TCA vs Phenol Peel vs Chemical Peel - Which is Better?

TCA or trichoroacetic acid peels come in different strengths.  Mild peels are in the range of 10 to 20%.  These peels freshen the skin but don't provide much in the way of line improvement.  Treatment effects are on the order of many months.  TCA peels in the 25 to 35% range generally benefit from having anesthesia to tolerate the procedure.  Recover for a 35% peel is about a week and at this point the skin will be red which resolves in 6 to 8 weeks.  This peel will provide generalized skin tightening and will remove considerable sun damage.  However, this peel will only provide help for fine lines.  To deal with deeper lines, a phenol 89% peel is often used.  The critical thing is to understand that this is a very powerful peel that very few cosmetic surgeons are properly trained to perform.  This agent is very powerful but it also can damage normal pigment.  In fact this is not even considered a complication but rather a known treatment effect.  How this treatment effect is used and when it is used is the mark of a master chemical peeler.  This agent is very powerful in firming skin and reducing lines.  Generally it is not appropriate to have a full face phenol peel.  It is best used in the under eye area and at the edge of the mouth were the skin color is lighter.  This type of peel is not appropriate for olive or darker skin due to depigmentation.  Finally the deepest peel is with a combination of phenol and croton oil called a Baker's peel.  These are seldom needed and the ability of this peel to permanently scar the skin is profound.

There is no "best" peel; there is simply a "best" peel for the needs of an individual patient.  All of the reading that you do here cannot take the place of a consultation with a physician who is experienced in different types of chemical peels and resurfacing techniques.

The TCA peel has an excellent track record.  It gives a medium depth peel.

Phenol peels tend to be more intense, and have a longer recovery, but can have more impressive results.  They come in a variety of slightly different mixtures.  I prefer the Hetter formula over the classic Baker-Gordon formula.  With the Hetter formula, the risk of chalky-white loss of pigmentation referred to earlier is reduced.

I think pre-treating the patient with Obagi and Retin-A for several weeks beforehand is always helpful.  Also, get Valtrex (or equivalent) if you have a history of cold sores.

 

All the best,

A Phenol peel is, by definition, a "deep" chemical peel,  A TCA peel can be administered as either a mild, medium, or deep chemical peel according to the concentration.  Phenol peels have a greater incidence of hypopigmentation, and have a certain degree of cardiac risk.  Since the refinement of the ultra-pulse CO2, erbium, and later the fractionated CO2 lasers, phenol peels have been used with lesser frequency for skin resurfacing.

Hello,

Phenol peels are deeper with more potential benefit, but more risk as well. TCA treats less deeply but has a better safety record. The best depth of a peel is best judged by your surgeon who can consider your skin type and history to give you the best result. We all have varying experience with different peeling agents as well.

Best Regards,

John Di Saia MD