plastic surgery

When to Consider Cosmetic Surgery

Cosmetic surgery is a big deal, and it can absolutely make you look younger—but is it right for you? This checklist reveals how to tell if you’re ready and what to do next if you are!

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In the world of beauty nothing seems to stir up as much controversy as the topic of cosmetic surgery. Some of the debate is about celebrities who have distorted their faces with cutting and pasting to the point of absurdity, something insiders call the "Hollywood Heave-Ho" or the "New York Yank." The fear of going too far with cosmetic surgery and ending up looking like a caricature of your former self keeps many people from going under the knife!

A far more serious aspect is that cosmetic surgery is, in fact, surgery, and elective surgery at that. The risks of any surgery are undeniable, and taking these risks for the sake of beauty is admittedly a bit extreme. But, even more foolish is signing up for cosmetic surgery without reviewing all the benefits and risks. However, if you weigh the pros and cons carefully based on facts and what the research says, you’ll be able to make the best decision for your needs and budget.

What About Just Aging Gracefully?

On the flipside of those who opt for cosmetic surgery are the naturalists among us who say we should forget cosmetic surgery or procedures and instead age as healthfully and gracefully as we can. There is no question that being healthy is fundamental regardless of your age, but aging gracefully seems somewhat contradictory to what actually happens as you get older. Given what the ravages of sun damage and passing years do to your face and body, what can result "naturally" is anything but graceful. It’s not something we should casually accept as inevitable, but of course, that’s a decision each of has to make for ourselves.

Cosmetic surgery is a personal choice, and it’s not for everyone. But, whether you’re pro- or anti-cosmetic surgery, the truth is that cosmetic surgery, along with cosmetic treatments, such as lasers, Botox, and fillers, are the only ways to truly shave years off your appearance after the age of 50 (or before that, depending on the amount of sun damage you have). Of course, good skincare plays a pivotal role also, but some signs of aging, such as sagging and undereye bags, cannot be fixed by skincare alone. Even the best skincare routines and products have limitations, but there is no question that after a certain time, the combination of a brilliant skincare routine coupled with surgical or corrective procedures is the best solution to looking younger, longer.

When Is the Right Time for Surgery?

Most women start considering cosmetic surgery when they hear their friends talking about it. Once those conversations begin, you’ll find yourself pulling your skin gently up and back in front of a mirror to see what it would look like to improve your jaw line and facial wrinkles, giving you an idea of the look you hope cosmetic surgery could accomplish. Typically, that’s the point when your friends tell you you don’t need cosmetic surgery because you look great. What then?

You could consider putting off surgery "until you really need it," but, truth be told, when you still look great might be the best time to consider having cosmetic surgery. Waiting until your skin is hanging loosely from your jaw, your neck is waddling, or your wrinkles are lying in folds like drapes certainly isn’t the ideal time to book that surgeon. And it’s well past the time if your friends begin asking you if you’re scheduling your cosmetic surgery this year!

One key factor in having a procedure done sooner rather than later is that it’s safer to have surgery, any surgery, including cosmetic surgery, when you are younger versus older. First of all, your skin and your body are better able to heal when you are younger. The older you get, the longer it takes for the skin to repair and heal itself. Having cosmetic surgery sooner rather than later also is less dramatic when your face is just beginning to show signs of age, as opposed to when you already look older and people have become used to seeing your "older" face and neck.

Important Factors to Consider

The decision to have cosmetic surgery shouldn’t be made lightly, and absolutely not as a result of some emotional upheaval in your life, such as an affair or divorce; those are not the reasons, and should not be the time, when you decide to go under the knife. And you certainly should not make that decision just because you have a desire to get the latest celebrity’s "it" body part. Here’s what you really need to think through before you make the decision to have something done:

  • What are your expectations? If you expect cosmetic surgery to turn you into a model or a sexier version of yourself at 40, then you will be disappointed because that isn’t what will happen. Cosmetic surgery won’t necessarily improve your chances on or get you that new job. It doesn’t mean that those things won’t happen, as most of the world is focused on the appeal of youth, but if that’s the only reason you’re contemplating cosmetic surgery, then you are considering it for the wrong reasons. Those who report the greatest satisfaction after cosmetic surgery are the ones who kept their expectations realistic—and didn’t expect their new, lifted face to magically transform every aspect of their life. They also did it for themselves, rather than to please someone else.
  • Can you afford it? Cosmetic surgery is rarely covered by health insurance plans. There are exceptions, such as breast reductions to ease persistent back pain or eye tucks where the flap of the upper eyelid has sagged to the point of blocking vision, but that’s about it.

