Question 1

What is a TCA peel?

Accepted Answer

TCA peels are one of the most popular types of chemical peel performed in-office by dermatologists. These FDA-approved, noninvasive treatments use trichloroacetic acid (TCA) to remove the damaged top layer of skin, which is replaced over the next week with new skin cells, creating a smoother, brighter, more evenly toned, and younger-looking complexion.

Usually, TCA face peels are applied in light- to medium-strength concentrations. If your physician recommends a deeper peel, that can be done in one session or as a series of milder peels, for cumulative results, which decreases both risks and recovery time. TCA can also be used as an intensive spot treatment.

TCA chemical peels can treat hyperpigmentation, discoloration, uneven texture, freckles, acne scars, or other skin blemishes. It's also especially good for treating small areas of sun damage.

RealSelf Tip: TCA is used in a treatment for atrophic acne scars called TCA CROSS (chemical reconstruction of skin scars). The procedure involves applying high concentrations (up to 100%) of TCA into the scar, triggering a healing response that forms new collagen fibers. This can reduce scar depth and make them less noticeable, but it's usually not enough to fully treat them. See the top treatments for acne scars.

Question 2

What are the pros and cons of a TCA peel?

Accepted Answer

Pros

TCA skin peels can treat a variety of skin conditions, including fine lines and wrinkles, blotchiness, age spots, scars, and even some precancerous lesions.
This versatile acid can be effective on its own, at a high concentration, or layered with other acids, at a lower strength.
TCA’s effect on the skin is relatively easy to predict. “It’s very well tolerated, even at higher levels of concentration,” says New York City–based dermatologic surgeon Dr. Ronald Shelton.
It can work well for small areas or spot treatments, especially around the mouth and eyes.
It’s among the safest chemical peel treatment for all skin types, including people with olive or brown skin. However, New York City dermatologist Dr. Michele Green notes that patients with olive or deep skin tones must be wary of high percentages of TCA, which can create a risk of post-treatment hypopigmentation.
Compared to lasers that treat the same issues, TCA peels are extremely cost-effective.
The effects can be substantial, even though there’s not a lot of downtime afterward.

Cons

Redness, weeping, flaking, and irritation are common after TCA face peels. The degree largely depends on the depth of the chemical peel. “Typically, the stronger the peel, the longer it will take to recover from the procedure,” says Dr. Green.
TCA acid peels can reactivate cold sores. This doesn’t mean you can’t have the peel, just that you’ll need to take preventive medication prescribed by your doctor.
There’s a risk of scarring, if the concentration of TCA is too high. Be sure to consult with a physician who has experience with multiple chemical peels and with a range of skin tones and types.
While most RealSelf members say their TCA peel treatment was Worth It, a significant percentage had a negative experience, with concerns ranging from a lack of results to burns, patches of hypopigmentation, breakouts, and wrinkles they didn't have before. These risks increase in inexperienced hands, so find a board-certified dermatologist with glowing patient reviews for this procedure.

Related: Which Type of Chemical Peel Is Right for You?

Question 3

How much does a TCA peel cost?

Accepted Answer

Costs can vary widely, depending on your provider’s level of experience, their practice location, the size of the area you’re having treated, the strength of your peel, and whether you have a series of treatments.

Because this is a cosmetic treatment, it isn't covered by insurance.

See our complete guide to TCA peel costs

Question 4

TCA peel before and after pictures

Accepted Answer

The TCA peel photos in our gallery have been shared by the provider who performed the procedure, with the patient's consent.

Question 5

Who is a good candidate for a TCA peel?

Accepted Answer

Light to medium TCA peels are best for people looking for anti-aging skin benefits and skin rejuvenation, treating concerns like sun damage and fine lines. They're generally safe for all skin tones.

Related: 3 Pro-Strength Chemical Peels for Every Hyperpigmentation Problem

Dr. Green cautions that people with brown or deep skin tones (V or VI on the Fitzpatrick scale) aren't ideal candidates for strong TCA peels due to the risk of hypopigmentation. “Having a strong TCA peel on one area of the face can cause a lightening effect on that treated area, creating a ‘mismatch’ of skin color. I’ve seen this happen when patients have a strong TCA peel for lip lines and are left with a lightening effect around the mouth.”

You might be a good candidate if you:

Aren’t pregnant or breastfeeding
Don’t have a history of keloids (a type of raised scar)
Haven’t taken Accutane (isotretinoin) within the past year
Can avoid sun for at least two weeks post-treatment

Question 6

How does a TCA peel treatment work?

