Jessner's + 25%/30% TCA Peel - Beverly Hills, CA

GOAL: My primary goal of this process is to fix...

GOAL: My primary goal of this process is to fix the texture of my skin that was damaged from the ProFractional with MicroLaserPeel laser I had 3 years ago when I was only 23 years old. My secondary goal is to fix the acne scarring.

THE SYNOPSIS ABOUT LASER DAMAGE: The dermatologist who did my laser should not have allowed me to have these lasers for minor acne scarring. I am now left with pinholes and poor texture especially where he went deeper (nose! why even do the nose, no scarring) and cheeks. I used to have baby smooth, PORELSS skin. Now I have to deal with this damaged skin and a damaged soul. I still have to write a review for this laser. This was done by a doctor who now primarily practices in Flagstaff, AZ.

DOING THE HOMEWORK: I chose to have a TCA Peel after having 6 glycolic peels. Glycolic peels are great but I knew they were too superficial for fixing the texture of my skin. They are, however, great for acne.

I read many journals and even ordered textbooks about chemical peels. I read reviews. I google searched. I talked to others who had these peels and most importantly I interviewed 10+ doctors.

My skin is tricky not only because of the laser damage, but I also had acne at the time BUT the primary concern was my mixed ethnicity. I am half Caucasian and half Chinese. My skin scars easily from acne and I believe it is due to my Asian half.

HOW I FOUND MY CURRENT DOCTOR: I actually found him through a RealSelf review and I am so thankful! I actually already had another doctor in Scottsdale, AZ and was scheduled for a 20% TCA peel however due to their poor business practices, I left as an angry customer after they canceled/pushed back the peel THREE times. This was back in August when I had a month off and needless to say, my summer was ruined.

HOWEVER, with this disappointment I found the dermatologic plastic surgeon who I trusted the most. This was after interviewing at least 10 dermtologist and/or plastic surgeons, no joke. My new doctor resides in California so I had some roadtrippin' to do.

INITIAL CONSULTATION: This was back in mid September. He was intelligent, personable, and most of all, I felt like I could trust him He was very thorough and talked about all the various techniques available and what he thought was best. We decided on a Jessner + 20% TCA Peel. He suggested starting at a lower percentage (which I had wanted) due to my skin type. Like I said, since I have half Asian in me, I have to be more conservative.

He said that each peel we will go higher in strength so the next one may be Jessner with 25% TCA. I was also prescribed Epiduo for my hormonal acne. This also helped to prep my skin.

SKIN PREP: My appointment was booked for mid November so I was able to prep my skin for 2 months. I used the Epiduo (Retinoid + Benzyl Peroxide) every day, once a day at night. I also added the Obagi Blender 4% hydroquinone on and off but because it broke me out, I was unable to use it as much as I would have liked. Next time I will get pure hydroquinone instead since I think the other ingredients broke me out.

THE PEEL: I had my Jessner + 20% TCA Peel yesterday. Everything went well although the fumes did irritate my right eye. Make sure you ask for the air to be turned on before he starts (this he admitted).

I asked what was in the Jessner because I had conflicting information that I read. He said there was lactic acid in it but I am not sure of the rest (I either was distracted by the peel or he didn't say, I do not remember and will ask next time).

He did the peel himself while my husband watched. To be honest, the pain was not bad. I was apprehensive about the pain before the peel because of all the reviews. I have a high pain tolerance so I was prepared. Well, the pain wasn't all the bad.

He did 2 layers with a cotton swab. First the Jessner and then the TCA. The process was quick. I frosted well. The nurse who came in later mentioned that my frost stated longer than what she usually sees and she said this is good. This means that I got a better, deeper peel. I have a picture of some of my frost and will continue to be adding daily photos.

THE NEXT STEP: I have to go back in 2 weeks so he can evaluate my skin and we will go from there. I will be updating this journal/review with photos, etc.

DAY 1

See "THE PEEL"
I look "sunburned", not bad. Still tingled about an hour or so after the peel. Wore a big beach hat and shaded the car windows for the drive home.

Was told to use the prescribed Triamcinolone Acetonide Cream 0.1% up to 5 times today but since I left it at home in AZ, I only used it once when I got home. To be honest, I do not like using a steroid cream that often as I know it can thin the skin. He did say however after the first day to then use it twice a day for the next 2 weeks. I will play it by ear. I used Aquaphor in the mean time. I did not wear any sunblock. I was also told to splash water on my face 4-5 times a day.