    Cosmetic surgery is not about shopping for a bargain. For example, trying to save money by having the surgery done overseas can end up being expensive. First, you must pay for the travel, and the follow-up appointments (which are extremely important) aren’t possible unless you are willing to travel back and forth or if you live overseas in the area until your recovery is complete. The costs of all that add up fast!

  • What are the risks and how long is the recovery? There are always risks with surgery, and the time for recovery differs, greatly depending on the procedure and what you do to assist healing (or make matters worse) during recovery. You must discuss these items at length with your physician. If the doctor you are seeing gives these vital, and rather unpleasant, details short shrift, or just hands you a piece of paper with a list of the potential problems, then you are seeing the wrong doctor. We repeat: There are risks with any type of surgery as well as with non-invasive cosmetic procedures. Any doctor who glosses over the risks or downplays your concerns is not one to trust with your appearance and well-being.

What About Skincare That Claims to Work Like Cosmetic Surgery?

You may wonder if the skincare products that claim to work like cosmetic surgery can really do that, even if only to a minor extent. The answer is: No, they cannot! Although a comprehensive skincare routine and well-formulated skincare products (it always takes more than one product) can make a huge difference in the appearance of your skin, they simply cannot approximate what cosmetic surgery or cosmetic procedures can do—it just isn’t possible. Also, although it might seem as if cosmetic surgery is expensive, it doesn’t have to be! In fact, if you take all the money you’d normally spend on overpriced skincare products and put that in the bank, you very well might have enough money to invest in cosmetic procedures or surgery within a relatively short period—and you will be much more satisfied with the outcome!

Finding a Qualified Cosmetic Surgeon

Our best advice here? Take your time! The good and the bad news is that there are dozens and dozens of reputable, talented cosmetic surgeons. But the sheer number of doctors vying for your beauty dollars makes it difficult to tell if the doctor you want is the best in class for what you’d like to have done.

We strongly suggest you deal only with a surgeon who is board certified by the American Board of Plastic Surgery or the American Board of Facial Plastic and Reconstructive Surgery. Beware of misleading certifications from unrecognized or self-designated boards. Always check online with the aforementioned accreditation groups before assuming that a framed picture of a certificate hanging on a doctor’s wall has any validity or relevance.

If you’ll be having a procedure that requires general anesthesia, be sure that the operating facility is accredited by a national- or state-recognized accrediting agency, such as The Joint Commission, or is licensed by the state where the facility is located. You also must be sure the anesthesiologist is board certified to administer anesthesia. Again, check online. Do not ignore these critical requirements—your life may well depend on it.

Another important point is whether or not the doctor is willing to provide enough time for your consultation, or does he or she rush you through the consultation. Remember: This is surgery, not something you can or should decide in minutes. A reputable surgeon will not make you feel rushed or pressure you into having additional work done, or into having anything done at all, for that matter. You should leave the consultation feeling informed and empowered, not condescended to or insecure about your decision—even if you decide to wait.

In the end, whether you choose to have cosmetic surgery, a cosmetic corrective procedure (like Botox), both, or nothing at all is 100% up to you. Your decision should be based on improving how you feel about yourself from the healthy perspective of wanting to feel more confident and look as young on the outside as you feel on the inside. If that’s your mindset, if you’re willing to take the time to find the right doctor for the job, and you keep your expectations realistic, then there’s every reason to go for it!

plastic surgery

Blepharoplasty: What to Know Before Scheduling Your Eye Lift Surgery

Forget "miracle" eye creams! Sagging, bagging, or puffy skin on the eyelids or the lower eye area can often be corrected with a relatively simple procedure known as blepharoplasty. This surgical technique literally removes excess skin and fat, or tightens lax muscles to improve the appearance around the eyes.

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Forget "miracle" eye creams! Sagging, bagging, or puffy skin on the eyelids or the lower eye area can often be corrected with a relatively simple procedure known as blepharoplasty. This surgical technique literally removes excess skin and fat, or tightens lax muscles to improve the appearance around the eyes. Statistically, it is among the most popular surgical cosmetic corrective procedures performed

Eye Lift Results

Eye lifts are the third most common cosmetic surgery people have, right behind liposuction and breast augmentation. As mentioned above, results from an eye lift (known as blepharoplasty) can be outstanding. But as successful as this procedure can be, it is important to realize that this type of surgery does have limitations.

