35% TCA peel 2 days by a dermatologist. Melasma looks to be even darker is this permanent or how it is supposed to look?(photos)

Question

I had a 35% TCA peel 2 days ago performed by a cosmetic dermatologist. I had melasma pretty dark a few years back but with Obagi products and 1% retin a I was able to almost get rid of it. Now it looks to be back!! Is this Normal for 2 days out or is my melasma back and I will have to start from scratch? I am using Vaseline still however when I was my fave the dark spots are very tight and rough

Jason Emer, MD · Answer

I recommend getting a formal evaluation with a cosmetic dermatologist for after care and treatment for Melasma. Melasma needs a combination approach to get the best improvement and will need a series of treatments. In our practice, we combine Clear + brilliant, peels, microneedling/PRP, aerolase, Cosmelan, and sometimes erbium laser (coollaser) to get the best results. Melasma will need life-long maintenance. Best, Dr. Emer

Sapna A. Patel, MD · Answer

The brown/ darker areas on your forehead look like its just the skin that will slough/ peel off. Typically for 35% TCA peels on the face, it can take 5-7 days for the skin to peel/ slough off. Thinner skin ie. lower eyelids may peel faster than areas with thicker skin. We typically have patients use a dermal wound cleanser or diluted vinegar soaks which provides antibacterial properties and allows the skin peeling to happen in a gentle manner with a lower risk of scarring. Definitely, do not peel the skin off on your own and avoid scratching the area as this can increase the likelihood of scarring. Also, make sure to apply antibiotic ointment or vaseline to all areas treated to help speed up the healing time.

Lisa Jenks, MD · Answer

Most likely, what you are seeing is normal after the TCA peel.  Most people do have quite a bit of redness, darkened areas and peeling for about 7 - 14 days.  Be sure that you are following the post-peel protocol as far as products go that your dermatologist recommended.

Davin Lim, MBBS, FACD - Account Suspended · Answer

Yes, I use to do TCA peels over a decade ago for melasma, and this can be a fantastic method, but rebound is high. Having said that your dermatologist will have their own skin care protocol to help you heal and reduce rebound. Its normal for 2 days out, if in doubt, a quick visit will help alleviate your fears. 
Melasma can not be completely cured, however effective treatment are possible. This is because your skin is extremely sensitive to UV and even the smallest amount can stimulate your pigment cells to produce colour. The mainstay of treatment is strict UV protection- hats, sunglasses and SPF every 4 hours. 
  
I prefer to use a combination of creams and laser for melasma. Hydroquinone can be used (5-8%), along with vitamin A creams. I usually start my patients on laser (low dose Q switch or Picosure) a few weeks after they commence on creams. Another laser I use is the Clear and Brilliant in the Permea setting combined with creams. 
  
In some cases I combine glycolic AHA peels, and in other cases I use a tablet called Tranexamic acid to help. Melasma treatments should be tailored to each patient. 
  
All the best, Dr Davin Lim. Laser, surgical and aesthetic dermatologist. Brisbane, Australia

35% TCA peel 2 days by a dermatologist. Melasma looks to be even darker is this permanent or how it is supposed to look?(photos)

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