DAY 2

My "sunburn" look is a little darker red today. I think the darker areas are the areas the will peel more, such as my temporal and cheek area. I should turn brown tomorrow but we will see. I will continue to splash cold water and use Aquaphor, as well as the steroid cream 2x a day. I did buy a Cetaphil Antibacterial bar that I use to wash my hands before touching my face.

DAY 3

So I tried to sleep mostly on my back last night and that was a dud. I am a side sleeper so it's going to be a rough few nights not trying to irritate or scratch my skin on the pillow!

I woke up red albeit slightly a darker red with some minute patches of light brown on my temporal area and the right crack of my mouth. I rinsed my face and put on the steroid (Triamcinolone Acetonide Cream 0.1%). I see why it was prescribed because it works VERY well! My redness dissipated and eventually slathered on some Aquaphor and my physical sunblock (EltaMD SPF46 which has 9% Zinc - LOVE IT! ).

I feel like I look "too normal" despite feeling the tightness and dryness of the skin underneath. I am trying to be patient. What is concerning though is I notice that many of my laser created holes are looking clogged. I don't know if it's because everything is being pushed out or what. I am still slightly swollen but not as much as I was the day when I had the peel. I also believe that the swelling/edema has made my skin smooth. I am trying not to keep my hopes up.

I hope these photos are helpful. I feel like you cannot see much of a change. I don't know if it's the lighting or perhaps the fact is the changes I am going through right now seem so minute.

Day 4

I'm peeling! I'm peeling! Well sort of. The crack of my mouth. A bit. See attached photo.

I work up today pretty red. I washed my face and put on the steroid. Within the next 15 minutes the redness subsided. I then put on Aquaphor and then my physical sunblock. Remember to pat on the creams and not rub them in.

I managed to sleep on my back last night which is great.

I think I'm a little browner but not much. This afternoon I finally starting peeling by the left corner of my mouth. That makes sense as many people have mentioned that it starts to peel where you have the most movement.

When I make facial expressions I can see that the rest of my face is crepe like. So far so good I think. Just have to be patient!

On a side note, supplements I have been taking for months now for my skin and body include:
-Navitas Naturals Organic Pomegranate Powder (Antioxidants, Vitamin C,Polyphenols)
-Nature's Way Hydraplenish Hyaluronic Acid
-Emergen-C (1,000 mg Vitamin C)
-Zinc 50mg
-Multivitamin
-Yaz

Day 5

At the rate I'm going I will probably need more than a week to fully recover. The hardest part really is being patient! I am peeling more by my mouth and nose as you can see in the photo.

Also my intuition was correct in that acid did indeed get extremely close to my right eye. There is browning and wrinkling in the inner corner of my right eyelid, as well as the more obvious peeling, browning and wrinkling on the lower part of the eye (harder to see in photos but the white "dot" on my eyes is where skin is peeling). Next time I will not hesitate to ask for more protection for my eyes, e.g. cotton balls or maybe even Aquaphor. From the research I did, I knew getting acid in the eyes is a risk for this procedure.

Aside from my eye irritation, I am still happy thus far that I had this procedure and look forward to seeing my new skin.

Day 6

There is more peeling around the mouth & nose area. I had to carefully trim the skin that was already peeled. I continue to rinse my face 4 times a day, use the steriod 2x, and lots of Aquaphor and sunscreen even though I stay inside. I read in the "Manual of Chemical Peels" by Mark G Rubin that some fluorescent lights can emit long UVA rays. I highly recommend this book to anyone thinking of getting a chemical peel.

Day 7

Slooooowly getting there. Still some more peeling. Nothing too exciting. Trying to be patient. I have my followup appointment early next week so I hope I'm done peeling by then!

Day 8

At the rate I'm going I feel like I will need another week (2 weeks total) of peeling. I guess that's good because the deeper the peel, the longer it takes to recover.

Book

I'm not sure how I mixed up the books but the book I recommend reading is actually "Chemical Peeling and Resurfacing" by Harold J. Brody. He currently practices in Atlanta.

