| Loss of skin quality is a crucial factor in lower eyelid aging. While blepharoplasty is designed to remove or reinforce excess tissue, this does little to improve on the wrinkles, roughened texture, and irregular coloration. Such changes are caused by damage to the skin itself and require a resurfacing procedure.
Chemical peel is a process whereby the surface of the skin is wounded by a chemical agent with the goal of removing a controlled thickness of damaged skin. After the treated skin regenerates, there is a decrease in fine wrinkling, a more even skin tone, and an improvement in skin quality.
Indications: Eyelid chemical peeling is indicated in any patient whose eyelid skin may benefit from reduction in fine wrinkling, softening of deep creases, and smoother texture. While some loss of pigmentation is inevitable, it presents little or no problem for light-to-average skin tones (skin types I, II, III). Patients with olive or darker skin (skin types IV, V, VI) or with previously fair skin that has been permanently darkened by long-term sun exposure are at far more risk for unacceptable alterations in pigmentation and are not good candidates.
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Skin Types (Based on Fitzpatrick Classification):
Type I - Never tans, always burns
(extremely fair skin, blonde hair, blue/green eyes)
Type II - Occasionally tans, usually burns
(fair skin, sandy to brown hair, green/brown eyes)
Type III - Tans on average, sometimes burns
(medium skin, brown hair, brown eyes)
Type IV - Usually tans, rarely burns
(olive skin, brown/black hair, dark brown/black eyes)
Type V - Mostly tans, almost never burns
(dark brown skin, black hair, black eyes)
Type VI - Never burns
(black skin, black hair, black eyes)
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Chemical: The depth of a chemical peel varies with the chemical used as well as its strength. For the thin and delicate skin on and around the eyelids, trichloroacetic acid (TCA) offers many advantages over more aggressive types of skin peels utilizing phenol or phenol-based mixtures. While 20% TCA peels can yield a mild "freshening" effect, they offer little potential for longer-term improvement. Medium-depth 35% TCA peels produce a more satisfactory effect and yet are unlikely to result in scarring, contracture, or unacceptable pigmentary changes.
Areas Treated: Both upper and lower eyelids may be treated as well as the peri-ocular skin (crowsfeet area). Wrinkling and sun-induced surface irregularities are all helped, thus achieving a more complete rejuvenation of the eyelid complex than with surgery alone.
Timing: Eyelid chemical peels may be performed as a stand-alone procedure, in conjunction with blepharoplasty surgery, or after healing from surgery. There is no disadvantage to having the peel at the same time as the blepharoplasty. Prior to a peel, patients undergo a two week course of Retin-A treatment to provide for more uniform chemical uptake and to prime the skin for quicker healing.
Healing: Peeled tissue will crust and should be coated with an ointment until it is fully resurfaced in about 6-8 days, after which time makeup may be applied. Redness lasts between 2-4 weeks (as opposed to phenol-based peels or deep laser resurfacing, where redness may persist for 6-18 months). Treated skin must be shielded from sunlight for several months (wraparound sunglasses, wide-brimmed hat, sunscreens) to minimize the chance of excessive or splotchy pigmentation.
Milder Peel: For those patients with darker skin tones (Type IV) who are not candidates for 35% TCA peeling, repeated applications of milder-strength solutions (such as 20-25% TCA) may reduce the risk of pigment loss and noticeble demarcation between treated and untreated skin. Likewise, patients who need a quicker recovery may opt for a weaker peel.
Risks: As with all invasive eyelid surgery, chemical peel is associated with certain potential complications. While uncommon, complications include loss of pigmentation, splotchy or over-pigmentation, scarring, prolonged redness, delayed peeling, and ocular damage.
Chemical Peel Photos
View Healing Day-by-Day
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