TCA Peel: A trichloracetic acid (TCA) peel is often used for the treatment of wrinkles, pigmentary changes and skin blemishes. Many patients can benefit from having TCA applied not only on the face but also on the neck and other parts of the body that have been exposed to the sun. For spot peeling of limited areas such as around the mouth or eyes, TCA formulas are often preferred because they have less bleaching effect than solutions containing phenol, another popular peeling agent. For the same reason, some surgeons have found TCA to be effective in treating darker-skinned patients.
Milder TCA peels can be repeated frequently in order to achieve cumulative effects, or TCA can be used to achieve a medium or even a deep peel, depending on the acid concentration and manner of application.
How is a TCA peel performed?
The surgeon will select the best chemical or chemical mix for the individual patient. A solution is applied using a sponge, cotton pad, cotton swab or brush to the areas to be treated (or the entire face, avoiding the eyes, brows and lips).
Who should consider a TCA peel?
Any of the following conditions may indicate that you might be a good candidate for a TCA peel:
- wrinkled or sun-damaged facial skin
- vertical wrinkles around your mouth, such as those that cause lipstick “bleed”
- “crow’s feet” lines around your eyes and perhaps some skin laxity in your lower eyelid area
- fine wrinkling of your upper eyelids
- brown spots or blotchy skin coloring
- certain precancerous skin growths
- acne or chicken pox scars
- superficial facial scars from a past injury
Like the other resurfacing methods, the TCA peel is effective in treating wrinkles, blotchiness or age spots, and scars from acne or other causes. It can be used on the entire face or specific areas. Certain other characteristics of your skin, such as its thickness and texture, may influence whether you are a good candidate for this chemical peel.
In addition to your surgeon performing a history and physical examination, your therapist consultation is the time to ask questions.
Additionally, your therapist will evaluate the condition of your skin, discuss your treatment expectations, and review your medical history.
Skin Evaluation: Your therapist will carefully examine your skin to determine which resurfacing technique, or combination of treatments, will provide you with the best results. Your skin type, the severity of any sun damage, the extent of uneven pigmentation and the depth of skin imperfections will be evaluated. Fine lines, coarse wrinkling or deep acne scarring each may require a different approach to treatment.
Medical History: You should come to the consultation prepared to discuss your medical history. This will include information about any medical conditions, drug allergies, medical treatments you have received, previous surgeries, and medications that you currently take. Be sure to tell your therapist if you have ever had x-ray treatments of your facial skin such as those used in the treatment of acne or if you have had a prior chemical peeling procedure. Current or past use of Accutane, as well as Retin-A and other topical skin preparations, must be reported to your therapist. For your safety, it is important that you provide complete information.
Getting ready for TCA peel
Your therapist may place you on a pre-treatment program during which you will apply special creams, lotions, or gels to your skin for a few weeks or longer. You may also be given certain oral medications that you should begin taking prior to your TCA peel. Your therapist will provide you with additional instructions.
Before a TCA peel
Medications will be administered for your comfort prior to the treatment. Frequently, local anesthesia alone or combined with intravenous sedation is used for patients undergoing skin resurfacing procedures. Sometimes, general anesthesia may be desired.
After TCA Peel
When the treatment is completed, your resurfaced skin may be covered with petroleum jelly or other protective ointment. In some cases, dressings, tape or a bandage may be applied.
Some patients experience discomfort after a deep chemical peel, but this can be controlled with medication. A few days after the procedure, new skin with a bright pink color akin to sunburn will emerge; the pinkness will fade within a few days. Post-operative puffiness will also subside in a few days, but the skin will remain sensitive. Patients should avoid exposure to sunlight and continue to use sun block.
It is important to realize that the amount of time it takes for recovery varies greatly among individuals.
First few days: A TCA peel will produce redness and swelling to varying degrees. Depending on the post-treatment regimen selected by your therapist, a scab may or may not form over the treated area. You will be advised about cleansing your skin, as well as if and when you should apply any ointments. In the case of men who have undergone resurfacing procedures, shaving must be delayed for a while. It is essential that you follow your therapist’s instructions and avoid doing anything that might interrupt the healing process.
Within 7 to 10 days: New skin will have begun to form. After the initial redness subsides, your skin may be pink for several weeks to months. Camouflage makeup usually can be used within a couple of weeks, but your doctor will advise you.
Depending on the type and depth of your skin resurfacing, straining, bending and lifting should be avoided during the early period following your procedure. For deeper resurfacing, you should be able to return to work within a week or two.
Results: what to expect from TCA facial peel
Because of the persistence of skin pinkness following many types of resurfacing procedures, it may take months before you can fully appreciate your new look. Most patients feel that the results are definitely worth waiting for and, in the case of deeper treatments, the benefits are relatively long-lasting. More superficial resurfacing treatments may need to be repeated periodically in order to maintain their benefits.
Your skin will, of course, continue to age. Also the type of wrinkles caused by movement of your facial muscles will eventually reappear. Some wrinkles may recur sooner than others, depending on their location as well as the type and extent of your resurfacing treatment. Despite this, you can expect that improvements in skin quality and texture achieved by resurfacing will make your complexion appear younger and fresher for many years to come.
TCA peel side effects
The subject of risks and potential complications of surgery is best discussed on a personal basis between you and your therapist, or with a staff member in your surgeon’s office. Skin resurfacing procedures are generally safe when performed by an experienced board-certified therapist.
Potential risks include:
- abnormal healing
- allergic reactions
- if prone to herpes, possible eruption
- raised or thickened scarring
- unanticipated skin color changes or skin blotchiness
Following all resurfacing treatments, it is important that you avoid direct or indirect exposure to the sun until all the redness or pinkness of your skin has subsided. Even after that, it is advisable for you to protect your skin by regular use of a sunblock and, whenever possible, a wide-brimmed hat. If the area around your eyes has been treated, you should wear good quality sunglasses when outdoors. After some types of skin resurfacing treatments, you may need to be careful about exposing your skin to chlorinated water.
Additional considerations for deeper peels:
- possible post-operative complications can include scarring, infection or abnormal pigmentation. Tends to have a bleaching effect, and patient may need to wear make-up to match treated and untreated areas.
- EKG monitoring is advised.
- cannot be used on the neck or other parts of the patient’s body.
- not as effective in treating individuals with dark, oily complexions.
- some facial skin disorders do not respond to chemical peeling.
- skin pores may appear larger, and the skin may not tan properly.
- can activate latent cold sore infections.
- all forms of deep skin peels include the risk of delayed healing and scarring.
You can minimize certain risks and help to maintain the results of your skin resurfacing treatment by following the instructions of your therapist.
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