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TCA Peels
  • TCA peels use trichloroacetic acid to remove the top layer of skin, and come in a variety of concentrations.
  • Downtime can vary from none at all to three weeks, depending on the intensity of the peel.
  • TCA peels can burn or sting, but the pain doesn’t usually last beyond the duration of the treatment.

Chemical peels use mild acids to remove the top layer of skin, either revealing less damaged skin beneath or causing the cells to produce new skin altogether, depending on the intensity of the peel.

This process helps improve the appearance of multiple skin conditions, including acne scars, wrinkles, age spots, hyperpigmentation, and sun damage.

TCA peels use a type of acid that can be customized to a variety of applications and strengths, from a quick lunch-break treatment to a complete restart for your skin.

Here, we explain exactly what a TCA peel is and how it works, and discuss the different levels of peels, the characteristics of a good peel candidate, and possible side effects.

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What is a TCA peel?

TCA is the abbreviation for trichloroacetic acid, a chemical commonly used in a wide range of peels.

“Trichloroacetic acid is a derivative of acetic acid (vinegar) and is used to remove the top layer of cells for a smoother, clearer complexion,” explains Dr. Rhonda Q. Klein, MD, MPH, FAAD, of Modern Dermatology in Westport, CT.

Among the conditions that can be treated with TCA are melasma, sun damage, actinic keratoses, lentigos, texture, and rhytides. The strength of TCA depends on what condition is being treated, says Dr. Klein.

Medium and deep peels, including those that involve TCA, usually require a week or two of downtime as the old skin peels off.

How does a TCA peel work?

TCA acts on keratin, a common protein found in the skin, hair, and nails. The chemical denatures the keratin proteins — in other words, removes their outer structures — which causes them to stop functioning correctly, lightening the skin and making the top layers peel off.

“I describe it to patients as being similar to what heat does to the albumin protein in the clear part of an egg. Just like the cooked egg, the skin protein turns white when the protein is denatured,” explains Dr. Cynthia Bailey, a board certified dermatologist based in Sebastopol, CA.

“We can actually see it when we apply TCA. The degree of white we create with application correlates to the depth of the peel, giving us a visual measure of control.”

Dr. Bailey describes the delicate balance of the injury and renewal cycle in gauging a peel’s effectiveness:

“The deeper the peel, the more substantial the injury we create,” she says. “Denaturing keratin protein creates an injury. As the skin heals, new collagen is created. It’s the new collagen we are really looking for when we are treating fine lines and wrinkles, but we don’t want to create such a deep injury that we heal with the ultimate in collagen formation: a scar.”

Different levels of TCA peels

TCA peels vary in strength and results depending on the concentration of acid used.

While at-home TCA peels are available, Dr. Jennifer Haley, MD FAAD — a board-certified dermatologist and former VIP dermatologist consultant to the U.S. Capitol — recommends that any TCA concentration over 20% should be applied by a board-certified dermatologist to prevent unwanted side effects or too much peeling.

“I have seen many patients scarred from improper treatment by unqualified individuals over the years,” she cautions. “Results depend on the person performing the peel and the strength of the peel.”

A peel with TCA concentration in the 20 % range can be applied to the neck, décolletage, hands, and arms to help sun damaged or aging skin.

Peels with TCA concentrations up to 35% should only be applied to the face, and can be used to treat deeper wrinkles and precancers.

A lighter peel or a series of lighter peels are a good option if you don’t want or can’t afford days of downtime. Deeper peels often require a week or more of downtime as the skin peels off and then renews itself, and can only be done once annually.

Many factors affect the depth of a TCA peel, and it can be customized for different individuals and skin issues.

“Depth is determined by how well you remove all skin surface oils with your prep, whether you exfoliate the skin first — which will make the peel much deeper and harder to control — how many layers of application you do, and what concentration of TCA you start with,” explains Dr. Bailey.

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Who is a good candidate?

As with other chemical-based beauty treatments, TCA peels are generally most successful on lighter-skinned individuals.

Darker-skinned individuals can certainly get chemical peels, but they should consult with a dermatologist before trying one, because they can develop permanent skin pigmentation issues if the chemical peel is not properly administered.

TCA peels cannot be performed if the skin is open or injured because of infections, active skin disease, cuts, sunburns, or active cold sores.

Patients should exercise extra caution and talk with their doctors if they are nursing or pregnant, have taken Accutane (isotretinoin) in the previous six months, have used prescription skin products and/or bleaching and lightening agents in the previous 48 hours, or have psoriasis, eczema, dermatitis, or rosacea.

Do TCA peels hurt?

One of the most pressing questions for patients considering any kind of chemical peel, including a TCA peel, is whether they hurt.

Generally, discomfort is related to the depth of the peel. A more superficial TCA peel will sting for a few minutes, whereas a deeper treatment can cause the skin to burn during the entire procedure. Skin might also feel uncomfortable for a day or so after a deeper peel, although it shouldn’t actively hurt.

For a deep peel, you’ll be under general anesthesia so you won’t feel anything during the procedure. Some peels containing TCA have a numbing agent (like phenol) that eliminates the discomfort of the procedure, and makes a medium-depth peel generally more tolerable.

“Initially, there is a warm feeling and then a burning that lasts two to three minutes. A fan and cool gauze soaked in ice water help the time pass quicker,” Dr. Haley says. “After the treatment, when the skin is exfoliating, there should be no pain.”

Caring for your skin after a TCA peel

TCA peel treatments don’t stop when you leave your doctor’s office: Diligent care is needed to ensure the desired results and prevent any side effects, such as hyperpigmentation or scarring. Lighter peels might only require the daily application of lotion and sunscreen to keep the skin moisturized and protected as it heals.

Medium skin peels are a bit more involved, because the skin can redden, swell, and even blister. Usually, the skin must be soaked daily, followed by an application of ointment and antiviral medication. The sun should be completely avoided until the skin heals, which takes a week or two.

Deep peels require the most care. Four to six daily soaks might be needed, and ointments and thick moisturizer should be applied every day for a couple weeks. You might also need to take a short course of antiviral medication to prevent cold sore outbreaks (oral herpes), and avoid sun exposure completely for three to six months.

Typically, variations in depth, chemicals, and manufacturers will dictate the post-peel regimen for proper care and optimal results.

Potential side effects

When performed by an experienced dermatologist, the side effects related to TCA chemical peels are generally few and temporary. These can include reddening, itching, lightening, or darkening of the skin.

Following your doctor’s instructions is critical to the prevention of side effects after a chemical peel. Protect your skin from the sun, care for your skin as instructed, and avoid tanning beds. Don’t scratch the treated skin, pick off a scab, apply makeup, or remove bandages before the skin has healed.

One known side effect of TCA peels is the possible reappearance of cold sores. “Activation of herpes cold sore virus is always a concern,” Dr. Bailey says. “People who have a history of cold sores should take antiviral medicine prophylactically before and during the peel process and early healing days.”

TCA peels are a versatile and common beauty treatment that can help treat a variety of skin issues, sometimes over your lunch break. Because of the possible intensity of TCA peels, be extremely careful with any over-the-counter options.

» If you’re looking for anything more than a little brightening from your TCA peels, use Zwivel’s online directory to search for cosmetic doctors in your area.

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