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a) How chemical peels work for skin rejuvenation

Chemical peels are a method of resurfacing and rejuvenating the skin. By inducing a controlled wound, chemical peeling agents can remove surface layers of the skin and stimulate collagen and remodelling. In turn, issues of hyperpigmentation, fine lines and wrinkles, congestion, acne and scarring can be addressed.

The benefits of skin peeling

1. Refinement and strengthening of top skin layers.
2. Removal of dead skin cells.
3. Skin rejuvenation – stimulate the production of collagen, elastin and hyaluronic acid.
4. Hyperpigmentation reduction. Breaks down clusters of melanin pigment to treat pigmentation concerns.
5. Deep cleanse and clarify congested skin.
6. Reduction of inflammation by restoring the barrier function of the skin.
7. Improves atrophic scarring typically associated with severe acne.
8. Rebuilds skin tissue.
9. General anti-ageing, skin smoothing and refinement.
10. Tightens and firms skin.
11. Skin hydration. Many peels are mostly humectant, preserving moisture.
12. Stimulates blood flow, increasing oxygenation and nutrition delivery to skin cells.

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b) What are the risk associated with chemical peels?

Chemical peels are a safe effective method of skin rejuvenation. Adverse reactions are very rare if treatment is performed by a qualified practitioner following protocols. This includes a thorough consultation, skin assessment, review of any potential contraindications and adhering to safety guidelines.

Adverse reactions are more common in DIY situations. Using chemical peel agents that are too harsh or applied to skin that isn't sufficiently prepared can result in problems. Additionally, chemical peels are universally known to increase the skin's sensitivity to sunlight.

Peeling skins of colour

The consideration of the Fitzpatrick skin type is vital when assessing a skin for a chemical peel

• Skins of colour (Fitzpatrick IV – VI) will have a greater tendency for PIH post-inflammatory hyperpigmentation and so must be treated with extreme care.
• Professional grade peels will often indicate whether a peel is suitable for Fitzpatrick 4, 5 and 6. DIY chemical peels without prior knowledge of the skin or indeed the product being used can pose significant risk.
• Skin types 4, 5 and 6 should avoid medium/deep peels without any prior skin exfoliation or peel applications. Understanding what constitutes a medium or deep peel is essential.
• A gentle progressive approach with an insistence on pre-treatment skin priming and post-procedural care of the skin is essential.
• Applying a chemical peel that is too harsh will ‘shock' the skin. As part of the skins' healing process, excess pigment or loss of pigment is likely to occur. This will result in an uneven and patchy skin tone.

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c) What chemical peel is best for my skin?

The best chemical peels for you can be determined through a treatment consultation. In general terms, each chemical peel agent has a set of properties which can be used to addressed specific skin concerns. Beyond the selection of the peeling agent, the strength of peel must be determined.

Several factors can influence the depth of a peel and how it works such as:

• The concentration of the peeling agent – ie percentage strength
• The addition of active ingredients included in the formulation
• The PKa and pH of the acid solution
• Whether the product is buffered or not
• The mode of application
• Number of passes or layers applied to the skin
• Timing
• Skin type / condition
• Skin preparation

What follows is a very basic guide to the most common chemical peels, their sources, and properties. Some of the best formulas are offered in a combination form. Such peels will address several skin complaints at once.

Additional active ingredients

Chemical peeling or exfoliative products may be enhanced by additional active ingredients and this element makes chemical peeling a very diverse and bespoke practice in remedial skincare.

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100% L-Ascorbic Acid Powder

Vitamin C is an effective antioxidant that brightens the skin tone and reduces the appearance of signs of aging. This formula offers a very fine L-Ascorbic Acid powder that visibly targets the appearance of uneven skin tone, dullness, and signs of aging and is formulated to be mixed with other treatments.

