Phenol peels will clear up scarring and deep wrinkles, but it comes at a cost.
Oh, what we wouldn’t give for our skin to be like a dry-erase board. Acne scars? Sun damage? Deep wrinkles? Swipe them with some felt and start anew. Unfortunately, dry-erase isn’t an effective skin treatment. To undo the past, you’ll need something a little stronger. Actually, a lot stronger — like an alpha hydroxy or even phenol peel.
Chemical peels are the closest you’ll get to a blank slate treatment, and they’re exactly what they sound like. A chemical is applied to your skin to loosen the bonds holding dead skin cells to your face, allowing them to fall off and reveal newer, undamaged skin cells. But not all chemicals are created equal — a dry eraser can swipe off the first few layers of marker, but Windex is needed to penetrate multiple passes of ink. Likewise with chemical peels. Many AHA (alpha hydroxy acid) peels and BHA (beta hydroxy acid) peels are mild and can even be performed at home. Their results are also relatively mild, and downtime is little to none. Phenol peels, however, are at the complete opposite end of the spectrum — they can wipe away a lot. And could never happen in your bathroom.
“A phenol peel is one the strongest peels available,” says Blair Murphy-Rose, MD, a board-certified dermatologist based in New York City. So strong, in fact, that it’s sometimes administered under IV sedation. Without it, the pain would be pretty terrible, even with a topical numbing cream. And due to the corrosive strength of the phenol, a full recovery can take months (and the early phases can be a little er — gruesome).
Phenol peels have been administered since the 1920s and were once the only option for smoothing coarse wrinkles or acne scars. But they’ve become a less and less common offering in doctors’ offices ever since ablative lasers (like the CO2 and YAG) arrived on the scene in the 1990s. In fact, while the American Society of Plastic Surgeons reports that nearly 1.4 million chemical peels were performed in 2019, New York City-based plastic surgeon Dr. Melissa Doft says she is rarely asked about phenol peels. In recent memory, she says, there has only been one patient who wanted one — because her mother had seen dramatic results years ago.
While it is generally viewed as a last-resort treatment for serious damage, a phenol peel can bring you lasting results — the clean slate you’ve been dreaming of. So is it worth the risk and recovery? We asked the pros to tell us more about phenol peels, what to expect, and if there are better alternatives.
What is a phenol peel?
Let’s start with the basics: What is phenol? “Phenol is an organic molecule derived from petroleum derivatives,” says Tanuj Nakra, MD, a double board-certified facial and ophthalmic plastic surgeon in Austin, Texas. “It is used in aesthetics because of its ability to penetrate deep into the skin — causing a controlled injury that when healed, can produce dramatic improvements in facial wrinkles.”
The ingredient also has acidic properties, says Dr. Nakra, which is why it lends itself to skin-care applications, too. While an AHA or BHA peel encourages the gentle shedding of dead skin cells sitting on the surface of your skin, a phenol peel goes past that superficial layer. Way past. “It’s a deep and aggressive type of chemical peel that induces a shedding of all of the epidermis and part of the dermis,” says Dr. Murphy-Rose.
Because phenol peels are so aggressive, they are not definitely not a fit for everyone. “A phenol peel is only recommended for those with moderate to severe acne scarring, deep wrinkles, or sun damage from chronic UV exposure who are not candidates for other types of treatments,” says Murphy-Rose, who does not offer phenol peels in her office at all (she prefers to get similar results from lasers or a series of milder peels).
How do I prepare for a phenol peel?
A phenol peel is no walk in the park and you’ll want to mitigate risks as much as possible beforehand, says Dr. Nakra. “Some skin types will require pre-treatment to manage melanin issues, and also areas of redness that could be associated with rosacea. It’s best to manage these conditions in advance as lasers and peels could exacerbate pigment disorders like melasma, and also make the redness from rosacea worse.” So even after you’ve decided you want to get a phenol peel, you may need up to a year of prescription treatments before you’ll be free and clear to get one. Dr. Murphy-Rose recommends discontinuing retinol one week before your peel and avoiding the sun, as well.
What can I expect from a phenol peel?
A phenol peel should only be administered by a board-certified dermatologist or plastic surgeon. “The procedure is performed in a clinic-based setting, with monitoring of vital signs due to the potential effects that phenol can have on cardiac function in an overdose situation,” says Dr. Nakra, who does not perform phenol peels in his own office because of the extensive monitoring needed. (Told you — this treatment is serious business.)
During the treatment, your physician will apply liquid phenol to segments of the face sequentially and then allow the phenol to absorb, says Dr. Nakra. The sequential application (apply phenol to the forehead, remove, wait 15 minutes, apply phenol to the right cheek, remove, wait 15 minutes…and so on) is to reduce cardiac risks. The wait in between applications also allows your liver to detoxify the phenol and your kidneys to excrete it — decreasing your risk for systemic toxicity (basically a phenol overdose).
Topically applied phenol can also cause extreme discomfort, so typically the physician will inject local anesthetics and offer oral or IV sedation to make the procedure more bearable. From start to finish, the process takes one to two hours.
Wait, how much does a phenol peel hurt?
Remember: Phenol is no at-home facial. It’s a chemical that penetrates all the way into the dermis. Any substance with that kind of power is bound to hurt. While physicians usually offer sedatives or anesthetic blocks, the pain will still register at about a five on a scale to ten, says Dr. Doft. “It feels like a bad sunburn.”
