To help with pigmentation issues, dull skin, and fine lines, I'm considering having either a series of 3 to 4 7% TCA + 2% salicylic peels, or just a single TCA peel at a higher strength (25% to 35%). What would you recommend? What are the advantages and disadvantages of a series of low-strength peels vs. one higher strength peel?
One High-strength Chemical Peel Vs. Several Low-strength Peels
Doctor Answers 10
For dark skin, several lighter peels do better for discolorations than 1 medium peel
For light skinned patients, the 1 medium TCA peel with only 1 week downtime is great for wrinkles and discolorations. For darker complexed patients, 4-6 light peels at 2 week intervals with no downtime do well since a medium peel can cause a lot of irritation which may hyperpigment with sun exposure and make discolorations worse. Always use a cortisone lotion for the first 1-2 weeks after any peel and sun screens and bleaching creams to prevent discoloration later.
Yes, several lower strength peels and be useful if you do not want to undergo a higher strength peel. It is really up to you whether you want to undergo one long recovery (1 week or so for the higher strength peel) or several shorter recovery (1 day or so for the light peels). Cost may also be a factor since one peel may end up being less expensive then several lower strength peels. Good luck.
High Strength Chemical Peel vs Several Low-Strength Peels
For those people who have significant sun damage with many areas of hyperpigmentation and telangiectasia (red spots) in association with multiple wrinkles (deep and moderate lines), I recommend CO2 laser resurfacing or a good deep chemical peel with a phenol solution. These are the gold standard treatments for these conditions.
TCA at 25 to 35% will not appreciably help. Stronger TCA may help but there is a risk of scarring at the higher concentrations. For mild etchings of the skin in association with a dull and coarse complexion and mild pigment issues, I recommend an ongoing treatment with a good glycolic acid program consisting of monthly or bi-monthly chemical peels combined with the use of home glycolic preparations two or even three times per day. The glycolic acid
should be unbuffered with a low pH and a concentration of 50% (or 75% ) for the peels and 10% for home use.
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Light peel vs deeper peel
Without evaluating you specifically, light peels can be performed to give a gradual appearance with almost no downtime. However, it may not give you the results you want. A deeper peel may be better and get the results that you want sooner.
Very light peels vs. light peels
Unfortunately, several small steps do not equal one big step when it comes to chemical peeling. Below are the advantages and disadvantages to the options you're considering:
Very light peels - The 7% TCA/Sal acid combo is a very light peel. It will help some with discoloration and skin texture if you have a series of them over several months. Your downtime will be less, but so will the benefit. Also, they will not help with fine lines... the peel is just not strong enough to reach the deeper layers necessary for improvement in fine lines.
Light peels - 25-35% TCA by itself (not combined with Jessners peel). You will peel more with this one and get greater benefit in discoloration and texture, but also have more downtime. This one will not help with fine lines either.
Medium depth peel - Jessners plus 25 - 35% TCA. This peel will help sun damage, discoloration, and even fine lines and wrinkles. You will peel dramatically, however, with 7-10 days of peeling followed by 2-3 weeks (and sometimes longer) of redness.... but will get the greatest benefit.
Peels effects are cumulative
The effect of peels is cumulative. Several peels will build and remodel collagen and elastic fibers in the skin as a deep peel.
7% TCA is too week
TCA to be of any effect use 15% one or two layers.
or 35% three layers for deeper peel. Remember if you want to maintain the results then you should continue with the peels, less frequent. and a medical grade skin care product should be started before the peels and continue after the peels
Stronger peels for lighter skin more effective
I have had great success treating patients with a single medium depth peel (Jessner's combined with TCA 20-35%) in the appropriate patients. These patients are fair skinned, do not tan, and don't mind a week of downtime with scaly, darkened, peeling skin.
For darker skinned patients and those that want a shorter 3-4 day recovery, lighter peels are effective but require more treatments. Either way, these peels are excellent for uneven pigmentation, texture, and fine lines. In the right patients peels can be a less expensive than laser procedures and with similar results.
There is no free lunch in chemical peeling
Several weaker peels does not equal one stronger peels. The mild peel that you are describing is very mild. It will modestly freshen the skin. It is associated with almost no downtime. However, the results simply will never equal the effect of a TCA 25%. Two 25% TCA peels will never equal the effect of a single 35% TCA peel.
Gradual vs. downtime
If you can do the 7+ days of downtime, one 35% TCA peel will give you dramatic results for discoloration in just one treatment. The advantage of a less aggressive series is NO DOWNTIME. But, the price is the results will take months. Both are reasonable options. Good luck.
One high-strength chemical peel vs. several low-strength peels
First of all, 25 to 30% TCA is a medium peel not a high strength peel. I would always start with a stronger peeling to get the initial result than use lighter peels as a follow up.
From MIAMI Dr. B
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