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Azelaic Acid Suspension 10%

Found in grains, Azelaic Acid is produced naturally by yeast that lives on normal skin. It brightens the skin tone while visibly improving the evenness of skin texture and reducing the look of blemishes. It is a multi-functional support ingredient for all skin types and also acts as an effective antioxidant. This formula offers a very high 10% concentration of high-purity Azelaic Acid in a lightweight cream-gel system.

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Granactive Retinoid 5% in Squalane

This water-free solution contains a 5% concentration of an advanced retinoid active complex called Granactive Retinoid that has been shown to offer better results against multiple signs of aging than retinol without any of the irritation and drawbacks common with retinol.

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Alpha Arbutin 2% + HA

Alpha Arbutin reduces the looks of spots and hyper-pigmentation. It's used at a high 2% concentration versus a standard concentration of 1% and supported with a next-generation form of Hyaluronic Acid for enhanced delivery. Alpha Arbutin is much stronger in effect than Arbutin or Beta Arbutin.

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For further details on actives and cosmeceuticals see a guide to cosmeceuticals and skincare products.

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d) Glycolic acid peel for skin rejuvenation

The original AHA (alpha hydroxy acid) first seen in 1900's for exfoliation. Glycolic acid became popular in 80s & 90s. It has the smallest molecule which essentially means it penetrates the skin promptly and with ease. This makes Glycolic an aggressive chemical peel.

Glycolic acid initiates the arachidonic inflammatory cascade which effectively regenerates collagen, reducing wrinkles. Due to the aggressive nature of Glycolic acid, it is not an optimal choice for sensitive or dark/deep skins. Primary targets are fair/light skin with primary concerns of ageing whether premature or natural.

Additionally, Glycolic acid is not an optimal choice for oily skins or acne type condition. This is regardless of skin colour. The agent will not penetrate through oil whereas, a chemical peel such as salicylic acid will do this quite easily. Glycolic acid is usually found in up to 15% in cosmetics. 20-50% in preparations and 70%+ in medical treatments.

AHA 30% + BHA 2% Peeling Solution

Alpha hydroxy acids (AHA) exfoliate the skin's topmost surface for a brighter and more even appearance. Beta hydroxy acids (BHA) also exfoliate the skin with an extended function to help clear pore congestion. This combined 32% AHA/BHA solution offers deeper exfoliation to help fight visible blemishes and for improved skin radiance.

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e) Lactic acid peel for skin rejuvenation

Lactic acid, another AHA has a molecule larger than Glycolic and therefore is a milder peeling agent. It's well absorbed by the skin and effective for photo-ageing and post-inflammatory hyperpigmentation. Lactic acid is a notable humectant as well as a keratolytic, thereby reducing roughness and scaling and aids in retaining moisture.

Lactic acid can often be found in cosmetics for the treatment of rough, dry and bumpy skin conditions. It's versatile, accessible and cheaply available.

Lactic Acid 10% + HA

Lactic Acid is an alpha hydroxy acid that exfoliates the skin. This 10% formulation offers mild exfoliation and is supported with a purified Tasmanian pepperberry known to reduce signs of inflammation and sensitivity that is often associated with exfoliation. A milder 5% formula is available here.

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f) Mandelic acid peel for skin rejuvenation

Mandelic acid, an AHA, has one of the largest molecules. Does mandelic acids’ larger molecule mean it is weaker or less effective? Absolutely not. It simply means, it works slower and therefore safer. Mandelic acid amongst its micro-exfoliating properties has the ability to lift the excess pigment from the surface of the skin.

And unlike other acids, mandelic works in the deeper skin layers to inhibit melanin production. It is anti-bacterial, anti-fungal and anti-inflammatory. It clears dead skin cells, kills bacteria, reduces redness and inflammation, and helps to diminish the appearance of acne scars.

Mandelic acid also has benefits for ageing skin. It accelerates cell renewal making skin appear lighter, brighter, firmer, and smoother. At the same time, mandelic acid promotes collagen production to increase skin’s elasticity and youthful appearance.

