In this article I’m going to be talking about the TCA peel. I’m going to explain what it is and what it can help with. I’m going to tell you everything you need to know before considering getting a TCA peel
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What is a TCA Peel?
A TCA peel is a type of chemical peel. Chemical peels are procedures performed by dermatologists, estheticians and plastic surgeons to exfoliate the skin and treat a wide variety of skin lesions.
Chemical peels fall into three categories:
Superficial chemical peels exfoliate the very top layer of the skin. Medium and deep peels reach down to the deeper layers of the skin, the dermis, for deeper exfoliation.
Depending on the depth of the peel, that is going to determine the treatment results.
Superficial chemical peels are used to treat things like blackheads, whiteheads. They can improve the look of sunspots and they can smooth out skin texture and very lightly exfoliate the skin.
Whereas medium and deep peels are going to be used to target the deeper layers of the skin to improve the look of wrinkles and certain types of scars.
The deeper the peel, the longer the healing time and the greater the risk of adverse side effects, like hyperpigmentation and scarring.
There are a wide variety of reagents that can be used to peel the skin.
TCA stands for trichloroacetic acid and it is a skin peeling agent.
When people say I’m interested in having a TCA peel, that’s not very specific. TCA can be used as a superficial peel. a medium peel or a deep peel. Whenever anyone’s talking about having a TCA peel, your follow-up question should be what was the depth.
The depth of a TCA peel is going to determine the results and the depth is determined by the concentration of the TCA and the number of passes or applications of the TCA onto the skin.
What a TCA Peel Can Do?
A superficial TCA peel is only going to target the top layer of the skin and it can be helpful for improving some of the lesions of acne, namely blackheads and whiteheads. It also can help with post acne redness.
A superficial TCA peel can also help with skin texture and if you have some hyperpigmentation that is located up high in the skin, it can help exfoliate that out and just improve overall skin tone.
A medium depth TCA peel can help in targeting wrinkles and fine lines, because in medium depth, you’re starting to get into the dermis. The dermis is really is really the heart of where wrinkles are forming. So it can help with that.
It also can help remove pre-neoplasias, beginning stages of skin cancers. It is also beneficial for sun damage. A lot of people, especially people who have a lot of sun damage, make a lot of skin cancers.
A medium depth peel is something that can have potentially chemo preventative outcomes by removing some of those early damaged skin cells that might otherwise go on to form skin cancers.
A medium depth TCA peel also may be useful for improving acne scars. In some cases, before a medium depth TCA peel, if the aim is to improve the look of scars, you can actually take solid C02 and carefully freeze the edges of the scars.
What this ends up doing is it causes local destruction of the skin cells and a lot of edema, so that the TCA that you would then apply on top of that can penetrate deeper.
It kind of allows for a little bit more finesse in destroying the edges of scars and smoothing things out while doing TCA.
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Side Effects of TCA Peel
Overall TCA is a very safe reagent. It’s not absorbed into the body. It’s even technically safe enough to use during pregnancy.
However, when we’re talking about peeling the skin, exfoliating the skin and causing localized destruction of certain skin cells, there’s definitely a risk of scarring and post inflammatory hyperpigmentation, especially a medium to deep skin tones.
TCA is not the best option for those folks. Instead when it comes to peeling reagent, salicylic acid is often a better choice, depending on particular skin lesion that you’re looking to improve and the depth of the peel.
TCA Peel Results
First and foremost I would recommend seeing a board certified dermatologist or plastic surgeon, especially if you are considering a peel of a medium depth to improve the look of the photo aging, wrinkles, to tighten the skin.
A board certified dermatologist or plastic surgeon should be the one doing peels at that depth.
With a superficial TCA peel there’s actually very little down time. You can expect to have peeling usually around four to five days.
If you’re having a deeper TCA peel, the peeling after the procedure can last around 10 days. So be prepared for the peeling aspect of things.
Before the procedure though, the weeks leading up to the TCA peel, it’s really important to be very aggressive with sun protection.
The reason this is helpful is that if you’re getting a lot of sun exposure before the peel, that’s going to make it more likely that it will heal with post-inflammatory hyperpigmentation.
Then of course after the peel you have to be equally aggressive with sun protection by wearing broad spectrum sunscreen and relying on sun protective clothing, hats, scarves, not staying out in the sun.
