As a facial plastic surgeon, I understand the importance of the appearance of the face and neck skin. The skin is the canvas of the face. If the skin is of poor quality, it can create an aged and tired appearance. Fortunately, there are many options in improving the quality of the facial skin. One of the best options is a TCA or Tri-chloroacetic acid chemical peel. TCA chemical peels are a tried and true method of improving the quality and appearance of the facial skin and neck. There are a variety of different strengths of TCA peels. This page is going to discuss more advanced or aggressive TCA peels for patients seeking better results. This depth of peel can only be performed by a qualified physician.
What are the Indications for a Medium to Deep Depth TCA Peel?
A medium to deep TCA chemical peel is a great option for a variety of skin conditions. TCA will improve:
- Brown spots
- Fine lines and wrinkles
- Acne scarring
How does a TCA Peel Work?
To improve the quality of skin, the skin must be damaged to stimulate the production of new skin. The way we damage the skin during a chemical peel is by putting TCA on the skin. The TCA causes a reaction called keratocoagulation or protein degradation. This removes old damaged skin to make room for new young skin to develop.
What do I need to do prior to my TCA Peel?
There are a few steps that patients need to take before undergoing a TCA peel. These steps will help ensure a safer peel and a better result. For 6 weeks before a peel, I suggest that patients:
- Avoid sunbathing or tanning beds
- Wear a sunscreen on the anticipated area that protects against UVA and UVB rays
- Apply Retin-A daily
- Apply Hydroquinone daily
Retin-A increases the growth rate of the skin and thins the skin in such a way to allow for a more even peel. For lighter skinned patients, I recommend stopping Retin-A 1 week before the peel. For darker skin-toned patients, Retin-A is stopped 2 weeks before the peel. Hydroquinone is best used for patients with multiple sunspots or in patients with darker complexions.
How is a TCA Peel Performed?
The peel can be performed in the office or under light anesthesia. If the peel is going to be completed in the office, I will have patients take a valium 1 hour before the procedure. On arrival to the office, I will apply a topical numbing agent to the area that will undergo the peel.
The patient will then lie on the chair at a 30 degree angle, and the skin will be cleaned with septisol and acetone. After cleaning, the TCA peel will be applied with light brushing of q tips or gauze.
Does a TCA Peel Hurt?
During the peel, the patient will experience a stinging sensation. Patients are able to tolerate the stinging. At the end of the peel, a cold compress is placed on the face. The cold compress will relieve the stinging. For those patients who do not want to experience any discomfort, I recommend having the TCA peel under a light anesthesia.
What does the Face Look like during the Peel?
The peel will change the color of the skin from a range of a little red to white frost. The more white frosting in appearance, the deeper the peel. The depth can be controlled by the strength of TCA solution and the technique of the peel. The end point of the peel is the color of the skin and is not affected by the addition of water (unlike other peels).
Can African Americans or Patients with Darker Complexions undergo a Chemical Peel?
Yes, African American and patients with darker complexions can undergo a TCA chemical peel. The weaker peel is secondary to the increased sensitivity of the skin to a chemical peel. Initially a 10-15% TCA peel is completed first to see the patient’s response. Depending on the response, an additional stronger peel maybe completed at a later date.
What happens at the completion of the Peel?
The face will be covered in an ointment similar to petroleum jelly or Aquaphor.
What is the Care Involved after a TCA Peel?
There are a few steps involved to take care of the skin after a TCA peel. They are:
- Wash the face twice a day with a mild non-detergent soap.
- Vinegar soaks are applied to the face 2-4 times a day. Vinegar solution is made by combining 1 tablespoon of white vinegar to 1 pint of warm water. This helps clean and remove crust of the skin.
- The face is kept moist with a layer of Aquaphor or petroleum jelly applied to the face throughout the day. This prevents drying and scabbing of the skin.
Depending on the depth of the peel, this care may be required for 1 week. After that time, a facial moisturizer is used on the skin.
What is the Recovery after a TCA Peel?
With a lighter peel there will be some mild flaking of the skin and swelling and redness for 3-4 days. For more advance peels, the skin will:
- Feel and look tight
- Pigmented spots will darken considerably and look brown or grey
- Swelling will occur, which will be worse at 48hrs after the peel and resolve over a few days
- 3-5 days after the peel, the skin will begin to come off and weep
- By days 7-10 normal skin will have began to grow back, but will be pink
The skin may remain pink for 2-4 weeks after the peel. During this time, make-up can be applied to cover any sort of discolored areas of the skin.
How Do I Schedule a TCA Peel in Charlotte?
Patients interested in undergoing an advanced TCA peel by facial plastic surgeon Dr. Kulbersh should call (704) 842-3644 or fill out the online contact form.