The peel is accomplished by chemical or mechanical means. See PROCEDURES/INSTRUMENTS in the REFERENCE TOPICS for a full discussion of mechanical exfoliation techniques.

The chemistry of exfoliation seeks to remove dead or viable cells, or both, in the epidermis. Peels that reach down to within the bottom three cell layers of the epidermis (which is only 14-18 cell layers deep) are close to requiring a skin graft to replace the lost tissue and are usually called ‘deep peels.’ More limited removal is called ‘exfoliation’ but the terms peels and exfoliation are often used interchangeably.

The deep peels are usually carried out by medical estheticians and physicians using a combination of phenols and acids (see JESSNER’S SOLUTION). There is significant downtime associated with such an extreme peel, a month or longer not being uncommon and avoiding sunlight is important. The follow-up care often is high doses and frequent topical applications of highly charged retinoic acid (Vitamin A) as well as other immuno-suppressing topicals like hydroquinone.

This last is particularly distracting as it often causes a rebound effect when withdrawn and a resulting swarm of pigment blotches take hold. Continued usage to suppress has toxicity concerns. Vitamin A at continuous daily usage also suppresses the natural immune response, becomes weak and dependent and ultimately prematurely aged.

To add insult, the whole process more often than not leaves the patient (victim?) in the same visible straits as when she began. Nothing positive changed in her skin biology. What she did get for all her trouble and expense and downtime was a few months of maybe “younger looking” surface tissue.

And a virtual guarantee of older looking skin at a younger age.

There are any number of internet supporters of self-inflicted deep peels done weekly (!) to make the Skin Dork question if sanity is now the exception on the web. These self-destructive ‘success’ stories read like the man who jumped off a building and half way down was heard to say: “Great so far!”

Setting aside deep peels, let’s look at the more common surface oriented practice in exfoliation peels.

The phenol, salicylic acid (a so called ‘beta-acid’) that is in fact not an acid (just to confuse you), dissolves the cement between the upper layers of inactive cells in the epidermis. These cells then are free to slough off. The chemistry does not attack living viable cells and for that reason may be considered benign. But, read on.

Concentrations in a vehicle vary from 2% up to 30%. It can be lethal to spread high concentrations of salicylic over large areas of the body. A facial in a studio setting using 30% concentration is not uncommon and not overly worrisome when competently performed, but, again read on.

The message sent to the cells below deck however is clear: the skin is now very vulnerable for the loss of its upper layers and a call to action is sent out to produce more protection. Right now!

This is a classic REPAIR MODEL response.

The natural thirty day cycle of epidermal cell turnover is disrupted and the usual metabolic progression of the epidermis is now under control of the immune system. Huge amounts of fragmented cells, proteins and a flurry of excess cross-linking in the extra-cellular matrix (ECM) occurs over the next week or longer. The ECM is that ocean between the cells where messages are sent back and forth and has a vital function in how we look and feel. (see ECM / EXTRACELLULAR MATRIX)

Whatever is going on frantically down under, nevertheless, the surface of the skin however feels and looks fine and a lot of bumps and surface irregularities are gone. Not bad.

Done once every few months and the acceleration in aging is not worth the worry. Done every day or even a few times per week or per month in a low concentrate cleanser or moisturizer and the Skin Dork guarantees you will have problems in addiction response and visibly unhappy skin. And your skin will age faster.

There is no free lunch.

Problems that arise from such a regimen take a long time to go away. The immune system likes to be in charge and steps all over normal metabolism.

This frequent application approach is almost always the go-to technique to stop acne, or at least curtail it. And it works for a short while and then it doesn’t and the next move (usually) is to add a powerful VITAMIN A to the salicylic treatment. This suppresses the normal metabolism further, as the vitamin A product also ends up being used daily. You have two powerfully addictive ingredients going on and often combined with a synthetic sunscreen agent whose irritation potentials are off the charts and do far more damage than ultraviolet rays ever imagined.

As that all inevitably brings on very inflamed skin then moisturizers and other idiocy is brought to bear on the problem. Finally, in desperation the acne troubled or the aging concerned user of this crazy mix of products must deal with the eruptions that will not stop. The products typically are stopped in total on a dime and only a benzoyl peroxide is used to dab at comedones. All hell is breaking loose from the withdrawal away from the addictive products and benzoyl peroxide seems to keep things in check. It however carries a sledgehammer to the skin.

The outcome of that experiment in try-this-try-that can head off in several directions. Most often consumers go toward more exfoliation, now with benzoyl peroxide, to which is then added a moisturizing sunscreen, composed of dermatitis capable chemical agents. At this point, and again typically, makeup is layered on and the skin has withered in looks and functionality. Taking it to rehab is not always a pleasant journey. (see SKIN INFLAMMATION / ROSACEA / DERMATITIS)

Frequent use of ANY exfoliating product is an age accelerating phenomena, an addictive process, and the inflammation cannot be ignored for long. Nature will find you and you will pay.

The day to day visible deterioration from frequent exfoliation would seem undesirable but is often endured as some sort of sacrifice to fighting the look of age. That becomes a Monty Python skit, not skincare.

Let’s look at the alpha-hydroxy acids (see ALPHA – EXFOLIATING ACIDS) which are true acids, meaning they are fully charged molecules. Glycolic and lactic acids are the most common but many others exist from natural and synthetic sources.

Alpha acids attack viable living skin cells. They generate a powerful and unwanted immune reaction and are prime movers in the classic skin addiction response: weakness and dependency requiring ever stronger concentrations to get the same smoothing effect or to reduce acne breakouts.

To counter the negative effects of inflammation the industry provides, of course, more products. This approach of adding products to addicted skin assures the industry of a wealth of clients spinning this way and that to find temporary (and expensive) relief.

The light touch approach to reduce acids to spot checks or perhaps application only a few times per week accomplishes little. Alpha acids make no biologic sense for topical usage.

When a chemical agent reacts negatively with the skin, it never forgets. Never. The re-application, even years later, can immediately inflame the skin all out of proportion to the concentration.