Chemical peels: which to choose, does it hurt, and is it OK after botox?

Acids loosen the bonds between dead cells in the outer layer, so they shed more easily and the skin renews faster. Depth depends on the acid, its strength and how long it stays on: a superficial peel works in the epidermis, a medium peel reaches the upper dermis. Deep phenol peels are rarely used today, and only under general anaesthesia in a surgical setting.

Melior’s peels are based on trichloroacetic acid (TCA). In PRX-T33, hydrogen peroxide softens the effect of TCA, so the skin does not visibly peel. Ingredients are listed on the acid peels page.

After a peel the skin is more sensitive to sun, and UV raises the risk of dark spots, especially on darker skin and in people who mark easily. In autumn and winter it is easier to avoid tanning before a peel (5 days to 2 weeks for Melior’s peels) and to protect the skin afterwards. A course of 4–6 sessions can finish before the spring sun.

Melior’s peels do not cause heavy peeling and also suit summer, with SPF 50 every day. For pigment spots, see the guide Pigmentation and broken capillaries.

For 3–7 days before, skip retinol, AHA and BHA acids and scrubs; avoid tanning and self-tan for 5 days to 2 weeks, depending on the peel. Before deeper peels, skin is sometimes prepared with creams for several weeks – the specialist decides.

If you get cold sores often, mention it beforehand: for deeper peels, antiviral prevention starts 2 days before. Medicines are also discussed at the consultation, especially those that increase sun sensitivity, and isotretinoin.

In a randomised trial, a medium-depth peel was done 7 days after botulinum toxin; in another small study, on the same day. Melior’s gaps are longer (see above). Between plasma therapy and a peel in the same area at least 2 weeks are left, and at least 3–4 weeks between ELOS and a peel.

There is a separate guide on how long botulinum toxin lasts.

Autoimmune disease is a contraindication for PRX-T33, and a flare of atopic dermatitis or psoriasis for APPeex. After isotretinoin, medium and deep peels are not done for 6 months according to the IADVL guideline; for superficial peels, the specialist decides.

On darker skin (phototypes IV–VI) the risk of pigment changes and scarring is higher, so lighter peels are chosen. The final decision is made by the specialist at the consultation.