Trichloroacetic acid (TCA)
Trichloroacetic acid (TCA) is typically used as an intermediate-to-deep peeling agent in concentrations of 10 to 35%. This type of peel is useful for patients with surface wrinkles, superficial blemishes, and pigmentation problems. TCA may be used on the neck as well as other areas of the body such as the hands, forearms, and chest. The treatment is rapid, requiring only thirty minutes from beginning to end. There is some burning upon application, and intravenous sedation may be necessary.
Once the treatment is completed, you can expect to shed the dead, outer layer of skin for approximately three days. Following this, you can expect your skin to be completely healed within ten to fourteen days. At that time you will notice improvement in the appearance of your skin, which will have less wrinkles, blemishes, and pigmentation problems. You will also notice a healthy glow as your face appears radiant and shining.
TCA is a deeper peel than most of the superficial peels discussed in this section. Because it is a deeper treatment, your “downtime” will be approximately one week. During this time of peeling and healing, you will be required to keep your facial skin moist with A&D Ointment or Vaseline at all times. After you are healed, sunscreen use is very important because you are initially much more sensitive to the harmful ultraviolet radiation from the sun.
A deep chemical skin peel, or phenol peel, is the strongest of chemical peels, and is reserved for individuals with deep wrinkles from sun exposure or is used to treat skin wrinkling around the lips and chin area. The procedure diminishes imperfections in sun-damaged, unevenly pigmented, or coarsely wrinkled facial areas by peeling away the skin’s top layers.
A full-face deep chemical peel takes 1 to 2 hours to perform. A more limited procedure (such as treatment of wrinkling above the lip) will generally take less than a half-hour. A solution is applied to the area to be treated (avoiding the eyes, brows and lips). There is a slight burning sensation, but it is minimal since the solution also acts as an anesthetic. After the peel solution has worked on the skin, it is neutralized with water. Approximately one hour later, a thick coating of petroleum jelly is layered over the patient’s face, covering the protective crust which develops rapidly over the area. This stays in place for 1 to 2 days. In an alternative technique, the patient’s face is covered by a “mask,” composed of strips of adhesive tape, with openings for the eyes and mouth (this is particularly effective in cases of severe wrinkling).
Some patients experience discomfort after a deep chemical peel, but this can be controlled with medication. A few days after the procedure, new skin with a bright pink color akin to sunburn will emerge; the pinkness will fade within a few days. Post-operative puffiness will also subside in a few days, but the skin will remain sensitive. Patients should avoid exposure to sunlight and continue to use sun block.
- Effects of a phenol chemical peel are long lasting, and in some cases are still readily apparent up to 20 years following the procedure.
- Improvements in the patient’s skin can be quite dramatic. Normal work schedule and other activities can be resumed after 1 to 2 weeks.
- Variants in the phenol peel formula can create a milder solution for broader use.
- Possible postoperative complications can include scarring, infection or abnormal pigmentation. Tends to have a bleaching effect, and patient may need to wear make-up to match treated and untreated areas.
- Cannot be used on the neck or other parts of the patient’s body.
- Not as effective in treating individuals with dark, oily complexions.
- Some facial skin disorders do not respond to chemical peeling.
- Skin pores may appear larger, and the skin may not tan properly.
- Can activate latent cold sore infections.
- All forms of deep skin peels include the risk of delayed healing and scarring.