Chemical peels resurface then skin by chemical wounding. The agent used and the depth of wounding are determining for the effects of the peel.
Superficial peels are used for: dyschromias, melasma, comedonal acne, skin refreshing.
Medium peel are used for: actinic changes and preneoplasia, fine rhytides, pigmentary dyschromias, selected superficial scars.
With deep rhytids and overall skin laxity the patient may be better served with a rhytidectomy.
Dynamic wrinkles, especially around the eyes and the forehead may be better treated with botulinum toxin.
Preconditioning of the skin is somtimes used to decrease potential complications and increase wound healing speed.
Poor candidates for chemical peels may be some of the following situations: patients with collagen vascular disease (bad scars), with a history of previous radiotherapy to head/neck (we may consider a punch biopsy first to assess the presence of enough skin appendages), with a history of hypertrophic/keloid scarring, patients under isotretinoin (Accutane), patients with advanced HIV disease and immunosuppression, patients with fitzpatrick skin type 5/6 (unless using superficial peel), patients with general poor mental and physical well-being, patients with a history of melasma, recent pregnancy and women under estrogen use (or other photosensitizers), patients unwilling to avoid the sun