Books worth reading

Oh my gosh this is why I need an edit button, I must be tired as I did not sleep well. The following books I recommend reading if you plan to get a peel, are as follows:

1. Manual of Chemical Peels, Superficial and Medium Depth by Mark G Rubin
2. Chemical Peeling and Resurfacing by Harold J Brody

Day 9

Day 10

Developed a 2-3 pimples. Still peeling. Posted left & right cheeks.

Follow Up

My follow up appointment went well. I still was not done fully peeling (mainly the perimeter of my face, forehead, chin) so he proceeded to remove the dead skin carefully with forceps. After that, he did microdermabrasion on me to further smooth off the dead skin and it felt like a massage for my face. That was my first experience with microdermabrasion. He would have done another peel but my face still had some dead skin left.

Overall, my face does feel smoother and less dry. I also think my microholes look smoother but they are still there as expected. The skin is still healing and I know changes will still occur over the next several weeks. He said that my skin did well which I am very happy about so my next peel will most likely be the same combo but with 25% TCA. I have not decided when I will do my next peel but it will be either in 1 month or in 3 months time. This certainly is a process. Also between now and my next peel, I was prescribed and instructed to use Retin A nightly.

Retin A (Tretinoin)

I was prescribed .1% Retin A which I expected and wanted but I'm left disappointed. I wish I just stuck with Epiduo because it worked well for me. Well 2 days after using Tretinoin I am stuck with red little bumps on where I used it. My checks and chin have red little bumps and one deep pimple. I also start school tomorrow so I'm pretty frustrated.

My peel went well and I was enjoying my fresh face. Now back to square one with healing and being patient. Once my skin calms down, I will reintegrate Epiduo again in order to prep my skin for my next peel. Peel #2 is end of this month.

Peel #2

I had my second peel today and I frosted very well, white and even throughout. 5 weeks in between Peel #1 and Peel #2. This time he upped the strength of the TCA to 25% along with the Jessner's. It definitely burned like a mofo. He wants to see me in a month but unfortunately due to school, I will most likely have Peel #3 in March.

7 days out (6 days post)

Taking awhile longer to peel this time I think due to the fact it was a deeper peel. I'm pretty sure I'll still be peeling while going back to school, oh well. If that's the case then I'll be less self conscious if I choose to do another peel during school. The red area by my mouth is concerning because it's pretty red and I feel like there are swollen bumps in that area. I am putting on my steroid 2x a day but did not take the prescribed prednisone the first 2 days as I did not think I needed it. I am also on an antibiotic but that is for an unrelated reason and I hope that it will not cause any issues.

Day 9

I ended up taking the oral steroid though I wish I took it sooner which I was supposed to. Took it twice as instructed. Anyway, going to school like this! Oh well this is where humor will come in handy. With that said, chemical peeling and trying to fix the texture of my skin from laser damage is really an emotional journey. Even though logically I know these peels at this strength will not erase the microholes, it is still disheartening. The good news is that this peel was upped to 25%. I hope to get to 35%, which is "only" 10% away. I also made an appointment with my local derm to make sure I am healing well. I am debating having one end of this month, which means I will be peeling again in class. I figured they will already see me this way so why not. I don't want to wait until March because it may not be as effective. Should I go for it? A test of inner strength.

Peel #3 is booked

for the end of this month! I don't mind looking scary in class :)

BTW, still peeling for peel #2...almost done and redness is dissipating. Also my local doc said I'm healing fine.

Quick Update

Micro holes on cheeks and nose look softer but still too soon to tell if it's here to stay. Still flaking but finished sheet peeling (I had to peel the rest of the dead skin off of my forehead, chin). I will be doing Peel #3 end of this month and from there we will see. If suggested, I may Peel #4 in March but I will be asking him about dermasanding and dermabrasion + TCA just so I have some more knowledge about it. I also have a consultation with another doctor in March who does chemabrasion (TCA 35% + dermabrasion).

Retin-A, we meet again!

Still not a fan as it's causing so many tiny pimples. Very annoying after a peel. I'm trying it every 3rd day before my next peel coming up because I'm tired of taking almost 2 weeks to fully peel! I don't have much time until my next peel (next week) but I thought I'd at least try to get a little Retin-A in.

On second thought...