For some candidates, the pain is worth the long-term payoff. “Phenol peels are some of the most powerful treatments that exist for treating deep face wrinkles. With good skin care products and facials, the results can last a lifetime,” says Dr. Nakra.
What is recovery like for a phenol peel?
“Phenol peels are not something I perform commonly,” says Dr. Doft. “Most patients do not want this long of a recovery.” Or this intense of a recovery. While your skin recovers from a phenol peel, you can expect to experience peeling, crusting, oozing, swelling, discomfort and redness in the treated area, says Dr. Murphy-Rose. Total recovery time is about four to six weeks, with redness hanging on for several months.
You can expect to go through phases of healing over those six weeks. It’s almost like the metamorphosis of a butterfly but with…more scabbing. In the first stage — for about five to 10 days — you’ll notice the top layers of your skin start to peel off, frightening any small children you may come in contact with. (This is when Dr. Nakra recommends using greasy occlusive dressings, like Aquaphor, and frequent lubrication to minimize the risk of scarring and pigmentation.) Your face will then completely scab over. Consider keeping your Zoom camera off for at least that first week. It will be more than two weeks before you’ll be able to safely use makeup.
When the scab starts to shed it will reveal freshly pink (but smoother) skin. During this whole process, you’ll want to stay out of direct sunlight and be extra diligent about sun protection, says Dr. Murphy-Rose.
What risks are associated with phenol peels?
Phenol peels are so risky that some dermatologists do not offer them, and many recommend trying other treatments first. You’ll definitely need to weigh the pros and cons before committing to the treatment (more on that later).
In terms of your skin, phenol peels carry the risk of scarring and pigmentation disorders, says Dr. Nakra, though that risk can be minimized if you see an experienced provider (who can also suggest alternatives to the treatment if you seem like you might be more prone to these side effects). Because skin is being removed and you’ll essentially have an open wound for at least a week, infection is another possible risk.
But your skin isn’t the only thing you’ll need to keep an eye on. “Phenol can also cause systemic side effects including problems with the heart, kidney or liver,” says Dr. Murphy-Rose. Because of this, it’s important to be totally honest with your physician about any medical problems you have. “When performed by an experienced physician, a phenol peel can be safe,” says Dr. Murphy-Rose. “That said, it is one of the more risky chemical peels.”
If you’re worried about the risks, you can start with something a little less intense. A phenol peel could then be an option if those treatments don’t work. Consider a TCA (trichloroacetic acid) chemical peel, which is much stronger than a typical AHA or BHA peel but the recovery is still far faster than with phenol peel. Plus it’s safe for all skin types, including darker tones (Dr. Nakra would not recommend a phenol peel to anyone with a Fitzpatrick 3 skin type or higher).
Dr. Nakra also mentions lasers as an alternative: “Light fractionated laser resurfacing is low risk, can produce impressive changes, and can be performed on almost all skin types, except for the darkest pigmented skin tones.” But the results may not be as targeted. “Deep wrinkles around the mouth are difficult to treat with fractionated lasers. These are the patients that I would recommend a phenol peel for.”
A more intense ablative fractionated laser, like Fraxel Repair, is another option for deep wrinkles. “The depth of penetration is more controlled with a laser than it is with a peel,” says Dr. Doft, noting that the precision and lessened downtime has made this a much more common choice for patients. Plus, ablative lasers don’t carry the same systemic risk as phenol.
Phenol Peel: Pros and Cons
A phenol peel is a whole different ball game than your average glycolic (AHA) treatment. Because it’s the deepest chemical peel on the market and comes with some risks (and a high price tag), you’ll need to weigh the pros and cons.
Pros:
- Phenol peels can achieve substantial improvements in the skin, smoothing deep wrinkles or acne scars when other methods may not be able to, says Dr. Murphy-Rose.
- A phenol peel could reduce the risk of skin cancer because of its ability to remove substantial layers of damage, Dr. Murphy-Rose adds.
- “With good maintenance with skin-care products and facials, the results of a phenol peel can last a lifetime,” says Dr. Nakra, who also notes that it’s not the elixir of life. Your skin will continue to chronologically age over time.
Cons:
- There is risk of infection (even though phenol is bactericidal, any open wound is susceptible to infection) and scarring.
- Although unlikely if performed slowly and by an experienced practitioner, there are systemic risks, such as dangerous cardiac, kidney, and liver effects. (In one study, cardiac incidents occurred in 6% of deep peel patients.)
- It’s more expensive than gentler chemical peels. A doctor-administered glycolic peel usually costs under $500, for example, whereas a phenol peel will run you anywhere between $3,000 and $6,000 depending on your location and the extent of the treatment. An ablative laser treatment (like Fraxel Repair) can cost about the same but will only have five to seven days of downtime.
- Recovery is intense and will take a month, if not longer. “Phenol peels create an all-over wound in the skin that must heal,” says Dr. Murphy-Rose.
Phenol peels are about as close to hitting the “reset” button as you can get for your skin. However, the power of the chemical also makes it a fairly risky procedure (for both your skin and your systemic health). Think about trying less intense treatment options with your dermatologist before turning to a phenol peel as a last resort.