For the most part, blepharoplasty will only remove wrinkles that are physically cut away, it cannot change or impact "crow’s feet," lift the eyebrow, or alter skin discolorations such as natural discoloration or pronounced dark circles under the eye. Most of these concerns can potentially be corrected by chemical or laser resurfacing treatments in tandem with a forehead lift and/or dermal fillers. Though blepharoplasty can be performed as a single procedure, physicians often recommend a combination of treatments to achieve the best, most dramatic results. For example, an eye lift may be accompanied by Botox for crow’s feet or dermal filler to plump wrinkles.

Scarring from Eye Lifts

Incisions for blepharoplasty follow the natural contour lines in both upper and lower lids, and if the goal of creating thin surgical scars is met, these incisions are barely visible and blend into the eyelids’ natural lines and folds. How you scar depends on both the skill of the surgeon and your own genetic propensity for scarring.

To eliminate some types of bagging under the eye, a technique called transconjunctival blepharoplasty is used. This removes excess fat by making the incision on the inside of the lower eyelid, leaving no visible scar.

Risks of an Eye Lift

It’s important that you know that there are risks with ANY cosmetic surgery procedure, just as there are risks with non-surgical procedures. It is important to discuss these risks as well as postoperative care with your surgeon so that you can be assured of the best possible outcome (and keep your expectations realistic).

A talented surgeon can avoid some of the typical risks or complications such as creating a scar above the fold of the upper eyelid, overpulling the skin, or removing too much of the fat pad areas which creates a sunken, drawn appearance. Other risks include decreased sensation in the eyelid area, dryness, burning, stinging, or gritty sensations in the eyes, asymmetrical appearance of the eyes, whiteheads where the sutures were placed, and difficulty closing the eyes.

Eye Lift Alternatives

Although blepharoplasty can do away with drooping eyelids, some physicians may recommend performing only an endoscopic forehead lift as a less invasive alternative to lift the eye area and improve the appearance of the forehead. This can produce more desirable results, without risking complications around the eye area or causing potentially obvious scarring. Discuss this option with your physician, especially if you have other concerns such as drooping brows.

Sources: Plastic and Reconstructive Surgery, April 2004, pages 1459-1468;, Plastic and Reconstructive Surgery,April 2004, pages 1242-1250; Annals of Plastic Surgery, March 2004, pages 234-239; Archives of Facial Plastic Surgery, May-June 2004, pages 150-154; and Ophthalmic Plastic and Reconstructive Surgery, January 2004, pages 1-9.

plastic surgery

What is Liposuction Surgery, and What Can Go Wrong?

Liposuction is a cosmetic surgery procedure that removes excess fat from various parts of the body. This is done using a variety of methods and tools, depending on the area being suctioned. This article discusses the different types of liposuction and what can go wrong so you can make a more informed decision!

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Brace yourself for both the expense and the graphic description! Ranging from $1,500 to $7,500 depending on the area treated, liposuction is a general term for a procedure where excess fat is removed from the thighs, calves, ankles, buttocks, abdomen, back, arms, face, neck, and chin using a thin tube that literally sucks it out. Sometimes this fat is just sucked away and discarded and sometimes it can be reused on parts of the face to improve facial contour and plump up lines.

What is Liposuction?

Simply put, lipo means “fat” and suction, well, that’s self-explanatory! So, liposuction is a surgical procedure wherein various methods and tools are used to suck (OK, vacuum) unwanted fat from various parts of the body. Liposuction is most often used as a means to remove excess fat from the things, buttocks, abdomen, back, calves and ankles (“cankles”) and upper arms. The ideal person for liposuction is someone who is within 30% of their ideal weight, with relatively elastic skin and good muscle tone. It is also sometimes used to remove excess deposits of fat that haven’t responded to changes in one’s diet or exercise habits. According to the American Society for Aesthetic Plastic Surgery, liposuction was the #1 cosmetic surgical procedure performed in 2013, taking the top spot from breast augmentation. Let’s go over the most common types of liposuction.

Tumescent Liposuction

This is a refined version of the dry liposuction method. It involves injecting a sterile saline solution into the area about to be worked on. The saline stretches the fat cells before suctioning with a tube known as a cannula begins, allowing a greater volume of fat to be removed. To minimize bruising, bleeding, and discomfort, the saline solution is mixed with xylocaine (a local anesthetic) and epinephrine, which constricts blood vessels.

Ultrasound-assisted or Ultrasonic Liposuction

This method uses high-pulse sound waves to liquefy excess fat, which is then removed by the same vacuum device used in other liposuction procedures. Ultrasonic liposuction is thought to be more effective for loosening the fat cells attached to muscles or organs and is also useful in breaking down fat cells so they are easier to suck up into the cannula (tube). Risks for Ultrasonic liposuction were once believed to be higher than for other liposuction procedures, but current research indicates that it appears to have benefits and risks similar to the tumescent method.

