October 2023

Facing Off
With The Phenol Peel

What's The Big Deal About Phenol Peels?

The surge of conversation around facelifts has revitalized interest in bygone procedures from the old days of plastic surgery. One such treatment called the Phenol Peel is getting a reboot as a powerful anti-aging corrective by both journalists and social media. And while the Phenol Peel is making a surge, is the attention worth the hype in 2023? To answer this question, let's review the chemical peel and its modern-day counterparts.

What Is A Phenol Peel?

Chemical peels are cosmetic procedures that use chemicals to resurface or rejuvenate the skin. Most chemical peels are conservative and can be administered by aestheticians and nurses in a medical spa setting. However, the Phenol Peel is quite different due to its deep penetration into the skin and high risk of potentially adverse effects. The peel is useful for softening deep wrinkles and coarse wrinkles, improving acne scars, tightening the skin, and lightening the skin and sun damage. The treatment itself is typically administered by a board-certified dermatologist or plastic surgeon. Phenol peels use carbolic acid and Croton oil. This combination penetrates the deepest layer of the skin called the reticular dermis, making the chemical peels effective but also very dangerous in the hands of an inexperienced provider and for certain skin types.

It should be emphasized that this deep peel carries great risk

The downtime is extensive, often lasting more than 2 weeks. It requires meticulous wound care to assist the skin in safe healing. Patients also experience a lot of swelling and a long period of transient redness after the skin has healed. The aggressive peel lightens the skin but also can destroy the pigment-producing cells of the skin, causing uneven skin tone. In patients with more melanin and pigmented skin types (Fitzpatrick III-VI), the lightening effect can be deforming resulting in treated skin looking much different than non-treated skin. Oftentimes, the face is isolated for treatment, resulting in a “line of demarcation” between the treated facial skin and the untreated skin of the neck.

PIH: Post-Inflammatory Hyperpigmentation

Phenol peels can also cause a condition called “post-inflammatory hyperpigmentation” where the skin becomes temporarily darker and unevenly pigmented. Treatment for hyperpigmentation requires prolonged treatment under close medical supervision with topical bleaching cream, Retin-A, and a mild steroid medication to reverse this effect.

Systemic Absorption & Close Medical Care

The chemical ingredients in a phenol peel treatment are not confined to the skin and are absorbed into the body itself. This can cause irregular heart rhythms and even damage the heart muscle itself. For this reason, Phenol Peels require cardiac monitoring during treatment. The toxic effect is not confined to the heart but also can affect other organs such as the kidneys. Finally, phenol peels are very painful and require either IV sedation or general anesthesia.

Don't Fall For Phenol Hype

While it might appear on social media that Phenol chemical peels are commonplace, most doctors avoid the procedure as the risks and side effects far outweigh the benefits, especially in light of the evolution of cosmetically elegant peels or lasers with superior delivery systems and results. There are a few doctors who still perform phenol peeling, but these physicians' methods fall under exception rather than the rule.

Rejuvenation With Less Risk and More Reward

Facial wrinkles, acne scarring, and extensive sun damage can be addressed a number of ways without injuring the skin and other organs.

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Laser Skin Resurfacing

We live in the age of lasers for everything from skin discoloration to skin remodeling. Lasers carry a greater degree of precision by delivering energy to the layer of the skin for the greatest benefit. Ablative or fractionally ablative lasers are equally effective with fewer side effects than the phenol peel procedure.


Erbium laser resurfacing is designed to improve the appearance of skin by reversing sun damage, treating fine lines and wrinkles, and reducing hyperpigmentation. The erbium laser emits short pulses of light energy that promote healthy tissue growth while removing damaged surface layers. As a result, the smooth layers of skin are revealed underneath. This treatment can be used on most types of skin including those with deeper skin tones due to its precise approach.

The erbium works by treating micro-layers of skin one at a time until the desired endpoint is achieved. Compared to other treatments, it generally takes less time and requires less downtime for healing and recovery afterward. In addition to softening signs of aging on the face, it can also be used for many areas of the body such as hands and chest, and is a great option for anyone looking to make significant improvements in their skin’s appearance quickly and safely.


CO2 laser skin resurfacing is an effective treatment to improve the appearance of skin by removing scars and wrinkles. The procedure involves the use of a laser that emits pulses of carbon dioxide (CO2) at a significantly high intensity which vaporizes the outer layers of the skin. The damaged surface layer is replaced by healthy, new collagen-producing skin cells. This results in smoother and more even-toned skin while correcting existing sun damage such as wrinkles, blemishes, age spots or pigmentation irregularities.

Carbon dioxide lasers are very effective and can produce more firming and wrinkle reduction than Erbium. However, CO2 lasers also deliver more heat to the skin and arguably have more side effects including prolonged post-treatment redness and pigmentary changes.

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Trichloroacetic Acid Peels

TCA peels are a popular chemical peel treatment for skin resurfacing. In this procedure, an even layer of the topmost layer of skin cells, known as the epidermis, is removed. TCA peels reduce wrinkles and fine lines in addition to evening out skin discoloration and texture. They also help boost collagen production for improved tone and elasticity. In more intense cases, a practitioner may extend the peel to the dermis layer below the epidermis.

For best results with minimal scarring or side effects, it is important that a trained professional applies and removes the TCA peel correctly, as there is an associated risk of over-peeling or burning if left on too long. 

Pictured: Pigmentation + Skin Brightening Protocol with TCA 3 Step Peel from ZO Skin Health available at EpiCentre Skincare & Laser Center

Laser Resurfacing Before and After in Dallas, TX by Dr. John Burns

Before and After Revision Deep Plane Facelift
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In Summary

It is important to remember that all faces are not the same and the technique should be tailored to fit a particular face and desired result. Take your research along with an open mind into your facelift consult. Be prepared to have clear and open communication with your board-certified plastic surgeon. Your facelift specialist will ultimately create the best recommendation tailored to your unique facial anatomy utilizing the techniques designed to give you the most natural and rejuvenated outcome. 

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