Tca Peel and Anesthesia

What is the strongest % TCA peel that can be used on the face without the use of anesthesia or pain pills.

Doctor Answers 4

TCA peels and anesthesia

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I once heard a patient screaming in pain - as a nurse applied 15% TCA peel to her face.

I consider it unethical to do a 15% or higher TCA peel without having available: 

  • local injections to block nerves. Topical anesthesia is fine but doses can get high.
  • sedation by mouth
  • Not everyone wants this - I don't require it.I do require blood pressure monitoring - if pain sends blood pressure too high, the peel must be stopped.  
  • Doing layers of weak TCA is more painful than one layer of a higher concentration. 

Hope this helps.

TCA peels and pain management

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I would suggest that any TCA peel of 35% of greater needs some time of anesthesia. Generally I perform 35% TCA peels with immediate topical lidocaine. Everyone is different and if pain is a concern, consider having the peel performed with an intravenous anesthesia, though I have never had this be a concern.

D.J. Verret, MD
Dallas Facial Plastic Surgeon

There is no need for anesthesia or pain meds with any TCA Peels.

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I've done thousands of TCA peels and have never needed anesthesia nor pain meds for TCA peels at all.  What you will need is prednisone pills to take down the redness and swelling and you will need a good cortisone lotion, sunscreen, gentle cleanser and good followups with your doc and well as retin A or bleaching cream afterwards.  Sincerely,

David Hansen,MD

David Hansen, MD
Beverly Hills Dermatologic Surgeon
4.7 out of 5 stars 46 reviews

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TCA peels and pain management

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TCA comes in many different strengths.  When you get to 35% or higher then pain is going to need to be managed,  That being said, I have some patients who need no anesthesia when I perform a 35% TCA peel but they are rare. In general, 4 nerve block injections do well to minimize much of the discomfort.  The peel is short lived and after pain control is not needed. Be sure you have an experienced dermatologist performing your chemical peels with TCA as they can scar if done inproperly.

Shawn Allen, MD
Boulder Dermatologist

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.