Is a Tsa Peel the Same As a Chemical Peel? What is a Phenol Peel? Also, Which is Better? What is the down time for a peel?
TCA vs Phenol Peel vs Chemical Peel - Which is Better?
Doctor Answers (9)
A Phenol peel is, by definition, a "deep" chemical peel, A TCA peel can be administered as either a mild, medium, or deep chemical peel according to the concentration. Phenol peels have a greater incidence of hypopigmentation, and have a certain degree of cardiac risk. Since the refinement of the ultra-pulse CO2, erbium, and later the fractionated CO2 lasers, phenol peels have been used with lesser frequency for skin resurfacing.
There are several different peel types but you are correct in that TCA (trichloracetic acid) is a peel. Phenol is a peel too but generally deeper and carries more risk than the TCA peel. I only perform TCA peels in our office since they are safe and very effective with minimal risk and downtime. The longest downtime for a TCA peel is 3-7 days depending on depth.
These are different types of chemical peels
TCA or trichoroacetic acid peels come in different strengths. Mild peels are in the range of 10 to 20%. These peels freshen the skin but don't provide much in the way of line improvement. Treatment effects are on the order of many months. TCA peels in the 25 to 35% range generally benefit from having anesthesia to tolerate the procedure. Recover for a 35% peel is about a week and at this point the skin will be red which resolves in 6 to 8 weeks. This peel will provide generalized skin tightening and will remove considerable sun damage. However, this peel will only provide help for fine lines. To deal with deeper lines, a phenol 89% peel is often used. The critical thing is to understand that this is a very powerful peel that very few cosmetic surgeons are properly trained to perform. This agent is very powerful but it also can damage normal pigment. In fact this is not even considered a complication but rather a known treatment effect. How this treatment effect is used and when it is used is the mark of a master chemical peeler. This agent is very powerful in firming skin and reducing lines. Generally it is not appropriate to have a full face phenol peel. It is best used in the under eye area and at the edge of the mouth were the skin color is lighter. This type of peel is not appropriate for olive or darker skin due to depigmentation. Finally the deepest peel is with a combination of phenol and croton oil called a Baker's peel. These are seldom needed and the ability of this peel to permanently scar the skin is profound.
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TCA vs. phenol peel
Phenol peels tend to be more intense, and have a longer recovery, but can have more impressive results. They come in a variety of slightly different mixtures. I prefer the Hetter formula over the classic Baker-Gordon formula. With the Hetter formula, the risk of chalky-white loss of pigmentation referred to earlier is reduced.
I think pre-treating the patient with Obagi and Retin-A for several weeks beforehand is always helpful. Also, get Valtrex (or equivalent) if you have a history of cold sores.
All the best,
Phenol versus TCA peel
Phenol peels are deeper with more potential benefit, but more risk as well. TCA treats less deeply but has a better safety record. The best depth of a peel is best judged by your surgeon who can consider your skin type and history to give you the best result. We all have varying experience with different peeling agents as well.
John Di Saia MD
TCA is a medium depth peel if used at a concentration of 35% , the phenol peel is generally a deep peel and the other peels are usually superficial peels. So depending on your treatment goals and concerns and skin type , you will need to work with your doctor to pick the optimal peel for you. Remember that all chemical peels can scar if used incorrectly or on the worng type of skin so beware and be informed.
TCA and Phenol are two types of chemical peels
There are many options for chemical peeling. There are light, medium and deep peels. Some have significant down time, while others have no downtime but require a series to see any effect. Certain peeling agents (phenol, for example) are not safe for certain skin types. It is important to have an in-depth discussion with your board certified dermatologist or plastic surgeon in order to choose the best option for your unique needs. There are no "good" or "bad" peels, just poor decisions.
There is no "best" peel; there is simply a "best" peel for the needs of an individual patient. All of the reading that you do here cannot take the place of a consultation with a physician who is experienced in different types of chemical peels and resurfacing techniques.