Eating Kiwis, Two Ways
open for peels and lasers
Hiya,
Happy Belated National Peel Day! Monday, March 10th, was the 6th anniversary of this holiday, which was started by PCA Skin with the goal of increasing awareness about the science, innovation and benefits of professional peels. I hope you all had a wonderful time celebrating.
In recognition of the holiday, I solicited questions from you guys about peels and only 2 of you replied (thank you, Maddie & KV!) This was okay though, because I really just wanted a few more questions to round out my response to a mammoth question that was submitted a few weeks ago.
But one thing before we start peelin’:
My best friend Sophia got a ZIIP 2 weeks ago and has not stopped sending me selfies. Her results are already so good and she wanted me to share them, but because she only started liking her jawline in the past 2 weeks, she didn’t have great before photos. I explained that people are skeptical and like to nitpick, so she, a doctor, responded by measuring the angles “like an x-ray.” Thank you for your commitment, Soph.
If you, too, would like to work on your angles, you can use ZIIPJOLIE for a discount. You can also read this or this for answers to all of your questions about the device.
Now, onto your questions.
Can you do a peel if you’re on tret? I use it 3x/week
You sure can! You just want to discontinue use 5-7 days beforehand (longer for deeper peels) and your provider will give you instructions for when you can resume post-peel, which again depends on the specific peel. Some protocols actually call for using retinoids in the days after to expedite the cell turnover. But most important is to avoid exfoliants in the week afterwards, since the peel just did major exfoliation!
Do you like VIPeel as an offering?
For the right candidate, yes! I actually got one last March and documented it in this now regrettably named issue speculating on the whereabouts of Kate Middleton, where you can learn more. As I say in the post, not only does your skin have to be right for it, but also your self-restraint. If you don’t think you can resist picking, you’re much better off with one of the many other types of peels that don’t leave you looking like you’re warning someone about the effects of nuclear war, as my husband so kindly (and accurately) put it. (Also, a quick note: I wrote in that post that I did the VI Peel to prep for a laser treatment. I didn’t wind up getting the laser for various reasons, some of which I’ll talk about when I publish my final wedding skin recap…soon…)
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Ok, ready for the big guy?
Please explain the difference in skin remodeling after fractional laser procedures vs mid-depth chemical peels, like TCA. Is the barrier disruption worth it? Are peels a more economical way of achieving somewhat similar results to fractional laser - smoother texture, scar reduction, fine line reduction? Any collagen induction with peels? Microneedle instead? I know YMMV based on skin type, sensitivity level, etc but what is your overall opinion of the potential benefit of chemical peels?
They didn’t even ask such involved questions on the state board! I’m going to work backwards first.
You are correct that your mileage may vary based on skin type and sensitivity, but also based on many other variables including, but not limited to: the ingredients/concentration/pH of the specific peel, how long it is left on, the state of your skin beforehand, how diligently you follow aftercare, if you do a series…etc.
Pending all of the above, my overall opinion of the potential benefit of chemical peels is highly favorable! Chemical peels are a cornerstone of esthetics and dermatology. It’s hard to emphasize just how many different types of peels there are, let alone variations of the same peel. Because of the variety, you can find peels capable of addressing pretty much everything under the sun, including acne, scarring, texture, dullness, hyperpigmentation, melasma, fine lines & wrinkles and in some cases, even precancerous growths. This doesn’t mean that chemical peels will always be the best option to address those concerns, but they are often a great choice and/or can be used in conjunction with other modalities. I love chemical peels because of their versatility. But I also love lasers and microneedling. It all depends and no option is inherently better than others.
Next, a little primer & terminology overview based on this part: please explain the difference in skin remodeling after fractional laser procedures vs mid-depth chemical peels, like TCA.
LASERS
Lasers can be ablative or non-ablative.
Ablative: remove the top layers of skin (epidermis) to heat the underlying layer (the dermis).
Non-ablative: keep the outer layer (epidermis) intact and only heat the dermis.
As opposed to treating the whole face, fractional lasers target specific areas (fractions) by creating microscopic columns and preserving the surrounding tissue, which can reduce downtime and side effects. Fractional lasers can be ablative or non-ablative.
There are different lasers that can treat uneven texture and tone, redness/vascular issues, fine lines & wrinkles, acne and acne scarring, ranging in severity from mild to severe.
PEELS
Chemical peels––of which there are so, so, so many different types––use chemical solutions to remove layers of the skin. They fall into 3 categories:
Superficial, or light peels: removes just the outermost layers of skin from the epidermis. You may see some flaking, but most of it will be microscopic. These can be great for general texture, tone, brightening and smoothing, lifting mild discoloration and acne. Best done in a series for lasting results. Some can stimulate collagen & elastin production to certain extents.
