TCA Vs. Laser for Sun Damaged Skin?

I want to even out the tone of my skin--I have a lot of sun damage and precancerous lesions. Not considering downtime or cost, would you recommened one over the other?

Doctor Answers 6

Either one would be an excellent choice.

Thanks for your very good question.

This is a question that gets posed quite a bit, and the answer is always a good one. Both TCA and IPL are excellent choices for reversing signs of sun damage and evening out skin tone. The combination of the two will give even better results. I will explain:

TCA is an optimal choice for patients with lentigos or mottled hyperpigmentation due to chronic sun exposure. It will work extremely well in renewing the skin and delivering a porcelain white, fresh, new appearance that patients generally love. The downtime is considerable, and the pain with the peel can be quite uncomfortable, although only for a couple minutes. It will not do anything for vessels, so if there is a reddish hue underlying the photodamage, that may remain. A TCA should be redone every 3-4 months for continuing optimal benefit.

IPL will target both redness and hyperpigmenation and is an excellent choice to even out the skin. It will take multiple treatments with very minimal downtime. The results can be augmented by doing a TCA to improve texture and acheive an even greater reduction in hyperpigmentation.

To specifically answer your question, you can't go wrong with either. But, if redness is a predominant feature of your sundamage, do the IPL and follow later with a TCA. If the dark spots are the primary concern, you can do either first, but a TCA should give you immediate results that, if done right, you should love.

Good luck!

Beverly Hills Dermatologist
5.0 out of 5 stars 1 review

Tca peel vs laser

I believe that you can get a lot more accuracy of depth of treatment with the laser. with sun damage and wrinkles, a deeper treatment is necessary, and lasers are more accurate.

Rick Rosen, MD
Norwalk Plastic Surgeon
5.0 out of 5 stars 22 reviews

TCA vs. laser for sun damaged skin would depend on the individual

Of course, this choice between TCA and laser would have to be individualized to specifically suit your skin type and skin issues. Generally, a TCA peel is often considered adequate to improve skin tone and address uneven pigmentation or even actinic keratoses (precancerous, sun-damaged skin). Patients are very pleased with the results of this much simpler treatment which generally has a quicker recovery time than laser resurfacing. On the other hand, the more significant the sun damage and the more aggressive the treatment goals, the greater would be my tendency to lean towards laser resurfacing as the more appropriate treatment.

Michael R. Macdonald, MD
Bay Area Facial Plastic Surgeon
4.6 out of 5 stars 18 reviews

TCA vs. laser for sun-damaged skin

For sun-damaged skin and pre-cancers, you have several options. One of the best treatments for this is application of aminolevulinic acid (ALA), a chemical sensitizing agent followed by activation of this chemical with blue light, red light or intense pulsed light (IPL). Two treatments with a 1 month interval between treatments can give you considerable improvement. TCA peels can also work, but the more effective medium-depth peel has a few more days of recovery time than the ALA-activation treatment. TCA peels on the other hand can also produce a bit of skin tightening and improvement in fine wrinkles. For your concerns, I would probably recommend the ALA treatment.

Bryan K. Chen, MD
San Diego Dermatologist
5.0 out of 5 stars 5 reviews

Both great for discoloration from the sun

While TCA peeling and numerous lasers improve the discoloration from sun damage, only ablative treatments that are more aggressive like fractional CO2, dermabrasion, and fully ablative laser treatments help eliminate pre-cancers. These mean downtime of at least 7 days.

IPL, which is a non-laser pulsed light treatment, is usually the gold standard for red and brown blotches from sun damage but not for skin cancers It has no downtime but requires 3-6 sessions. Pearl or other mid-range infrared lasers have about 5 days of downtime, but really help get rid of brown spots with just one treatment. Fractional non-ablative erbium-YAG laser devices require multiple treatments for discoloration and skin texture improvement, but also require at least 3 sessions. Your dermatologist can discuss these options, as well as the use of Aldara, Tazorac, sunscreen use, and the importance of regular skin cancer checks to watch for skin cancers.

Mary P. Lupo, MD
New Orleans Dermatologist
5.0 out of 5 stars 18 reviews

Photodynamic Therapy with IPL is the most effective sun damage treatment

TCA peels unless done very deeply are not adequate to remove sun damage and pre cancerous lesions. Deeper TCA peels have a history of causing irregular pigmentation and scarring.

The most modern up to date technique is called Photo-dynamic therapy which is excellent and effective.

A cream called Levulan is applied to your face. After about an hour, the cream is selectively absorbed by the damaged skin cells.

The Levulon sensitizes the damaged cells to light. Several different lights such as blue light, red light or IPL can be used. The light is flashed on the skin. The damaged skin cells are damaged and removed by the combination of the light and the Levulon.

This is a very effective treatment and is widely accepted as the best treatment availble for sun damage and pre cancerous lesions.

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.