Powered Liposuction

A relatively new type of liposuction, powered liposuction, uses a cannula that moves in a rapid back-and-forth motion. This vibration allows for easier removal of more stubborn or "tough" fat. Powered liposuction causes less pain and swelling and allows a more precise procedure which is especially helpful on smaller areas, such as the arm, knees or ankles.

What Can Go Wrong

As easy and helpful as all this sounds (and the results can be truly impressive), it is important to keep in mind that sucking fat out of your body (especially a lot of fat) is an intense medical procedure. Liposuction is an operation that can be painful, the pain can last for several weeks, and there is risk of complications that can range from mild to serious.

Adhering to postoperative guidelines is essential for success. "Touchup" work may be necessary because even the best techniques can remove fat unevenly resulting in unwanted bulges and contours. And please keep in mind that liposuction absolutely does not take the place of a diet or a healthy lifestyle. If someone is obese, gains and loses weight frequently, or has an eating disorder, he or she is not a candidate for liposuction. This surgical procedure is not a quick fix for instant weight loss, despite often being characterized as such.

When it comes to complications there are several issues and concerns you must discuss with your physician:

  • Liposuction does remove fat, but if too much fat is removed your skin will stick unnaturally to the underlying muscle and tissues creating an abnormal appearance.
  • Liposuction cannot eliminate dimpling (cellulite).
  • It cannot correct skin laxity (sagging or loose skin from aging or extreme weight loss).

For some patients whose skin has lost much of its elasticity, the plastic surgeon may also recommend a skin-tightening procedure such as a thigh lift, buttock lift, or arm lift, all of which leave scarring that can be more extensive.

Depending on the area treated, other side effects may include scarring and numbness in the area treated. Infection can also be a serious risk and there are studies showing this is more common in countries where discount liposuction procedures are performed. In short, liposuction isn’t something you should get done for the lowest possible price!

An article in Plastic and Reconstructive Surgery reviewed 631 liposuction cases over 12 years and found "Results showed the majority of patients to be women, aged 17 to 74 years old. Of the preoperative weights, 98.7 percent were within 50 pounds of ideal chart weight… Cosmetic results were good, with a 2- to 6-inch drop from preoperative measurements, depending on the area treated. Ten percent of patients experienced minor skin contour irregularities, with most of these patients not requiring any additional surgical procedures.

One year after surgery, 80 percent of patients maintained stable postoperative weights. No serious complications were experienced in this series. The majority of the complications consisted of minor skin injuries and burns, allergic reactions to garments, and postoperative swelling. The more serious complications included four patients who developed mild pulmonary edema and one patient who developed pneumonia postoperatively. These patients were treated appropriately and went on to have successful recoveries. The results show that large-volume liposuction can be a safe and effective procedure when patients are carefully selected and when anesthetic and surgical techniques are properly performed. Cosmetic benefits are excellent, and overall complication rates are low."

Another study published in Dermatologic Surgery reviewed current data and found that "The overall clinical complication rate… was 0.7% (5 of 702). There was a minor complication rate of 0.57%. The major complication rate was 0.14% with one patient requiring hospitalization. Seventy-five percent of the patients reported no discomfort during their procedures. Of the 59% of patients who responded to a 6-month postoperative survey, 91% were positive about their decision to have liposuction (rating of 4 or 5 on a scale of 1-5) and 84% had high levels (4 or 5 on a scale of 1-5) of overall satisfaction with the procedure. Conclusions. These findings are consistent with others in that tumescent liposuction is a safe procedure with a low complication rate and high patient satisfaction."

Is Liposuction Permanent?

If you gain weight, depending on how your body distributes fat, it can all show up exactly where the liposuction was performed. The good news is that adults only have a set number of fat cells and liposuction can remove a certain amount of them. You won’t add more fat cells but the remaining fat cells can grow bigger, which can return the liposuctioned area to its previous appearance. Now that is some fat to chew on!

Sources: Plastic and Reconstructive Surgery, June 2008, pages 396-403;; Dermatologic Surgery, May 2008, pages 709-716; CLINICAL Infectious Disease, April 2008, pages 1181-1188; Journal of the European Academy of Dermatology and Venereology, January 2008, pages 30-35; Seminars in Cutaneous and Medicine Surgery, March 2008, pages 72-82; Current Diabetes Reviews, November 2006, pages 367-73; Dermatologic Surgery July 2004, pages 967-978; Aesthetic Plastic Surgery, March-April 2003, pages 146-153; British Journal of Plastic Surgery, April 2003, pages 266-271; Plastic and Reconstructive Surgery, December 2002, pages 1748-1751; Plastic and Reconstructive Surgery November 2001, pages 1753-1763.

skin disorders

Hidradenitis Suppurativa: Causes & Treatments

Hidradenitis suppurativa is a skin condition that presents a number of challenges for those who have it. Here are the potential causes and treatments, including some encouraging new research on how to battle this condition.

