your blackheads and whiteheads in your mirror can be fraught with issues and also unclogging pores. I think one of the things people complain about a lot, at least in my practice is large pores. They want to know how to make the pores smaller. And I think popping pimples and doing things that are unclogging, they can often make the pores bigger so you don't want to have another problem from it. And also home peels reduces inflammation and redness. 

Dr. Furnas (09:10):
Yeah. The one difference that you'll find as far as the ingredients is the acid strength. So home peels typically use acids with what we call a ph, how acidic it is with the lower number being more acidic. So a home peel may be three to 4.5, whereas a professional peel in a med spa or doctor's office is going to be two to three, which means it's more acidic, which means it can penetrate deeper into the skin. 

Dr. Korman (09:44):
Yeah, I think basically the big difference between doing it in a doctor's office and doing it at home is the strength. This is the difference between products you can put on your face, devices that can be treating the face. It has to do with intensity. And in general, the stronger the more results you get. So I think at the end of the day, you got to figure out what's good for you and how far do home remedies take you safely, and when do you need to get a medical professional involved? 

Dr. Furnas (10:22):
And downtime is another consideration. So if you have a really light peel and an enzyme strength that's not very strong, you're going to bounce back. You may be a little red for a little bit, but you're going to bounce backwards. Some of the professional peels, you can be red, even a little swollen and peeling for a few days up to a week. And so sensitivity, some people just want a really light peel and aren't after a big wow result. But if you have a real skin condition that you're targeting hyperpigmentation or lines or acne, then you're probably better off actually spending your money getting a professional peel than a home peel. 

Dr. Korman (11:10):
Yeah, it's also important to know that we are a diverse population where we have a lot of different skin types. And in the medical lingo, it's sort of breaks down to type one through type six, type one being the most light skin, whereas six is the darkest skin and different skin types and different skin tones. And different skin colors react differently to some products. And it is really important not to treat the skin types and the skin tones with products that one won't help them or more cause damage that then can result in scarring and things like that. So it is important to understand your skin and realize it's clearly not one size fits all. 

Dr. Furnas (12:04):
Another thing that you could do at home is a mask. And we have actually Jessica from Houston, Texas was wondering what is more effective a mask or a peel? 

Dr. Korman (12:19):
So what is a mask anyway? 

Dr. Furnas (12:22):
Well, it's like the phantom of the opera. It's something that just, it's moist, you put it on your face and it tends to be made of ingredients like clay or charcoal or even honey. So they're generally gentle and safe. You put 'em on for about 10 or 20 minutes and then you rinse 'em off. 

Dr. Korman (12:45):
So if you do that, then how does that work with your skincare routine? Do you do that by itself? Do you do that after? Do you just wake up in the morning on a weekend and go, okay, today I'm going to use a mask? How does that work? 

Dr. Furnas (13:01):
Yeah, I think it's a great way to start. And then because it exfoliates, and that's the thing that masks have in common with peels is they both exfoliate, but masks don't have those chemicals. Some of them will have enzymes which are more gentle as we discussed, but they don't have those more stringent acids and stronger products. And so they tend to be more soothing. Some people will put on a mask just to relax and lie back and wait for the mask to do its work. And then some are embedded with something that will hydrate the skin, and so the skin complexion can look more dewy. And then from there you can put on the rest of your skin products and your makeup and be good to go. 

Dr. Korman (13:54):
So does that mean I should get some cucumbers, put them in the refrigerator and dip 'em in honey and stick 'em in my eyes? Is that going to help me? 

Dr. Furnas (14:01):
Wouldn't you look great after.

Dr. Korman (14:03):
Yeah, great. Of course I couldn't see. So you can't see if you've got the cucumbers on your eyes, how can you even see. You need someone to take a picture of you. Yeah. 

Dr. Furnas (14:15):
Yeah. But it's interesting. Some of these things, fruits and vegetables and whatnot, contain enzymes and that's really, enzymes are often derived from vegetables or fruits. Three really popular ones are papaya and pumpkin and pineapple. I mean, that sounds like a really good meal. 