This is really important for having a good outcome with a TCA peel.
One question I get about peels is do you need to stop your retinoid or retinol.
You need to ask the provider, the dermatologist, what topicals you should stop, because in some cases, it’s beneficial to use a retinol a few weeks before, like a superficial peel, it kind of primes the skin. It helps with more even uptake of the TCA .
Whereas in other cases it would be recommended to stop. In some cases we actually prescribe hydroquinone in advance to reduce the risk of post-inflammatory hyperpigmentation.
It’s going to depend on the type of peel and your skin and the depth.
That’s something to certainly clarify in advance. What topicals are okay to continue using, which ones you should stop and how long you should stop them, for how long after the procedure you should stop, when you can resume using them. All those things you want to clarify.
If you have a history of cold sores and you’re getting a medium or deeper peel, you will likely be prescribed an oral antiviral medicine to reduce the risk of an outbreak.
Before and After
How It’s Done
The day of the peel it’s actually a pretty quick process. It’s easier to not wear makeup, because you have to take it all off.
The first step is we actually rub acetone all over the skin. Acetone like what’s in nail polish remover. This may seem odd but really what this does is it degreases the skin and gets the skin more even for a better uptake of the TCA and more even uptake of the TCA.
Because if we don’t do that, you’ve got patches on your skin, where some areas are oilier than others, you’ve got some heaped up skin cells here and there and that’s going to lead to uneven application, which we don’t want.
After we degrease your skin with acetone, then we take some petrolatum ointment, like vaseline, and put it around your eyes, around your nose and around your mouth, because we don’t want the TCA going there. It can be too irritating in those areas, especially the thin skin of the eyelids.
Then as part of the peel, we take a cotton swab applicator, usually dunked in the TCA solution, and we basically paint it on to the skin, more or less in an even fashion. We are actually looking for that frosting, that precipitation.
To remind you, the number of coats dictates the depth.
The person coating your face with the TCA solution is paying attention to that frosting, that precipitation as an indicator of depth.
After the desired level of frosting is achieved, then we just apply some cool water for comfort and that’s basically it.
Again you want to be really aggressive with the sun protection because your skin is more vulnerable to sun damage and that’s going to put you at risk for post inflammatory hyperpigmentation.
After you leave the office, it’s not uncommon for there to be a little bit of swelling. That usually goes away after a few days.
You also are going to have peeling. The number of days of peeling of the skin is going to depend, again, on the depth, like four to five days for a light peel, up to 10 days for a medium to deep peel.
It’s very important to not pick at the peeling because if you pick that increases the risk of infection, that prolongs the peeling process, it aggravates the skin, leads to dryness and irritation, can flare the acne and it can put you at risk for post-inflammatory hyperpigmentation.
Keep your skin care routine very simple. Just a sunscreen, a cleanser and a moisturizer. You want to stick to fragrance free products. It’s fine to wear makeup, just keep it simple.
At Home vs in Office TCA Peel
How do the in-office peels compare to the at-home kits that you can buy and do your own peel at home?
Those are very superficial. You’re never going to get the level of results that you’re going to get with an in-office procedure, because the concentrations are much higher in office than what is allowed to be sold in these over-the-counter products.
That is a good thing. In the process of applying the peel, there’s a lot of room for error if you try and do it on yourself.
Typically when the peel is applied, you’re lying down and somebody is looking over you while applying it. They can see where things are going, they can make sure there re no skip areas or that they’re not doing too many coats in one area and not another.
Whereas doing it yourself, there’s more room for error. Plus depending on the depth, you could have scarring, post inflammatory hyperpigmentation.
You’re never going to get that level of results.
In my opinion, the at-home peels are useful for maintaining the results that you do get with an in-office peel. The at-home peel kits, they can be helpful for smoothing out skin texture, they can help in lifting up some superficial hyperpigmentation.
The at-home peels are helpful as maintenance and they definitely can yield some nice results as far as just smoothing out the surfaces of the skin, helping your makeup go on better.
If you use other active ingredients, like retinol or vitamin C serums, doing some sort of at-home peel allow for better uptake of those active ingredients.
So they’re definitely beneficial, but to reiterate, you’re never going to get the type of results with an at-home kit that you’re going to get in office.