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Hidradenitis suppurativa (HS) is a chronic inflammatory disease marked by the appearance of painful bumps beneath the surface of the skin. Also called acne inversa, the disorder most often occurs in areas where there are creases in skin, such as the armpits and groin. [1]

While this basic definition might sound simple, the disease itself is challenging. It can be difficult to diagnose and treat, and researchers don’t know yet what causes it. For hidradenitis suppurativa sufferers, this adds up to a lot of frustration and disappointment, and the search for a treatment that actually works can take years.

Hidradenitis Suppurativa: What the Research Says

After decades of theorizing it was an infection of apocrine sweat glands (which are localized to areas like the armpit and genital regions, where HS tends to develop), it’s now believed hidradenitis suppurativa is a defect of follicular epithelium—cells in the thyroid gland that are responsible for the production of certain hormones. [2,3,4] What causes this defect, however, remains unknown.

Although there are no established risk factors associated with the disease, there are reports that HS, which affects between 1-2% of the U.S. population, is more prevalent in women than men. There are also studies showing it occurs more frequently in those with African-American ancestry, and it generally doesn’t occur until the onset of puberty. [5]

One of the reasons HS can be difficult to diagnose is that in its early stages, it can resemble other skin conditions like acne or blackheads. [6] People initially notice red bumps on skin, but whereas acne lesions disappear over time, the bumps from hidradenitis suppurativa persist.

These bumps can continue to grow beneath the surface of the skin, becoming pea to marble sized, and eventually develop into painful nodules. In severe cases, these nodules can fill with pus and form tract-like connective tunnels to each other under the skin. When they burst, the result can be thick scarring. In some cases the scars become so hardened they make it more difficult to move, because they limit the range of motion in the arms and legs. [7] It’s important that if you do notice red, sub-surface bumps that don’t go away (especially in the armpit and groin area), you schedule an appointment with a dermatologist as soon as possible to get a diagnosis.

Hidrandenitis Suppurativa Treatments

Once you’ve been diagnosed with hidradenitis suppurativa, the first question is, what can I do about it? Just as there isn’t a known or agreed-upon cause, there isn’t a commonly settled-upon treatment, either. Dermatologists generally try several options before finding one that works for an individual with HS. Often what works for one person doesn’t work for another, making trial-and-error a critical, yet frustrating, part of the process.

The first line of treatment can involve changing some of the outward factors that can make HS worse; namely, losing excess weight to reduce the number of areas where skin rubs together, and wearing loose-fitting clothes to help prevent skin irritation due to friction.

In acute cases of hidradenitis suppurativa, doctors often prescribe antibiotics to prevent or treat any infections that might arise from lesions. [8] Because of retinoic acid’s ability to communicate with skin cells, retinoids can have some value for those who have moderate forms of HS, though more study is needed. [9] The anti-inflammatory action of corticosteroids is effective for some patients, while female sufferers might benefit from antiandrogens and estrogen therapy. [10,11,12] The anti-androgens and estrogen route isn’t one doctors take with male HS patients, as introducing these medications can wreak havoc on male hormones.

One emerging class of treatments is immunosuppressant drugs that impact the body’s inflammatory response. In September 2015, the U.S. Food and Drug Administration approved the immunosuppressant adalimumab (trade name Humira) for the treatment of moderate to severe hidradenitis suppurativa after clinical trials showed it was successful in reducing HS lesions. [13] This is the first FDA-approved treatment for the condition, marking a new and hopeful chapter in the fight against it.

Even more encouraging news, just two months after the approval of Humira for HS, the Journal of the American Medical Association published the results of a small, randomized clinical trial of another immunosuppressant, anakinra (trade name Kineret) on hidradenitis suppurativa. The data showed anakinra could safely and effectively treat the disease. [14] Clearly more research is needed, but it’s another positive step in the right direction.

Can Skincare Help Hidrandenitis Suppurativa?

The answer to questions about whether skincare can help in the management and treatment of hidradenitis suppurativa is yes, but only to a certain extent. Since the majority of HS bumps occur deep within the skin, there’s not much topical treatments can do, at least when it comes to complete relief.