Dr. Korman (14:41):
Yeah. The thing I'm trying to understand is that, and this is I think always a big question is what actually gets through the top layers of the skin to actually do anything? I think that's part of the question, that's sort of a big answer. Yes. Do you need to create an injury to the skin micro injury, anything to open the channels so that any of these products get in? I mean, as much as the cucumber thing is so popular to see in the ads, I don't know it beyond the fact that it's cold, does anything actually get through from the cucumber into the skin? So how does all this work? Is it the exfoliation? Will that do it? 

Dr. Furnas (15:28):
It's actually the enzymes that we were talking about how enzymes will catalyze a chemical reaction. And so there are little connections between the skin cells, and so those enzymes can help break that down. Now Josh, you were talking about injury, and when we think about injury to the skin, we generally think about something reaching the dermis. And so there's a top layer of the skin called the epidermis, and then the deeper, much thicker layer of the skin that will have a blood supply. That's the portion we think of with injury. You can bleed if you hit the dermis, you're not going to bleed if you're just at the epidermal layer. 

Dr. Korman (16:16):
So I think then the question is what do we do if we're using home products? Do any home products get into the dermis or do they basically stick at the epidermal level? 

Dr. Furnas (16:31):
They stick at the epidermal layer just as superficial peels even done in a professional office do. It's not a very scientific metric, but peels that are medium depth or deep tend to get into the very top of the dermis and a little bit deeper. And we'll actually talk about deep peels and medium peels in another episode. But the superficial peels, home peels are really acting at the level of the epidermis. However, you can take a lot of those ingredients, strengthen them. You can have a 70% glycolic acid peel and get into the dermis so you can create injury. And interestingly, injury is often what kicks up collagen production and can rejuvenate the skin. So we think of injury as being bad, but the body responds to injury through an inflammatory process, and that is basically rejuvenating when controlled. 

Dr. Korman (17:41):
So if we live in different kinds of climates, most of the people that have asked the questions have been in the sunnier climates, so maybe they're kind of more concerned about the sun, but how is the recovery time different if it's the summer or if it's in a sunnier climate, does that put us more at risk or should we do these things at certain times of the year or when we're going to be inside? How does that work? Can you do a home peel and still go out and play tennis in the sun? 

Dr. Furnas (18:17):
Well, I think with, yeah, some people live in really sunny climates, and so it's hard to isolate when they can have it done. So I think the most important thing is just to protect yourself from the sun, no matter the season, because some people are going to do home peels year round. It really does a lot for the skin's appearance and makeup can look a little less flaky or pasted on. And so you want to wear a good sunscreen and hat and uv protective glasses. And no matter what season or where you are, if there is bright sun out there, you need to avoid the direct uv damage. 

Dr. Korman (19:03):
Let's get to this thing about, down to the peels a little more. We all hear about glycolic peels and alpha-hydroxy, and so it's important to understand about those because I mean, I get confused understanding what are they anyway? 

Dr. Furnas (19:18):
Yeah. I mean even the name alpha-hydroxy acid, the alpha-hydroxy takes you back to chemistry in college, and I did not like chemistry. And then there's beta-hydroxy. And so alpha-hydroxy acids, we get them mainly from fruit and milk. The most common that you're going to hear about are glycolic, lactic and mandelic acid. Probably the most common is lactic acid because it's the smallest molecule, it penetrates the deepest, but people with sensitive skin may not be able to tolerate it. And so lactic acid is a little more gentle with a bigger molecule, doesn't penetrate as easily, and mandelic acid has the biggest molecule and happens to be really good for hyperpigmentation. 

Dr. Korman (20:09):
So wait a minute, one more time. Glycolic goes the deepest?

Dr. Furnas (20:13):
Yeah, it's like this little burrowing small molecule that can go the deepest. And so if you've ever had a glycolic-acid peel, it stings, you can feel it and you look shiny because all those skin cells that are dead have come off and it really does leave a really nice refreshing look. It's a great way to, anything that exfoliates can help your other products penetrate deeper. 

Dr. Korman (20:44):
So glycolic is the deepest and lactic is the middle, and mandelica is the most superficial. 