This Retin A really peeved me off. This can't be a good reaction to the cream. Used it once after using Epiduo for a couple of days and BAM! So many red pimples all over. So frustrating. Now I feel like I have to "start over". Hopefully these pimple things do not scar and at least the peel is in a week so I can start anew. Ugh. I don't think I'll touch Retin A again. After this peel, I'm going to give my face a rest and not use anything except for my zinc sunblock and moisturizing lotion.

What Retin A Did

Here's a photo 2 days after one time use. From clear to crazy overnight. Pimples/dermatitis/whiteheads.

Peel #3

I had my third peel today and it went well. I really like my doctor because he listens to my concerns and is empathetic. I had a Jessner's + 25% TCA all over my face with the exception of my cheeks which were 30% TCA. We did a higher percentage on my cheeks because they really bother me (deeper micro holes). I think it was fair because he was concerned I could not take a higher percent of TCA. Now we will see how I heal with the 30%. He also wants me to dilute the Retin A and then try using it that way. I also learned more about dermasanding and dermabrasion. I am getting really good about being in public after a peel lol. I wasn't going to add this picture but I will anyway. This was several minutes after the peel. I swelled up a bit but I think my skin is getting used to the peels because I feel like I did not swell up as much or get as red. I took one prednisone about an 1.5 hours after the peel. I ran into an older lady earlier who had something done to her face and she just smiled at me :)

Meds

I am still taking all the same supplements and meds prescribed however I had to change my birth control before this peel to one with slightly more estrogen. Hopefully this does not affect my healing as I know it can increase chances of hyperpigmentation.

Premature Peelibg

On both sides of my jaw area. Any way to stop it? I ran water on my face under the sink faucet instead of splashing....bad idea. Didn't realize that would cause premature peeling. I think I overdid that. What I also did differently was not stop any retinol or retinoids a week prior. Now some areas are raw, red and sore on my jawline and I'm concerned. I will try to keep the areas moist with Aquaphor and steroid.

My First Mistake

Was being too relaxed about my aftercare this time around. I got a little cocky considering I had two successful peels that's far. Well that was a dumb mistake. With that said, some panic set in and now moving forward to damage control.

Sleeping on my BACK only
No more hot showers
Reducing how much I wash
Keeping cracked areas moist and with steroids
Took two oral steroids today because I was behind on it
Made an appt to see my local Derm this Wednesday.

In hindsight I should have not done all these things during my prior peels! From now on, I will take care of myself the best I can. I've also upped my Vitamin C and zinc for healing, as well as a good diet.

Peel #3 Update

So I am annoyed that I am breaking out a lot with this peel. I did change my birth control during the same time which I did not want to do in case it did cause a breakout. I have several white heads and small red pimples. My local derm said I am healing normally. I hope this acne clears up soon and that my new birth control works like my old one to help my acne.

I went to school like this!

Should've followed my gut!

Well I knew it. My new birth control broke me out in MAJOR angry red cysts that hurt! I knew I shouldn't have switched during my peel because now my skin is so angry and sore from the acne. I seemed to have healed fine besides this issue. Back to Yaz for now until I try something else. One step forward, 2 steps back. Sigh.

Still Flaking

This happened last time. After the initial sheet peeling which was completed about 2 weeks, I am now having skin still flake off. Although annoying, I guess it's good since I think it means the peel went deeper. Still dealing with the acne from changing bc and fighting it with Epiduo, which also enhances the flakiness.

Scarring?

I knew switching birth control right before a peel was a bad idea. It caused major cysts. I have now reverted back to Yaz temporarily to help fix my skin but cannot stay on it as it keeps me from sleeping. Unfortunately it looks I may have developed some unusual scarring that may have been due to the cysts and the peel. I am concerned but cannot see a Derm for another couple weeks. In case it is a scar forming, I've been usin a little steroid and ordered silicone sheeting to place over it. I will post a photo tomorrow. Besides that, am not very flakey from Epiduo. I will stop it and evaluate my skin in a week to see if I have true improvement and not from swelling, because right now despite possible new scarring, my right cheek looks better.

Looks worse in photo

My scarring looks worse in photos it seems. Where the 2 arrows are pointing I feel like these are scars caused by cysts forming during the peel. I should have waited on changing meds. So annoyed/concerned. I feel like they are different scars because I feel the induration, or it feels hypertrophic to me.

