Oh, we wouldn’t give a damn if our skin was like a blank slate. Acne scars? Sun damage? Deep wrinkles? Erase them with some felt and start over. Unfortunately, a blank slate isn’t an effective skin treatment. To undo the past, you need something stronger. Stronger, in fact — like an alpha-hydroxy or even phenol peel.
Chemical peels are the closest thing to a blank slate treatment, and they’re exactly what they sound like. A chemical is applied to your skin to break the dead skin cells’ bond to your face, causing them to fall off and reveal new, undamaged skin cells. But not all chemicals are created equal — a blank slate eraser can erase the first few layers of marker, but it takes Windex to penetrate multiple layers of ink. The same is true for chemical peels. Many AHA (alpha hydroxy acid) and BHA (beta hydroxy acid) peels are gentle enough that they can even be done at home. Their results are also relatively mild, and downtime is virtually nonexistent. Phenolic peels, however, are just the opposite — they erase a lot. That’s impossible to do in your bathroom.
“Phenol peels are among the most potent peels available,” says Dr. Blair Murphy-Rose, a board-certified dermatologist in New York City. It’s so potent, in fact, that it sometimes needs to be used with IV sedation. Without it, the pain can be quite severe, even with a topical anesthetic cream. Due to the caustic effects of phenol, full recovery can take several months (and the early stages can be a little errrrrrrrrrrrrrrrrrrrrrrrr.)
Phenol peels have been used since the 1920s and were once the only way to smooth out harsh wrinkles or acne scars. But since ablative lasers, such as CO2 and YAG, came to market in the 1990s, they’ve become less and less used in doctors’ offices. Although the American Society of Plastic Surgeons reports that nearly 1.4 million chemical peels were performed in 2019, Dr. Melissa Doft, a plastic surgeon in New York City, says she’s rarely asked about phenol peels. She says she’s had just one patient recently who wanted one—because her mother saw dramatic results a few years ago.
While it’s often considered a last resort for treating severe damage, a phenol peel can give you lasting results—the clean, new start you’ve always dreamed 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 Dr. Tanuj Nakra, a double-board certified facial and ophthalmic plastic surgeon in Austin, Texas. “It’s used cosmetically because it penetrates deep into the skin, causing controlled damage that, once healed, results in dramatic improvements in facial wrinkles.”
The ingredient also has acidic properties, says Dr. Nakra, which is why it’s also great for skin care applications. Whereas an AHA or BHA peel promotes gentle shedding of dead skin cells on the surface of the skin, a phenol peel penetrates beneath that surface layer. Far below. “This is a deep and aggressive chemical peel that causes all of the epidermis and part of the dermis to slough off,” says Dr. Murphy-Ross.
Because phenol peels are so caustic, they’re definitely not for everyone. “Phenol peels are only recommended for people with moderate to severe acne scarring, deep wrinkles, or sun damage from chronic UV exposure for whom other types of treatments aren’t feasible,” says Murphy-Ross, who doesn’t offer phenol peels at all in her practice (she prefers lasers or a series of gentler peels for similar effects).
How should I prepare for a phenol peel?
A phenol peel is no walk in the park, and you should do everything you can to minimize the risks beforehand, says Dr. Nakla. “Certain skin types require pretreatment to address melanin issues and the redness that may be associated with rosacea. It’s best to treat these conditions ahead of time, as lasers and peels can exacerbate pigmentation disorders like melasma and can also exacerbate redness caused by rosacea.” So even if you decide to get a phenol peel, you may need up to a year of prescription treatment to work. Dr. Murphy-Ross recommends stopping retinol use and avoiding sun exposure a week before a peel.
What can I expect from a phenol peel?
A phenol peel should only be performed by a board-certified dermatologist or plastic surgeon. “The procedure is performed in a clinic where vital signs are monitored, as phenol can affect heart function if taken in excess,” says Dr. Nakra, who doesn’t perform phenol peels in her own clinic because of the extensive monitoring required. (I told you—this treatment is serious business.)
During the treatment, the doctor will apply liquid phenol to one area of your face at a time and then allow the phenol to absorb, says Dr. Nakra. Continuous use (apply phenol to forehead, remove, wait 15 minutes, apply phenol to right cheek, remove, wait 15 minutes… etc.) is thought to reduce heart disease risk. Waiting between applications also allows your liver to detoxify the phenol and your kidneys to excrete it, reducing the risk of systemic toxicity (basically, a phenol overdose).
Topical phenol can also cause extreme discomfort, so doctors will usually inject a local anesthetic and provide oral or IV sedation to make the procedure more bearable. From start to finish, the procedure takes one to two hours.
Wait, how painful is a phenol peel?
Remember: Phenol is not an at-home facial. It’s a chemical that penetrates the dermis. Any substance with that ability is inevitably going to cause pain. Even though doctors usually prescribe a sedative or anesthetic, the pain is still around a 5 on a scale of 1 to 10, Dr. Doft says. “It feels like a bad sunburn.”