Medium, or mid-depth peels: remove skin from all layers of the epidermis, potentially into the dermis. This is what you think of when you think of peels: visible flaking, tightness, perhaps swelling. (Ex: VI Peel). Best for moderate-severe acne, deeper lines and more severe hyperpigmentation and acne scars.
Deep peels: done by a physician and you’re usually under anesthesia. Less common these days in favor of lasers, which can reach the same depth with less (but still significant) recovery time.
Trichloroacetic Acid (TCA) is a very common peel ingredient. You can find TCA in light, medium or deep peels, just depending on the concentration/pH. VI Peels have a blend that includes TCA and are considered medium peels. However, one of my favorite and most commonly used peels, the Environ Cool Peel, uses TCA in a different way and is a light/superficial peel.
Skin remodeling technically refers to treatments that involve heat (usually radiofrequency) to “remodel” the collagen and elastin fibers in the dermis vs. skin resurfacing that tends to mean a treatment that removes old dead layers of skin, potentially also stimulating collagen & elastin. I’ve seen the words used interchangeably, but usually hear both lasers and peels referred to as skin resurfacing. I only bring this up because it was in the question, but the semantics don’t really matter here. Whatever you want to call it, the bigger picture is that by creating controlled injury to the skin (heating it up, removing layers, poking tiny needles etc.), you trick skin into thinking it’s injured which stimulates the skin’s wound healing response aka collagen & elastin production.
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Taking the other questions one by one.
Is the barrier disruption worth it? There really isn’t a definitive way to answer this question because the level of barrier disruption varies greatly, as does worth. Chemical peels disrupt the barrier because they literally work by removing some of it. Fractional lasers can be ablative (disrupt the barrier) or non-ablative (bypass the outer layers), but the ones truly focused on remodeling the dermis (deep wrinkles, severe scarring or sun damage) are usually ablative and come with significant downtime. All have pros and cons and are best suited for certain conditions, skin types and tones (for example: some lasers and peels are not suitable for darker skin tones as they may cause hyperpigmentation).
Are peels a more economical way of achieving somewhat similar results to fractional laser - smoother texture, scar reduction, fine line reduction? Economically speaking, yes. Peels are almost always cheaper than lasers, especially since most lasers are best done in a series. Even a series of peels would usually cost less than a single laser session. But don’t equate affordability with being less-than. It doesn’t necessarily mean you’re skimping on results. In theory yes, texture, scarring and fine lines can be addressed with peels or lasers, but the best option for you depends on a lot of factors. What’s the texture from, how deep are the scars, where are the fine lines etc. etc. etc.
Any collagen induction with peels? Microneedle instead? There can be collagen induction with peels! Superficial or light peels won’t have as dramatic an effect, but remember that any injury to the skin (peels, lasers, microneedling) stimulates the wound healing response and kickstarts collagen production. There are even peels (like my beloved Environ Cool Peel) that stimulate the release of growth factors, which directly impact collagen production. That being said, significant collagen induction is not where most peels shine. Microneedling, also known as Collagen Induction Therapy, is a much better option for collagen induction, such as for treating acne scarring and fine lines. Tiny, sterile needles puncture the skin at specific depths, triggering the body to heal these micro wounds with new collagen and elastin fibers.
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Alright, this was a LOT of information and only scratching the surface (no pun intended, but a scratch on the surface would trigger the wound healing response). When talking about this stuff, the phrase that always comes to mind is “there is more than one way to skin a cat,” but that’s a terrible metaphor, so I looked for something different and found this website which offered some alternatives:
Instead of using such a horrid expression, why not settle for something sweeter, such as "There are many ways to eat a kiwi" or "There are many ways to climb a tree"? I found on one website someone even replaced "cat" in this expression with "eggplant"!
So, in conclusion, when it comes to addressing your skin concerns, there is more than one way to eat a kiwi, naturally, like we all say.
Also, I took the bait this time because I couldn’t resist, but a humble request for the future to keep the questions more like a question and not 6. I’ll never get anything done again if I’m doing this every week.
Take A Rec/Leave A Rec
Have a rec or need a rec for an aesthetic provider? Tell us in the chat!
We have an outstanding request for Rhode Island or Boston!
This is an ongoing resource for subscribers and I’ll figure out a handy place for the link to live eventually, but bookmark it for now. [This is a crowdsourced list and should not be considered a recommendation or endorsement from me, but obviously I will share recs if I have them.]
Office Hours Reminder
Join us for Office Hours on Sunday! This exclusive weekly opportunity is available to paying subscribers. This is a great opportunity to ask 6-part questions!
Every Sunday at 5pm EST, I’ll begin a new thread for the week in Substack Chat, where you can ask me anything. Every Monday from 8-9pm EST, I’ll be in that chat live, answering questions for the hour. That way, if you can’t make it, you can submit any time after 5pm Sunday and still get an answer. If you can make it live, join in! You can ask questions in real time and (hopefully) interact with others in class ;)
Have a great week!
xx,
Jolie