Next Peel Coming Up

My fourth peel is next week and I have been toying with the idea of cancelling due to the downtown and emotional aspects of it. However, I think I will regret cancelling and I won't; plane tickets are booked anyway. With that said, I hope we do 30% all over or at least what we did last time. Hopefully I have something good to say after.

Typos

I mean down time*. Brain fried due to finals.

Well that hurt!

I made it to my appointment today (I kept thinking about cancelling even though I had already made it to the airport!) sleep deprived and stressed. I had a very long week and knew I would not be able to hand the chemical peel like I usually do. Stress and lack of sleep (and probably close to my period) makes it harder to tolerate pain.

Anyway, like usual my doctor was kind, courteous and always on time (if not sooner!). His demeaner puts me at ease and it says I tolerate chemical peels very well. Long story short, we did the same strength as last time but this time added 30% on my nose. Jessners + TCA 25% all over with 30% TCA on my cheeks and nose. It went well and I frosted as usual (see pic). Unfortunately I had some new bad scarring from when I swapped birth control pills.

We also talked more about dermabrasion as I am starting to more seriously consider it. The reviews on here do not make it seem promising but I feel like my damage is different and I am trying to level out my skin, not try to erase my scars with it. If I choose to do it, it will be early next year when I have completed grad school.

Spring Break!

Finally on Spring break. Photo is 1 week today. Peeling well and not much to report at this time. Will definitely update at 3 months to see if there has been any overall improvement with my four peels.

Tsk! Tsk!

On an emotional standpoint, I do not recommend doing 4 consecutive peels 4-6 weeks apart. I would limit yourself to 3 peels then take at least a 3 month break. I was naughty and peeled the rest of the skin off on Day 10-11. Although I would say I was 90% healed, I still should not have touched my face at least for 2 more days. I was just tired and burnt out on my peels. I will continue using my steroid twice a day until the end of the week then just solely use zinc sunblock n my face + ingest my supplements like 1,000mg Vitamin C daily for continued healing.

Hate these laser holes

It's been about 2 months now after my last peel. Overall my tone is better but my holes are still there. I've posted close up shots so you can see them. The bridge of my nose was left in tact and that's how smooth my skin was all over my whole face before I had the laser done. I was not born with all these holes and it makes me sad! Anyway, here are some photos for my update. The peels did help even out my skin tone overall, but I look pinkish right now because I am still using Epiduo & erythema is a side effect.

Update

Tone has improved. Maybe some improvement with the holes but hard to tell right now without stopping my Epiduo, which I don't want to do this yet. It takes about 3 months for Epiduo to really work & for the skin to get used to it so I will continue using it for awhile.

At this point I am still thinking dermabrasion or a light Phenol peel; the former was the recommended procedure by my doctor but I want to get more information on a light Phenol peel before I can fully commit without any doubts.
Beverly Hills Dermatologic Surgeon

Now I see why people travel out of state for their medical & aesthetic needs--The best doctors are in California! I was very lucky to have found Dr. Hansen through RealSelf, I actually think it was fate. He is kind, caring, extremely knowledgeable, personable, and funny. The office staff and nurse are great too! I never have to wait for my appointments and he actually got me in for my peel early when I arrived before my appointment time. I can't wait for my next one!

5 out of 5 stars Overall rating
5 out of 5 stars Doctor's bedside manner
5 out of 5 stars Answered my questions
5 out of 5 stars After care follow-up
5 out of 5 stars Time spent with me
5 out of 5 stars Phone or email responsiveness
5 out of 5 stars Staff professionalism & courtesy
5 out of 5 stars Payment process
5 out of 5 stars Wait times
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Comments (212)

