Medium Depth Peel. Will Jessner & TCA 35% do the job?

I find that lasers work better for lines around the mouth, but if you have not seen improvement with jessners + TCA 25 try TCA 30/35.  Best, Dr. Emer.

A 25% TCA peel is generally considered a superficial peel.  Combined with Jessner's, it is a more aggressive superficial peel. If considering a medium depth peel (35% TCA plus Jessner's), you might also want to consider a series of moderate energy fractionated CO2 laser resurfacing treatments.  A peel will work well in the right hands, but the combination of ablation and thermal energy from the laser is considered the gold standard for skin resurfacing.  Only a consultation will provide the information necessary to make the right decision.

Great question.  What you are describing, otherwise known as a Monheit Peel, works great, and it does more than what your 25% TCA did.  I like that you are currently on retina A, and are using botox to help with dynamic rhytids.  Irish fair skin will do well with a Monheit, however, sometimes you may need a little more depth to really polish those rhytids.  The best way to know is to see them and unfortunately without pictures its hard to make a recommendation.  Another option is certainly a medium Hetter peel (phenol based, percentage of croton oil changes the depth over a baker gordon) or a fractionated, ablative CO2.  I suggest you go and do a consultation with someone who is comfortable with each of these as every patient is different and obviously benefits from one vs the other.  I hope some of this helps.  Best of luck.

Many patients need several peels to accomplish what they want. Everybody should be doing at least 1 medium peel a year anyway but to get to the results you want may require a few to start with. If it is the lines around the eyes that is still bothering you then do a few jessner's plus 35% TCA peels just around the eyes. Then in the end, do a full face peel to blend the results nicely. It is very common to start with a lighter medium peel and move up as your skin tolerates a stronger medium peel.

Thank you for your question ciaren. Chemical peels work well for facial rejuvenation and improvement of wrinkles. TCA works well in concentrations of 10-35%. Gary Monheit developed a technique where Jessner solution is applied immediately before 35% TCA. This allows for deeper penetration of the TCA and a more aggressive peel. While traditionally 35% TCA is used, any strength can be used, and the higher the concentration, the more aggressive the peel. It is common to start with lower strengths and then gradually go stronger on peels. Usually a series of peels provide the best results. Now with fractional laser technology such medium depth peels (as well as deep phenol peels) are being performed less frequently. Please follow up with your doctor for specific recommendations. Good luck!