Accepted Answer

Prior to your peel, you’ll be asked to stop using prescription retinoids, as well as over-the-counter retinols and any products that contain alpha hydroxy acids, like glycolic acid; beta hydroxy acids, like salicylic acid; or benzoyl peroxide.

You’ll also want to avoid exfoliating treatments like shaving, waxing, electrolysis, depilatory creams, and laser hair removal for a week pre-peel. These skin-care products and treatments can compromise the skin and cause a poor reaction to the peel, such as burning or irritation, says Dr. Shelton.

When you arrive for your treatment, your skin will be thoroughly cleansed to remove oil, makeup, and dirt. This promotes even penetration of the peel solution and improves its effectiveness.

Your provider may also apply emollients, such as Aquaphor or Vaseline, to the corners of the lips and eyelids, to minimize the possibility of having the solution leak into your mouth and eyes.

Then they’ll apply the peel with cotton-tip applicators, small makeup pads, or even paintbrushes. “The applicator used is important, in terms of pressure and texture, since this can affect the depth of the peel’s result,” says Dr. Shelton.

Application takes about a minute, and the peel sits on the skin for the amount of time your provider deems appropriate to address your concerns. Your skin may show temporary frosting (when the peel changes from clear to white during treatment) before your provider applies a neutralizer.

The peel is uncomfortable—a stinging or burning sensation is common—but pain relief usually isn’t necessary. A fan may be used to blow cool air onto your skin.

The TCA self-neutralizes in five minutes, but your provider may apply a neutralizing solution to fully stop its effects. Afterward, your skin is gently cleansed again.

There are, of course, exceptions to this process. TCA may be combined with other acids, to take the peel to the next level. “While a 35% TCA peel is considered a superficial peel, prepping the skin with another type of peel beforehand will take the peel into medium-strength territory,” says Dr. Shelton. This also provides a more uniform and controlled depth of peeling while improving safety.

Question 7

How long does a TCA peel take to heal?

Accepted Answer

Recovery time depends on the concentration of TCA your provider uses and the unique characteristics of your skin.

Light peels: You’ll have a day or two of downtime.
Deep peels: You may want to take several days or even a week off work, to give your skin time for the peeling to finish and healing to begin.

“Depending on the type and strength of peel, a patient should expect to have redness, swelling, crusting, and peeling. We do a lot of aggressive TCA peels (35–50%), and the patients have about one to two weeks of redness, swelling, crusting, and peeling, followed by several weeks of redness,” says Dr. Channing Barnett, a dermatologist in Boca Raton, Florida.

Your doctor will send you home with specific aftercare instructions, which will probably include using an antibiotic, to prevent infection, and an anti-itch cream.

Dr. Shelton suggests using gentle cleansers and incorporating moisturizers and sunscreen with SPF 50 or higher into your aftercare routine. Avoiding sun exposure for at least two weeks afterward will help protect your fresh skin post-peel. “While the first two weeks are critical,” notes Dr. Green, “if you go back in the sun, you will be more susceptible to sun spots and hyperpigmentation in the future.”

Since heat and sweat can induce inflammation, avoiding strenuous exercise is also recommended.

Give yourself enough time to heal before an important event. That’s the advice of RealSelf member LaFemmeDeLaLune, who had a 30% TCA peel. “I didn't start peeling until the fourth day after the peel and then continued to peel until the 12th day. From what I've seen on this site, that’s a bit longer than most. But if you are thinking of getting a peel, make sure that you aren't planning to attend a special event or getting photos done for a week or two after the peel.”

Allow peeling skin to slough off naturally. Picking or peeling off flaking skin can lead to uneven pigmentation and scarring.

Question 8

When will you see results, and how long will they last?

Accepted Answer

Many people notice a difference in skin texture and tone right after their post-peel symptoms fade, but your skin will continue to improve for 30 to 60 days. It may take even longer before you see your final desired results.

Results can last anywhere from several months to a few years, depending on the depth of your peel and how well you take care of your skin, including daily sunscreen use.

Follow-up treatments can improve and extend TCA peel benefits. If you don’t want the recovery time of a stronger TCA peel, Dr. Green suggests scheduling a few lighter peels every two to four weeks. “They will have a cumulative effect and improve your skin tone and texture,” she says. After you achieve the results you want, an annual follow-up peel can help maintain them.

See TCA peel before and after photos

Question 9

What are the risks and potential side effects of a TCA peel?

