Medium depth chemical peels, or TCA (trichloacetic acid peels) are highly effective in promoting skin smoothness and vitality. They improve superficial discolorations, such as freckles and pigmentations, and help to eliminate fine wrinkles. When compared to other superficial or very deep resurfacing options, such as Erbium laser resurfacing, medium depth chemical peels provide an intermediate level of improvement at an intermediate cost and impose an intermediate period of recovery. They are ideal for the woman who wants more than a light peel, but cannot afford the expense or recovery time of a very deep treatment.
Medium depth chemical peels are not recommended as a treatment for deep acne scarring or for dynamic (movement related) wrinkles. Medium depth chemical peels are commonly achieved using trichloroacetic acid (TCA) at concentrations between 20% and 35%.
A TCA chemical peel will improve color, freshness, texture, skin tone, and fine wrinkles. It will also improve superficial discoloration, such as age spots. It may improve blotches and can sometimes improve dark circles under your eyes. Though chemical peels may be repeated as necessary, results are long lasting if you adhere to a skin care programme that includes cosmeceutical home care and occasional light peels or microdermabrasions.
Preparation for a TCA Chemical Peel
Preparing your skin prior to a chemical peel will result in deeper penetration, faster recovery, lower risk of side effects such as pigmentation, and a better result. A pre-peel preparation programme will be prescribed for you that will contain various concentrations of retinoic acid (vitamin A), lactic acid, vitamin C and/or a bleaching agent, depending on your skin type. This programme should be followed daily for four to six weeks prior to your peel.
Retinoic acid (a form of vitamin A) will help dead superficial layers of skin to shed and will allow the chemical peeling agent to penetrate more deeply. Retinoic acid will also stimulate your skin to regenerate and heal more quickly. Alpha hydroxy acids, such as lactic acid, will enhance the effects of retinoic acid.
Because patients who tan easily are at increased risk of developing blotchy pigmentation after chemical peeling, a bleaching agent may also be recommended for use both before and after their peel to minimize this risk. Such patients are also strongly advised to consider chemical peeling only during the winter months.
If you are already using cosmeceutical skin care products, your skin may already be adequately prepared for peeling.
TCA chemical peels are performed as office procedures and require 30-60 minutes. Your doctor may offer you tablets for pain and/or laughing gas to help you tolerate the discomfort of the treatment. After thoroughly cleansing your skin with acetone to remove all traces of oil, your doctor will apply the appropriate concentration of TCA to your skin, one area at a time. When the desired depth has been achieved, iced saline will be used to terminate the peel. You will experience burning or stinging for two to ten minutes. Your skin will initially look white, but will return to its normal color over 15 to 45 minutes. Aloe vera gel and SPF 30 sunscreen are applied before leaving the surgery. Post operative pain medication is not required.
There will be no discomfort following the procedure. You should wash your face several times a day using a gentle cleanser such as Cetaphil and apply a simple emollient ointment such as pawpaw ointment, Vaseline or sorbolene. Your face will initially appear red. Within a few days, the uppermost layers of skin will turn dark brown and feel tight. Peeling proceeds over four to seven days as illustrated below. There will be no open wounds and no scabs. Once your old skin has sloughed, your new skin will be bright and flushed. Once your skin has finished peeling, you may begin wearing makeup. You will physically be able to return to work immediately, but most patients prefer to take at least a few days at home to recover. Most patients are able to comfortably return to work and social commitments within seven days.
You should resume your normal skin care regime within two weeks of your procedure and remember to apply sunscreen daily for at least three months if not lifelong.
Total cost of a full-face chemical peel (TCA) is $500.
Expected Duration of Results
If you use appropriate skin care products regularly after your peel, avoid the sun and don’t smoke, you may expect to maintain your improvement indefinitely. Ageing however is relentless and chemical peels may be repeated at infrequent intervals as required. Some patients choose TCA chemical peels as the mainstay of their facial rejuvenation programme and may choose to undergo a repeat peel at about twelve monthly intervals.
Women who seek dramatically increased skin vitality with a reduction of fine wrinkles, who understand recovery and temporary duration of effect, and who do not expect improvement in dynamic wrinkles are generally satisfied with chemical peels.