What % TCA peel is recommended for a 65 year old woman (Korean) who wants brightening, tightening, and resurfacing?

Question

I'm 65, Korean, and have mature skin. I don't have lots of wrinkles. I am looking for the right TCA % peel for brightening, resurfacing, and tightening. I had melasma in my 40s and 50s. At 65, I still have some sun damage and hyperpigmentation that I want to get rid of with a more aggressive peel. I have used 10% salicytic acid, 25%, 20%, and 30% glycolic acid in the past with some okay results. What TCA % should I use? 20% 25% 30%?

Raffy Karamanoukian, MD, FACS · Answer

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Nelson Lee Novick, MD · Answer

Particular care must be taken when using peels for any reason in Asian skin and others with skin of color. In general, high concentrations of glycolic acid 70% and salicylic acid 35%, Jessner's Solution and low concentrations of TCA (jn the range of 10-25%) are considered generally safe for individuals with skin of color. A series of in-office, professionally performed peels is typically required to achieve optimal improvements accompanied by at-home prescription-strength topicals--brightening agents when treating hyperpigmentary problems and retinoids for fine lines and wrinkles and pigmentation. Make sure that you consult with a board certified aesthetic dermatologist and ask to see his/her personal before and after photos. Best of luck.

Johnson C. Lee, MD · Answer

TCA peel strength will vary depending on the area. Areas such as the neck and eyes will be a lower percentage than the face. Asian skin tends to hold more pigment so there may be a risk of hyperpigmentation (more brown areas) if the peel is too strong. For these patients, I start them on a 2-3 week course of topical medications to reduce the risk before performing the peel. Hope this helps!Johnson C. Lee, MDBoard-Certified Plastic Surgeon

What % TCA peel is recommended for a 65 year old woman (Korean) who wants brightening, tightening, and resurfacing?

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What % TCA peel is recommended for a 65 year old woman (Korean) who wants brightening, tightening, and resurfacing?

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