What are the possible side effects with TCA peels? Risks?

A youthful skin is sought after since the down of early civilizations, fruit acids were used to smooth skin and give a vibrant look. Chemical peels remain a very popular and viable method to achieve that.

However laser skin resurfacing advanced the technology to a precise art and science for better skin and remains the gold standard for a skin free of blemishes, soft, smooth, better quality skin and even tone skin. Laser skin resurfacing require a down time ranging from one to two weeks. Non ablative laser skin resurfacing has been a great disappointment both to patient and surgeon in spite of all the hype surrounding these newer untested technologies.

TCA peels can approach the results that a carbon dioxide skin resurfacing can achieve. TCA peels are safe, predictable, and easily control the depth of the peel in experienced hands. TCA action is seen immediately upon application by the coagulation of the skin proteins, similar to the egg white, producing frosting of the skin as the skin protein is coagulated and the peel gets deeper. The color and intensity of the frosting of the skin serve as an indicator of the depth of the peel and end point of the chemical peel depth desired, which correlate directly to healing time (down time0 and the clinical result.

Chemical peeling is an art and a science. Each patient presents with individualized set of circumstances and skin type and condition. Skin hydration, oily skin, thickness, sun damage and the acid concentration can all affect the penetration of the acid into the lower layers of the skin, the dermis. Therefore each patient may require a different treatment.

Pigmented and oriental skin always present a challenge in skin resurfacing and chemical peels. Such ethnic skin must be very well prepaired before a chemical peel is contemplated. TCA peels in such skin should be done by experienced physicians.

Almost all adults present with sun damaged skin, discoloration problems, wrinkles and dull aged looking skin. All these problems can benefit from TCA peels. The skin is prepared prior to the TCA peel with a medical grade skin care program to rid the skin of the dead layer of the skin and stabilize the pigment bearing layer of the skin to prevent hyper or hypo pigmentation of the skin and uneven peels. TCA peels can range from a 15% peel which has no down time and minimal flaking of the skin. Make up is applied by the next day to camouflage the flaking of the skin. Such peel is considered a superficial peel. The results are also modest; however multiple peels have a cumulative effect on the skin. The more layering of the acid the deeper the acid will penetrate the deeper layers of the skin. 15% TCA concentration applied in three or four layers can go deep and be equivalent to a deep peel or a 50% TCA peel, which require a 4-5 days to completely peel the skin. This peel depth would improve on the skin smoothness and pigmentation as well as improve fine wrinkles.

30% TCA concentration can be a deep peel, depending on how many layers are applied, require a week of down time. This peel is an intermediate depth peel, and

its depth is down to the upper dermis of the skin. Clinical improvement of pigmentation can be impressive at this level of peel, and fine-to-moderate skin lines can be improved. Treating the patient at 90-day intervals can make more impressive clinical results with deeper wrinkles or acne scars. I refer to a peel at this treatment level as a medium-depth chemical peel.

All patients undergoing chemical peels, except very superficial peels, require a skin care program to prepare the skin for the peel and prevent pigmentation problems and depth of peel problems.

Post peel care is very simple, application of moisturizers or Aquaphor is continued till the peeling is complete. Washing the face with a mild cleanser frequently, using the fingers very gently, and avoiding pulling on the peeling skin. Peeling begins about the third day and continues to the seventh day. This type of peel is a medium depth peel.

Superficial peels can be used on the neck and chest areas with extreme care because of the potential of scaring.

Medium peels require treatment with antiviral medication till healing is complete. Avoid direct sun exposure, use high SPF sunscreen.

TCA peels remain far superior to non-ablative lasers and lights that are hyped by the media and the industry.