And thanks to mandelic acid gentle action, it’s an option in the treatment of hyperpigmentation in intimate and the inner thigh area. A great starter and prepping peel, it's ideal for sensitive skin, oily conditions, dark/deep skins and as an active in cosmetics.

Mandelic Acid 10% + HA

Mandelic Acid 10% + HA offers superficial dermal peeling that is gentler than other alpha hydroxy acids. Mandelic acid to penetrates the skin more slowly which in turn makes it very gentle and suitable for all skin types. You don't need a concentration of more than 10%, because then you would simply be achieving an indirect peeling strength that is more easily offered through lower percentages of glycolic acid.

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g) Salicyclic acid peel for skin rejuvenation

Salicylic acid is the only true type of BHA (beta-hydroxy acid) and has wide use for superficial peels and the treatment of oily and acne skin. Commonly used in 20% & 30% concentrations, Salicylic has a larger molecule structure containing anti-inflammatory and anti-bacterial properties.

Most commonly known as an ‘acne' product, it's widely available in oily skincare products. Salicylic works particularly well for this skin group as it's lipid-soluble and therefore penetrates through oily conditions with ease.

In addition to its use in oily skin, Salicylic works well in dry skin conditions such as keratosis pilaris. A condition characterised by keratin accumulation in the hair follicles.

Salicylic has also been considered as a keratolytic agent, it has the ability to enter and cleanse pores, prevent oil buildup and unclogs hair follicles. It can directly dissolve keratin plugs and regulate the skin cells. Unlike Glycolic acid, Salicylic does not instigate a healing cascade, therefore it is a poor choice for the treatment of lines and wrinkles.

Salicylic Acid 2% Solution with Witch Hazel

Salicylic Acid is a beta hydroxy acid that exfoliates the skin. This 2% treatment solution helps exfoliate the inside walls of pores to fight the appearance of blemishes and for better visible skin clarity with continued use.

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h) Combination acid peel such as Jessner's for skin rejuvenation

Combination peels present a very versatile and effective treatment while still being highly tolerable. Different peel agents are blended for a multi-faceted treatment approach – different feature benefits, penetration strengths and pHs all in one formulation provide a tiered penetration and broad-spectrum effect.

Generally, this will be a relatively more gentle process than if one peel agent were to be used alone at a higher strength. Each ingredient in a combination chemical peel will penetrate the skin to a different depth giving a multidimensional treatment.

The Jessners peel

A very popular combination peel is Jessners. In its true form, it consists of Salicylic, lactic and resorcinol equally at 14%. Although superficial in nature it instigates a cascading healing effect deep into skin layers and effective for mild to moderate wrinkles and sun damage.

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i) The benefits of having a professional chemical peel treatment

The main benefit is having access to professional that will be trained in skin, skincare products and treatment application. Depending on skin goals, a professional can guide you on your skin journey. They can provide advice on the most effective products and treatments for you personally. Understanding the current health of your skin is essential in product and treatment selection.

Another benefit is having access to professional-grade products only. Chemical peel agents are freely available to purchase online but will usually be in a singular form. Some of the best products come in combination peels.

Occasionally professional-grade products may be available to purchase online. Without education and training, full benefits are unlikely to be unlocked. Having pre-prep support before the treatment, during the treatment and the maintenance after is priceless.

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j) What AHA products should I use at home?

A great selection of at home-use products are listed above. The Ordinary offers a fantastic selection of starter exfoliative products. Their pricing makes their products very accessible and products highly recommendable.

With regards to professional chemical peel treatments, it is worth investing in more advanced formulas that typical command a higher price tag. Mesoestetics is one of the most popular professional skin peeling treatments in the UK. The brand offers dedicated skin preparation kits. Such kits will often include a cleanser, serum, moisturiser and sunblock. Mesoestetics offers 3 kits for the following complaints – Acne management, De-pigmentation and Age management.

