TCA Peel

What it is: A TCA Peel is a type of Chemical Peel used as a skin resurfacing technique. Trichloroacetic Acid (TCA) solution is applied to the face to remove the outer surface layers of skin. A TCA Peel allows new, healthier skin to emerge.

  • TCA (trichloroacetic acid) peels are medium-skin-depth treatments
  • TCA Chemical Peels help with sun damage, facial wrinkles, uneven skin tone, and pigment abnormalities
  • The concentration of the peel varies according to need, and downtime can last up to 1 week

 

Inside this Guide   Content provided by the American Society for Aesthetic Plastic Surgery, ASAPS
1. Types of Chemical Peels   7. After TCA Peel
2. How is TCA Peel Performed?   8. Recovery
3. Who should consider TCA Peel?   9. Results: what to expect
4. Doctor Consultation: what to ask   10. Side Effects
5. Getting ready for TCA Peel   11. Cost
6. During TCA Peel    12. Terminology to know

 

Types of Chemical Peels

Chemical Peel solution is applied to the face

A TCA Peel is a light-to-medium strength peel. There are different types of chemical peels which vary according to their specific ingredients and their strength. The depth of their peeling action may also be determined by factors such as how long they remain on the skin and whether they are applied lightly or rubbed more vigorously onto the skin.

Light-to-Medium Strength Peels

Alpha-Hydroxy Acid (AHA) Peels: Generally, the most superficial peels are those using alpha hydroxy acids (AHAs) such as glycolic acid. Sometimes just a single treatment with an AHA peel will give your skin a fresher, healthier appearance and a radiant glow. Repeated treatments can help to further improve the texture of your skin. AHA peels can reduce the effects of aging and sun damage including fine wrinkling and brown spots. Your surgeon will recommend a maintenance program using AHA products that you can apply at home on a regular basis.

An AHA peel is performed in your plastic surgeon's office. No anesthesia or sedation is needed, and you will only feel a tingling or mild stinging sensation when the solution is applied to your face. Immediately after the procedure, you generally will be able to wear makeup, and you can drive yourself home or back to work.

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.

Deep (Phenol) Peel

A phenol peel is sometimes recommended for treating particularly rough and sun-damaged facial skin. Phenol is effective in reducing the appearance of wrinkles ranging from fine lines to deeper creases. It can correct pigmentary problems including blotchiness or age-related brown spots and may be used in the treatment of precancerous skin conditions.

Phenol is particularly useful for minimizing the vertical lines that often form around the mouth as a result of aging. The disadvantage of phenol for spot peeling of limited areas is that it often has a significant bleaching effect. After your skin has been treated with phenol, you may need to wear makeup in order for the treated portions of your skin to more closely match the skin color of the surrounding areas. Unlike TCA peels, phenol cannot be used on your neck or other parts of your body. Certain variations in the phenol peel formula, creating a "buffered" or milder solution, may allow for greater flexibility in its use.

How is 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 TCA Peel?

Any of the following conditions may indicate that you might be a good candidate for a TCA Peel.Glycolic Acid Peel can help treat many signs of aging
  • 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.

TCA Peel Experience

In addition to your surgeon performing a history and physical examination, your doctor consultation is the time to ask questions.

Additionally, your doctor will evaluate the condition of your skin, discuss your treatment expectations, and review your medical history.

Skin Evaluation: Your plastic surgeon 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 plastic surgeon 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 AccutaneT, as well as Retin-AT and other topical skin preparations, must be reported to your surgeon. For your safety, it is important that you provide complete information.

Getting ready for TCA Peel

Your doctor may place you on a pretreatment 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 doctor will provide you with additional instructions.

Your skin resurfacing treatment may be performed in your doctor's office, a free-standing ambulatory facility or a hospital. You should arrange for someone to drive you home after the procedure and probably assist you for a day or two.

During 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.

Recovery from TCA Peel

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 plastic surgeon, 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 plastic surgeon'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 doctor, or with a staff member in your surgeon's office. Skin resurfacing procedures are generally safe when performed by an experienced board-certified plastic surgeon.

Potential risks include:
  • infection
  • 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 plastic surgeon.

TCA Peel cost

TCA Peel cost can vary widely as reflected in the TCA Peel cost data posted on RealSelf.com. A doctor's cost for TCA Peel may vary based on his or her experience, the type of procedure used, as well as geographic office location.

Costs may include:
  • Surgeon’s professional fee
  • Facility fee
  • Anesthesia fee
  • Medications
  • Surgical garments
  • Medical tests

Insurance: Skin resurfacing procedures usually are not covered by insurance. Occasionally, however, if the resurfacing is being performed to treat precancerous skin conditions or improve certain types of scars, insurance coverage may be available. Your plastic surgeon or a member of the staff will explain how you can find out from your insurance company if a particular procedure will be covered. 

Terminology to know

  • Alpha-Hydroxy Acid: Alpha hydroxy acids are derived from foods, such as fruits and milk, and can improve the texture of skin by removing layers of dead cells and encouraging cell regeneration. Glycolic Acid is an Alpha-Hydroxy Acid.
  • Buffered Phenol: Buffered phenol offers yet another option for severely sun-damaged skin. One such formula uses olive oil, among other ingredients, to diminish the strength of the phenol solution. Another slightly milder formula uses glycerin. Buffered phenol peels may be more comfortable for patients, and the skin heals faster than with a standard phenol peel.
  • Chemical Peel: A chemical peel solution is applied to the entire face or to specific areas to peel away the skin's top layers. Several light to medium-depth peels can often achieve similar results to one deeper peel treatment, with less risk and shorter recovery time. Peel solutions may contain alpha hydroxy acids, tricholoracetic acid (TCA) or phenol as the peeling agent, depending on the depth of peel desired and on other patient selection factors.
  • Intravenous sedation: Sedatives administered by injection into a vein to help you relax.
  • Local anesthesia: A drug injected directly to the site of an incision during an operation to relieve pain.
  • Phenol: The chemical phenol is sometimes used for full-face peeling when sun damage or wrinkling is severe. It can also be used to treat limited areas of the face, such as deep wrinkles around the mouth, but it may permanently bleach the skin, leaving a line of demarcation between the treated and untreated areas that must be covered with makeup.
  • TCA: Trichloroacetic acid is used for peeling of the face, neck, hands and other exposed areas of the body. It has less bleaching effect than phenol, and is excellent for "spot" peeling of specific areas. It can be used for deep, medium or light peeling, depending on the concentration and method of application.
Source: American Society for Aesthetic Plastic Surgery & RealSelf.com