Where skincare can help is in treating some of the surface conditions that can arise as a result of HS. Since it’s an inflammatory condition, redness is common. Beta hydroxy acid (BHA), also known as salicylic acid, is an excellent and gentle anti-inflammatory agent that holds the potential to help reduce redness and surface tenderness when nodules become irritated.

It’s also important to use gentle skincare products in all aspects of your skincare routine to keep the risk of surface irritation to a minimum. That means avoiding products containing high amounts of fragrance and alcohol, as well as harsh scrubs that could cause surface tears on skin, all of which fuels redness and inflammation.

Since scarring is a common and sometimes debilitating result of having HS lesions, it’s also good to practice proper wound care to minimize the risk of developing severe scars. And of course, if the wounds are not responding to over-the-counter treatments, consult your healthcare provider for further options.

While we still have a lot to learn about hidradenitis suppurativa, the good news is that those who have the disease aren’t left without options. Moreover, the research on how to treat—and potentially cure—this condition is ongoing and getting more encouraging. If you think you might have HS, seek out a dermatologist who’s familiar with the condition, discuss all available treatment options with them (including those that are recently-approved), and use gentle, non-irritating skincare products, including a well formulated, gentle BHA exfoliant.

For more information on hidradenitis suppurativa, visit the Hidradenitis Suppurativa Foundation, Inc. website, which has a number of valuable resources available to HS patients.

References Cited

  1. The Mayo Clinic. Diseases and Conditions: Hidradenitis suppurativa. Definition. [Internet] [cited December 2015] Available from:
  2. Yu CC, Cook MG. Hidradenitis suppurativa: a disease of follicular epithelium, rather than apocrine glands. Br J Dermatol. 1990. 122(6):763-9.
  3. Attanoos RL, Appleton MA, Douglas-Jones AG. The pathogenesis of hidradenitis suppurativa: a closer look at apocrine and apoeccrine glands. Br J Dermatol. 1995. 133(2):254-8.
  4. Jemec GB, Heidenheim M, Nielsen NH. The prevalence of hidradenitis suppurativa and its potential precursor lesions. J Am Acad Dermatol. 1996. 35(2 Pt 1):191-4.
  5. Medscape. Overview: Frequency. [Internet] [cited December 2015] Available from:
  6. The Mayo Clinic. Diseases and Conditions: Hidradenitis Suppurativa. Symptoms. [Internet] [cited December 2015] Available from:
  7. The Mayo Clinic. Diseases and Conditions: Hidradenitis Suppurativa. Complications. [Internet] [cited December 2015] Available from:
  8. Medscape. Hidradenitis Suppurativa Medication. Antibiotics, Other. [Internet] [cited December 2015] Available from:
  9. Medscape. Hidradenitis Suppurativa Medication. Retinoids. [Internet] [cited December 2015] Available from:
  10. Medscape. Hidradenitis Suppurativa Medication. Corticosteroids. [Internet] [cited December 2015] Available from:
  11. Medscape. Hidradenitis Suppurativa Medication. Antiandrogens. [Internet] [cited December 2015] Available from:
  12. Medscape. Hidradenitis Suppurativa Medication. Estrogen Derivatives. [Internet] [cited December 2015] Available from:
  13. PR Newswire. AbbVie’s HUMIRA (Adalimumab) Receives First and Only U.S. Food and Drug Administration Approval for Moderate to Severe Hidradenitis Suppurativa. [Internet] [cited December 2015] Available from:
  14. Tzanetakou V, Kanni T, Giatrakou S, et al. Safety and Efficacy of Anakinra in Severe Hidradenitis Suppurativa: A Randomized CLINICAL Trial. JAMA Dermatol. 2015. 18:1-9.
nonsurgical skincare treatments

What Does a Chemical Peel Do?

Chemical peels are an excellent option to consider in tandem with an anti-aging skincare routine that includes daily sun protection. Find out which one is best and how they can help you have younger-looking, more radiant skin!

In This Article:

Chemical peels involve applying a type of "chemical agent" to the skin for the purposes of exfoliating sun-damaged, thickened surface skin while stimulating collagen production for firmer skin. The popularity of chemical peels lessened when lasers became the accepted method for treating wrinkles and brown spots but in balance, depending on the amount of wrinkling present and desired results, chemical peels still play a significant role in skin resurfacing.

What Do Peels Contain?

Peel solutions most typically contain either alpha hydroxy acids (an AHA such as glycolic acid), beta hydroxy acid (salicylic acid, also known as BHA), tricholoracetic acid (TCA), or phenol as the exfoliating agent. Each of these are categorized by the concentration and the resulting depth of the peel on the skin which can range from superficial (also known as micro or light peels) to medium or deep peels. Results are closely linked to the depth of peel performed.