For some patients, the pain is worth it for the long-term results. “Phenol peels are one of the most effective treatments for deep facial wrinkles. With good skincare products and facial care, the results can last a lifetime,” says Nacra.
How do you recover after a phenol peel?
“Phenol peels are not something I do often,” says Dr. Doft. “Most patients don’t want such a long recovery time or such an intense recovery.” As your skin recovers from a phenol peel, you can expect to experience peeling, scabbing, oozing, swelling, discomfort, and redness in the treated areas, says Dr. Murphy Ross. Total recovery time is about four to six weeks, with redness lasting for several months.
During those six weeks, you’ll go through several stages of healing. It’s almost like the metamorphosis of a butterfly, only with… more scabs. During the first stage—about five to ten days—you’ll notice the top layer of your skin start to flake off, scaring any small children you come in contact with. (Dr. Nakra then recommends using a greasy occlusive dressing, such as Aquaphor, and lubricating frequently to minimize the risk of scarring and hyperpigmentation.) Your face will then completely scab over. Just remember to turn off your zoomies for at least the first week. It’ll take a little over two weeks before you can safely use makeup again.
When the scabs start to fall off, fresh pink (but smoother) skin is revealed. Throughout the process, you should stay out of direct sunlight and be especially careful to use sunscreen, says Dr. Murphy Ross.
What are the risks of phenol peels?
Phenol peels are so risky that some dermatologists don’t offer the treatment, and many recommend trying other treatments first. You definitely need to weigh the pros and cons before deciding on a treatment (more on that later).
As for your skin, phenol peels carry the risk of scarring and pigmentation issues, says Dr. Nakra, though that risk can be minimized if you consult with an experienced provider (who can also suggest alternative treatment options if you seem more susceptible to these side effects). Since skin is removed and you essentially have an open wound for at least a week, infection is another possible risk.
But your skin isn’t the only thing you have to be concerned about. “Phenol can also cause systemic side effects, including heart, kidney, or liver problems,” says Dr. Murphy Ross. That’s why it’s important to be completely honest with your doctor about any medical issues you have. “Phenol peels are safe if performed by an experienced physician,” says Dr. Murphy Ross. “However, it is one of the riskier chemical peels.”
If you’re concerned about the risks, start with something less intense. If these treatments don’t work, a phenol peel may be an option. Consider a TCA (trichloroacetic acid) chemical peel, which is much stronger than a typical AHA or BHA peel, but still recovers much faster than a phenol peel. Plus, it’s safe for all skin types, including darker skin tones (Dr. Nakra wouldn’t recommend a phenol peel to anyone with a Fitzpatrick 3 or higher skin type).
Dr. Nakra also mentions lasers as an alternative: “Resurfacing with photofractionated lasers is low risk, can produce impressive changes, and can be performed on nearly all skin types except the darkest pigmented skin tones.” as a target. “Deep wrinkles around the mouth are difficult to treat with fractional lasers. I would recommend a phenol peel to these patients.”
More intense ablative fractional lasers, such as Fraxel Repair, are another option for treating deep folds. “Lasers allow for better control of penetration depth compared to peels,” says Dr. Doft, noting that the precision and reduced downtime of this approach make this a more common choice for patients. Additionally, ablative lasers don’t pose the same systemic risks as phenol.
Phenol peels: Pros and Cons
Phenol peels are completely different from your average alcohol-based treatment (AHA). Since it’s the deepest chemical peel on the market and comes with some risks (and a higher price tag), you need to weigh the pros and cons.
Pros:
Phenol peels can significantly improve skin condition and smooth out deep wrinkles or acne scars in a way that other methods might not be able to do, says Dr. Murphy Ross.
Phenol peels can reduce your risk of skin cancer because it removes a significant layer of damage, adds Dr. Murphy Ross.
“The effects of a phenol peel can last a lifetime through the use of skincare and facials,” says Dr. Nacra, however, also points out that it’s not an elixir. Your skin will continue to age over time.
Cons:
There is a risk of infection (despite phenol’s antiseptic properties, any open wound is susceptible to infection) and scarring.
While unlikely if done slowly by an experienced practitioner, there are systemic risks, such as dangerous effects on the heart, kidneys, and liver. (In one study, 6% of patients who underwent deep peels experienced heart problems.)
It’s more expensive than milder chemical peels. For example, a glycolic peel performed by a physician typically costs less than $500, while a phenolic peel can cost between $3,000 and $6,000, depending on the location and extent of the treatment. Ablative laser treatments, such as Fraxel, cost about the same, but require only five to seven days of downtime.
The recovery process is intense and can take a month or longer. “Phenolic peels create wounds in the skin that need to heal,” says Dr. Murphy Ross.
Phenolic peels are like hitting the “reset” button on your skin. However, the effects of this chemical also make it a fairly dangerous procedure (both for your skin and your overall health). Before you resort to phenol peels as a last resort, consider trying less-intensive treatment options with your dermatologist.