Accepted Answer

While it has a lower chance of side effects than other peels, TCAs can have an irreversible lightening effect. “The risk of hypopigmentation with Asian, Hispanic, and African American patients is important to understand and consider when choosing the strength of TCA,” says Dr. Green.

Peels can also be harmful to the eyes, which is why wearing protective eyewear during the peel is often suggested. Rarely, scarring can also occur following a TCA peel, along with increased hyperpigmentation—especially with patients with olive or brown skin.

If a patient has suffered from cold sores (HSV-1) in the past, there’s a risk of reactivation. “I won’t perform a peel if a patient is showing initial symptoms of sores. If someone does get frequent cold sores, we recommend antivirals, like Valtrex, to prevent an outbreak,” says Dr. Shelton. Be sure to ask your doctor to provide medication, to reduce the risk of a breakout.

Some RealSelf members have also been left with more wrinkles than they had prior to their peel. During your consultation, talk with your provider about how you (and they) can help mitigate all of these potential risks.

Question 10

Is a TCA peel worth it?

Accepted Answer

Not always. While many people have favorable outcomes from TCA peels, the treatment only has a type: embedded-entry-inline id: Ks6V6ARYAktTMUTOEu3el Worth It Rating from RealSelf members. Those who felt that it was Not Worth It cited no visible results or side effects like hypopigmentation or wrinkles.

As with any in-office procedure, it's essential to see an experienced provider to ensure the best results possible. It's also vital to discuss your skin concerns and aesthetic goals with your provider in order to determine if a TCA peel is the best option for you.

Question 11

Are at-home TCA peels safe?

Accepted Answer

Providers on RealSelf strongly advise against at-home peels containing trichloroacetic acid because of serious safety risks.

“I do not recommend home TCA peels because of the risks involved,” says Dr. Mark Taylor, a Salt Lake City, Utah, dermatologic surgeon. “TCA is a powerful chemical with many potential hazards to an inexperienced person. If you get the product in your eyes, it could cause severe damage. If you do the peel wrong, you could end up with permanent pigment damage and even scarring.”

If you’re looking for an at-home alternative, talk to your dermatologist about a low concentration glycolic acid, lactic acid, or salicylic acid facial peel.

Question 12

What are the alternatives to a TCA peel?

Accepted Answer

Many chemical peels are available, from superficial glycolic acid peels to deep phenol-based peels.

For a chemical-free option, laser resurfacing and microdermabrasion can be effective.

Laser resurfacing also heats up the lower layers of the skin, causing microdamage and triggering the body’s collagen production, to help retexturize skin and improve crow’s-feet, acne scars, dark spots, and sagging.
Microdermabrasion uses an abrasive applicator for physical exfoliation that sands away skin cells to smooth fine lines, improve the appearance of brown spots, and minimize acne scarring and melasma.

Related: Chemical Peel vs. Laser: Which Treatment Is Right for You?

Question 13

Sources & studies

Accepted Answer

Al-Waiz, MM, and AI Al-Sharqi. “Medium-Depth Chemical Peels in the Treatment of Acne Scars in Dark-Skinned Individuals.” United States Environmental Protection Agency, Environmental Protection Agency, 2002.

“Cosmetic (Aesthetic) Surgery National Data Bank Statistics.” The American Society for Aesthetic Plastic Surgery, 2018.

Nikalji, Nanma, et al. “Complications of Medium Depth and Deep Chemical Peels.” Journal of Cutaneous and Aesthetic Surgery, Medknow Publications & Media Pvt Ltd, Oct. 2012.

Soleymani, Teo, et al. “A Practical Approach to Chemical Peels: A Review of Fundamentals and Step-by-Step Algorithmic Protocol for Treatment.” The Journal of Clinical and Aesthetic Dermatology, Matrix Medical Communications, Aug. 2018.

TCA PEEL

Michele S. Green, MD

Julie Ricevuto

Michele S. Green, MD

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Michele S. Green, MD

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TCA PEEL REVIEWS

My Experience: TCA 35% for Acne Scarring - Age 23

Skin is no longer flaky, scarring is much better & redness almost gone

Mild TCA Peel at Home Peel on Face

TCA PEEL QUESTIONS

TCA cross at derm made my scars much worse - how can this be improved? (Photos)

How bad is my acne scaring and what would be the best procedure to get rid of it? (Photo)

Acne scar from an old pimple - what could help this? (Photos)

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