Superficial peels (typically those using low concentrations of AHA or BHA) offer far less dramatic improvement than medium or deep peels (usually TCA or phenol-based) do. Overall, you can expect minor to major improvement in fine lines and wrinkles, skin discolorations, skin texture, rebuilding of collagen, removal of blackheads, and a temporary reduction in excessive oil production (Sources: Cutis, February 2003, pages 18-24; eMedicine Journal, February 14, 2002, volume 3, number 2; Facial and Plastic Surgery, November 2001, pages 253-262; and Dermatologic Clinics, July 2001, pages 413-425).

What Can a Peel Do…and Not Do?

With any peel it is important to know what’s possible so you can keep your expectations realistic and spare yourself disappointment. Chemical peels in any form cannot remove or reduce the appearance of blood vessels on the skin, they cannot change the appearance of enlarged pores, they do not have an effect on keloidal (raised) scarring, they do not work as a face-lift, and they have limited benefit for improving skin discoloration for those with darker skin color. They can make skin smoother, help fade brown spots and an uneven skin tone from sun damage, and generally make skin’s surface look fresher and younger. Having peels done on a regular basis (say, every 6-8 weeks) will lead to collagen stimulation that improves the appearance of wrinkles.

There are definite drawbacks to consider with peels, but this is largely dependent on the type and depth of peel. Superficial peels have few associated risks but also offer less noticeable results. Some redness, swelling, and increased skin sensitivity can occur with superficial peels. You may also experience a period of intense flaking as the old, damaged skin is replaced by fresh, smooth new skin.

When significant results are desired, complications increase proportionately. Medium and deep peel complications can include scarring, infection, temporary or permanent changes in skin color (this is especially true for deeper peels), and cold sore breakouts for those with a history of cold sores. (Sources: Dermatologic Clinics, July 2001, pages 427-438.) For these reasons, many cosmetic dermatologists are forgoing deeper peels in favor of what can be accomplished more safely with light-emitting and laser devices.

Chemical peels are performed by the application of the specific solution that actually dissolves the skin’s top layers, either over the entire face or on specific areas. Often, several shallow to medium-depth peels can achieve similar results to one deep-peel treatment, with less post-procedure risk and a shorter recovery time. Talk to your dermatologist about this option and see if it may be the best approach to take.

AHA Peels

Alpha hydroxy acid (AHA) peels use glycolic acid as the peeling ingredient and these are considered superficial to medium peels depending on the concentration utilized. Typically the concentrations range from 30% to 70%. AHA peels are effective in improving skin texture, causing some collagen and elastin rebuilding, minimally reducing the appearance of acne scarring, and reducing the appearance of skin discolorations. Repeated treatments are necessary for all concentrations to maintain results. (Sources: Dermatologic Surgery, June 2002, pages 475-479; Plastic and Reconstructive Surgery, January 2001, pages 222-228; American Journal of CLINICAL Dermatology, March-April 2000, pages 81–88 and September-October 2000, pages 261-268; and International Journal of Dermatology, October 2000, pages 789-794).

Important Note: AHA peels are not medical procedures and as a result are not regulated by the FDA. A physician usually performs higher-concentration peels (more than 30%), but this is not always the case. Lower-concentration peels (20% to 30%), often performed by aestheticians, require repeated treatments to achieve and maintain the results seen immediately after the peel is performed.

After any peel, the practitioner should apply a broad-spectrum sunscreen (preferably one whose only active ingredients are titanium dioxide or zinc oxide) to your skin. Skin will be sun-sensitive for a few weeks after the peel, and it makes sense to use sun protection to protect the investment you just made. Don’t bother with peels if you insist on getting a tan, either from the sun or from a tanning bed. A reputable, ethical dermatologist would never offer a peel to someone who is visibly tan or cannot commit to daily sun protection.

BHA Peels

Beta hydroxy acid (BHA) or salicylic acid peels are not as popular as AHA peels, yet they can be equally effective and have specific advantages for some skin types. A salicylic acid solution can work in a way that is similar to a glycolic acid peel, but irritation may be reduced. Salicylic acid is a compound closely related to aspirin (acetylsalicylic acid), and it retains its aspirin-like anti-inflammatory properties. A deep BHA peel can be superior for many skin types because the irritation and inflammation are kept to a minimum due to the analgesic action of the BHA compound. Salicylic acid is also lipid soluble; therefore, it is a good peeling agent for blemish-prone skin with blackheads. The most common concentrations used today are 20% to 30% (Sources: Dermatologic Surgery, December 2003, page 1196 and March 1998, pages 325–328; and Cosmetic Dermatology, October 2000, pages 51-57).