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I also have laser damage. You can see some photos here: http://www.realself.com/question/dermasanding-achieve-result-than-laser-resurfacing-for-deep-ice-pick-and-box
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Hi, I will never go near another laser-ever. I am thinking of getting a phenol peel. going to a doctor in NYC tomorrow for another opinion.
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Keep us updated & good luck. I was thinking about a light one myself/exoderm.
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Hmm my doctor is recommending dermabrasion over Phenol at this point for me though Phenol is still in the back on my mind.
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Lefox I had the exact same problems as you. And I must say that the holes done look so bad. Your skin tone is beautiful I love it!!!! I took your success story and just got my first peel done after laser damage. I'm crossing my fingers and hope it goes well. Hansen is such an amazing doctor I hope I get amazing results now. I was going to say I can't message you. But I hope to keep contact with you! So anxious
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kamngetit, are the holes just on your nose or on your entire face? What kind of peel did you have? Please keep us updated and good luck.
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So glad to hear!!! Congrats and keep us updated. He's awesome! I will message you, I had it temporarily disabled. All the best! Yay
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I had a jessener and light tca peel. Only holes on my jawline where I shave my beard. It's crazy because the doctor who did this to me is getting a lot of negative reviews about laser. Finally people coming out and I think a lawsuit is underway. Ill def join in on that. Don't understand these physicians negligence. And yeah please message me lefox. I'm even concerned about the crepey dead looking skin the laser did to me. Did you have that problem too?
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IMO your nose looks good. Do your holes go across your whole cheek and to your jawline, or just the sides of nose? Did ANY of the holes seem improved in your opinion?
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I think it's REALLY hard to get a good picture of the laser holes. I can't get a picture that shows them well and people are always saying it doesn't look so bad but my nose is riddled with tiny holes that you can see if you get within a foot of my face. It's horrific. I can see from lef0x's picture that she has them too. They're not as "dense" as mine, I have areas where it seems like there are more holes then intact skin. I'll let her answer the question about them getting better but I just can't stress enough that our pictures don't always show the extent of the damage . Seeing it on your face daily in natural light in the only way to appreciate it.
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Thank you Janey I couldn't have said it better.
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I have laser damage holes also. It's almost a year and I have a constantly flaring face and bad nerve pain I have to medicate. My large cheek area is the worst. My nose and sides of nose I accept as I just feel it looks natural. I have holes there also, but I guess I just accept those areas more. My holes in the cheekbone and lower jaw area make me very depressed.
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I think the fact that the large cheek area was done against my consent adds into the agony. It was malpractice and ended up leaving me with every side effect. Before pain meds I was bed bound with a burning face for 9 months. Trust me I understand the pain, what lighting does to make it look diff. So did you get a smudge if improvement? Does anyone think needling can help?
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I remember you now! I'm so sorry about your pain I remember how horrible it was. Laser holes are the worst. I'm feeling particularly bad about things lately so excuse me if I get all drama queen on everyone. We're all struggling with our own battles. Things have calmed down with my kids at the moment and now I'm just super depressed about my skin.
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I'm thinking about needling but I keep hearing nasal skin is the hardest to treat. I think I'm opposite of you my nose bothers me more than anything else and my skin is a wreck everywhere.
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I know :( I mean I'm red all day it's too hot. I ice still to get it from getting worse but I harp on it all day. Mots a very difficult issue we are left with. What really gets me is the amount if surface area a cheek is, it's 50% of my face. I feel overwhelmed by it. It doesn't really match my chin or neck or under my eye so there are all these cutoffs. I guess my main goal for now us pain and redness. Then holes but I'm worried there is no treatment and I'm so sensitive idk what I can even do. I've never heard of anyone with extreme flaring this far from laser
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I did dermarolling two days ago! I'm waiting to see what happens
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Cool did you get a full face including nose?
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Thanks for responding about that! Keep us updated. I was even thinking needling vs dermarolling so you can target areas very well. How old is your damage and what is your damage?
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I had only done middle of forehead/between eyes, tip of nose due to a bad scar ( much worse than holes) which is better now thank god and sides of nose for scars which was a small area. That's prob why pores on nose don't bother me, because I had something worse that got better so I focus on that instead. But my last treatment he went down to the jaw and across to my hairline, two palm sized areas I didn't want done. I told him to stop and he ignored me it was so traumatic and confuses and makes me livid to this day. So no lip chin or temples were done
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I only did one cheek so far the skin is smoother the redness now is fading. My next appointment is on the 27th full face for laser damage.
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Are you doing it for laser holes and complexion?
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Let us know, or better yet if you have some time to kill make a review with pictures. If I try it I will do that. I may do a review for retin a. I tend to drop things though because I'm so crazy busy. I'm sure you all are too though.
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Yea basically. I hope it helps.
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I just had my second pen needling done on the full face.That was on the 9th. Not really seeing results yet. The nurse said by the third one you should start seeing results.
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