Acne Management Skin Preparation Kit

Purifying Mousse. Cleanses and purifies the skin in-depth, effectively removing make-up and eliminating impurities,  leaving it soft and feeling comfortable and pleasant. ACTIVE INGREDIENT: Chlorhexidine inhibits the growth of micro-organisms. Urea calms, hydrates and softens the skin

Acne One. Daily use treatment creams for optimal control of acne or oily skins. Reduces sebum, anti-bacterial, reduces epidermal redness, prevents acne triggers. ACTIVE INGREDIENT: m.acne complex™ containing synergistic ingredients; Salicylic Acid, Mandelic Acid, Sodium Lepargilate, Shikimic Acid. A comprehensive renovation of acneic and oily skins.

Collagen 360 Essence Reactivates vital functions of the skin by stimulating skin restoration processes. Skin recovers its vitality and elasticity, pores close and wrinkles smooth out. ACTIVE INGREDIENT: Chronosmart peptide promotes self- protection by day and repair and renew by night. Nicotinamide is a powerful anti-oxidant to protect, repair and unify the skin. Hydroxyprolisilane activates the production of collagen and elastin, increases cell proliferation and improves repair processes and wound healing

Mineral Matt Anti-Aging Fluid SPF50+. Very high sun protection for sensitive, combination and oily skin. Combines physical and chemical UVA, UVB filters with biological HEV + IR filters. Mattifying Action.

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De-pigmentation Skin Preparation Kit

Ultimate W+ whitening foam. Cleanses and purifies the skin in-depth, effectively removing make-up and eliminating dead cells and impurities. ACTIVE INGREDIENT: Glycolic & Lactic Acid, AHA’s to encourage skin regeneration and  boost the skin’s natural barrier function. Aloe Vera has a powerful moisturising, soothing and whitening effect.

Brightening Peel Booster. Renewing and lightening gel for hyperpigmentation, uneven tone, imperfections and signs of photo-ageing. It reduces melanogenic activity. ACTIVE INGREDIENT: Glycolic Acid 10% AHA to stimulate cell renewal and significantly increase moisture in the dermis. Phytic Acid 2% De-pigmenting and anti-oxidant effects

Ultimate W+ essence. Intensive whitening and anti-oxidant serum. Prevents and reduces dark spots. ACTIVE INGREDIENT: the [meso] white complex® to inhibit melanin synthesis and Garden Cress, a strong phytonutrient that inhibits binding of a-MSH to its receptor, reducing the appearance of dark spots and providing whitening benefits.

Light Water Anti-Aging Veil SPF50+. Very high sun protection for normal and combination and dry skins. Combines physical and chemical UVA, UVB filters with biological HEV + IR filters. Antiaging Action

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Age Management Skin Preparation Kit

Facial Gel Cleanser. Deeply cleanses and removes make-up, leaving the skin smooth and maintains the hydro-lipid layer. ACTIVE INGREDIENT: Lactic Acid, AHA to stimulate cell renewal and enhance hydration

Resurfacing Peel Booster. Stimulates cell renewal and activates collagen and elastin to reduce wrinkles and enhance the texture for a smooth complexion. ACTIVE INGREDIENT: Glycolic Acid 10% AHA to stimulate cell renewal and significantly increase moisture in the dermis. Salicylic Acid 2% BHA offers exfoliation, oil control and anti-inflammatory effects.

Collagen 360 Essence. Reactivates vital functions of the skin by stimulating skin restoration processes. Skin recovers its vitality and elasticity, pores close and wrinkles smooth out. ACTIVE INGREDIENT: Chronosmart peptide promotes self- protection by day and repair and renew by night. Nicotinamide is a powerful anti-oxidant to protect, repair and unify the skin. Hydroxyprolisilane activates the production of collagen and elastin, increases cell proliferation and improves repair processes.

Light Water Antiaging Veil SPF50+. Very high sun protection for normal and combination and dry skins. Combines physical and chemical UVA, UVB filters with biological HEV + IR filters. Antiaging Action.

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