BHA peels are also the preferred option for those with sensitive skin, including skin affected by rosacea. Note that some people with rosacea cannot tolerate salicylic acid. If you have rosacea, consider experimenting with a skincare product that contains salicylic acid, such as one of Paula’s Choice BHA exfoliants, before considering a BHA peel.

TCA Peels

Trichloroacetic acid (TCA) peels (sometimes called Blue Peel) in concentrations up to 50% are superficial to medium peels and have been around for years with a history of being effective and safe (Source: Dermatologic Clinics, July 2001, pages 413–425). This type of peel can be used for peeling the face, neck, hands, and other areas of the body. It has less bleaching effect than phenol (see below) and is excellent for "spot" peeling of specific areas. TCA peels are best for fine lines but are minimally effective on deeper wrinkling (Sources: Dermatologic Surgery, February 2004, pages 179-188; eMedicine Journal, December 5, 2001, volume 2, number 12; and Plastic and Reconstructive Surgery, January 2001, pages 222-228).

Jessner’s peel is a medium-depth peel containing 14% salicylic acid, 14% lactic acid, and 14% resorcinol. Though considered effective and easy to use, there is little research on this method. We do know this peel becomes stronger as more layers are applied. The amount of resorcinol in this peel makes it more irritating than AHA or BHA peels, and it is generally not recommended for those with dark skin tones due to the risk of resorcinol causing post-inflammatory hyperpigmentation (Source: Cosmetic Dermatology, Second Edition, Baumann, Leslie, MD, 2009, pages 154).

Phenol Peels

Phenol is sometimes, though rarely, used for full-face peeling when sun damage or wrinkling is severe. It can also be used to treat limited areas of the face, such as deep wrinkles around the mouth, but it may permanently bleach the skin, leaving a line of demarcation between the treated and untreated areas that must be covered with makeup. "Although phenol produces the most remarkable resolution of actinic damage and wrinkling among the various [chemical peels]… it also possesses some of the more significant [serious side effects]. Many have abandoned phenol in favor of other agents or laser resurfacing… . Hypopigmentation may occur in all skin types, noticeably lightening patients with darker skin and making lighter-skinned patients appear waxy or pale. A clear line of demarcation may be present between treated and untreated skin" (Source: eMedicine Journal, July 20, 2001, volume 2, number 7).

Buffered phenol offers yet another option for severely sun-damaged skin. One such formula uses olive oil, among other ingredients, to diminish the strength of the phenol solution. Another, slightly milder formula uses glycerin. A buffered phenol peel may be more comfortable for patients, and the skin heals faster than with a standard phenol peel, but it is still a risky procedure that can depigment the skin(Source: On balance, we recommend forgoing phenol peels in favor of laser treatments such as Fraxel.

What About At-Home Peels?

Many women ask us about the number of peels sold online for use at home. These peels often advertise having high concentrations of AHAs or BHA and some contain other peeling agents along with these popular standbys. We cannot stress enough how potentially dangerous these peels can be. If they’re as effective as claimed or if they really contain the amount of acid(s) advertised and the pH is within range for them to work, you could be setting your skin up for some serious damage. In the wrong hands or used incorrectly or too often, at-home peels can cause burns, extremely sensitive skin, discolorations (from loss of pigment), and persistently dry, flaky skin that doesn’t respond to even very rich moisturizers. If you decide to ignore our warnings and try this anyway, proceed with caution.

The other issue with at-home peels is that despite the impressive claims in terms of amount of acid they contain, the pH may be buffered beyond the range needed for efficacy. So yes, the peel you’re considering contains 50% glycolic acid, but because the pH when mixed is above 4, you’re not going to see much in the way of results. The good news? A higher pH like this means the peel poses less risk of causing excess irritation.

The Final Decision

Whether to have a peel and what type to get depends on the condition of your skin, your skin type, and keeping your expectations realistic. Most important is for you to know that a peel isn’t an anti-aging cure-all. For example, peels cannot help with sagging skin and they don’t replace the results possible from cosmetic corrective procedures such as Botox or any of the numerous dermal fillers.

Peels are helpful for improving skin tone, texture, and for some cases of hyperpigmentation (brown spots) but for best results, they must be accompanied by daily use of a well-formulated sunscreen rated SPF 25 or greater along with a brilliant anti-aging skincare routine. Now that’s a beautiful combination proven to help you look younger, longer!