Dr. Furnas (20:49):
Yeah. Just because of the size of the molecule. And so they're great for wrinkles and acne and hyperpigmentation, but the best for acne is actually the beta-hydroxy acid that is most commonly used, which is salicylic acid. And because it doesn't dissolve in water the way alpha-hydroxy acids or doesn't mix with water, I should say it's more consistent with oil. So it penetrates the pores with the sebaceous glands, and that's how these peels unclog pores. It's actually the chemical and it loosens up the pores and allows the dead skin and the oil that's plugged in there to escape. And so that's why when you have a peel that is specific for acne, it likely has salicylic acid, a beta-hydroxy acid. 

Dr. Korman (21:51):
So is this for active acne or for acne scarring? 

Dr. Furnas (21:56):
This will be for active acne, but some of these things will help with the acne scars, mainly by just taking off the dead cells and creating less shadowing. But the beta-hydroxy acid and even the alpha-hydroxy acids through shedding the extra skin that can clog pores, both of those can help with acne, but it's the beta-hydroxy acid that really interacts with the oil within the pore. So that's really the heavy hitter as far as treating active acne. Obviously this is not cystic acne that people will take accutane for, but it's more the blackheads and the whiteheads 

Dr. Korman (22:40):
And still it's really important to wash your face twice a day, which is what teenagers don't like to do, but it actually is the best thing. Okay. And then what about a Jessner's peel? What is that? 

Dr. Furnas (22:53):
Jessner's peel has been around actually for a hundred years, and it's just a combination of the alpha-hydroxy acids, beta-hydroxy acid, and something called resorcinol, which you'll see quite a bit in skincare products. It's actually derived from phenol and it just helps with shedding of the cells. And Jessner's is good for acne and hyperpigmentation. So it's just kind of a mixture and people found use for it through decades. 

Dr. Korman (23:29):
So obviously there's a lot of stuff. If you can look online, whether you go to Goop or you go to med spas online, you can find stuff to use at home and you can go into a med spa and they'll tell you what they think is best. So Heather, what would you want to use? 

Dr. Furnas (23:49):
Well, I think all these things have benefits. So I would say the alpha-hydroxy acid, the beta-hydroxy acid. I just did a pumpkin mask, which was a lot of fun and left my skin glowing and moisturized. So I think that all of these things, particularly when you could do a series of professional peels or ongoing home peels. And so a lot of it depends on what your own skin condition is. And so for me, a good exfoliation helps my makeup look better and helps my other products penetrate better. 

Dr. Korman (24:33):
So boys don't wear makeup? Well, some do, but I'll just say for those who don't wear makeup like me, I don't want something that's going to leave me too red or too pink for too long because then I feel like I can't go to work. Although I guess if I go to work pink, they want to know what I did. I guess that's an advertisement, but in general, I think it's too much pink, too much red is not so great for guys. And I think it's more the question of what is the quickest or the fastest downtime so that you can actually go to work or go to things. You don't have to stay at home and for the least amount of time. So what do you think the best thing for guys is? 

Dr. Furnas (25:13):
Well, I think you make a good point. And sometimes peels, particularly like the alpha-hydroxy acid peels are going to make you look a little bit red. So you may want to do that more in the evening or use something at very low concentration or an enzyme peel. But to really get that exfoliation, you probably will be a little bit red just temporarily. But if you do it at night, you should look good to go in the morning. 

Dr. Korman (25:41):
I think one thing that I know that we use in office that actually I think helps is it's really important just like any disease process where you want to be therapeutic. I think it's important to think of what can you do immediately after these treatments that essentially cause some minimal damage to the skin to accelerate the repair. And I think this is another reason why it's good to have some amount of expertise when you consider what you're going to do. Because certain oils, some people love coconut oil. My wife loves coconut oil for so many things to help repair things, I think you have to think about what can you do to repair what you've just done. And I think that will help minimize the redness and inflammation. 

Dr. Furnas (26:34):
Exactly. 

Dr. Korman (26:36):
So thank you for listening to this episode of Skintuition. Join us every two weeks as we tackle topics from hair loss to hormones, and pimples to wrinkles, discovering new ways to feel better about ourselves. 

Dr. Furnas (26:49):
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