TCA Chemical Peel
Trichloroacetic (TCA) has become the gold standard of chemical peeling agents. It has been well studied, it is versatile in its ability to create peels of different depths, it is stable, inexpensive, and nontoxic.
TCA is a chemical cauterant, which coagulates proteins in the skin. This is presumably the basis for the formation of the white frost seen when TCA is applied to the skin. The deeper the peel performed with TCA, the faster and more intensely white the frost. The intensity of the frost and its associated skin turgor are used to judge the depth of the peel. The levels of frost created by superficial and medium depth peels can be classified into four groups:
Level 0 - No frost: The skin may look and feel a little slick and shiny, but there is no frost and minimal or no erythema. This is a very superficial peel that, at most, removes the stratum corneum.
Level 1 - Irregular light frost: In addition to appearing shiny, the skin shows some erythema and scattered areas of wispy white frost. This is a superficial epidermal peel that creates 2 to 4 days of light flaking.
Level 2 - White frost with pink showing through: The skni has a uniform white color but there is a strong pink background. This is a full thickness epidermal peel that takes about 5 days to heal.
Level 3 - Solid white frost: The skin has a solid, intense white frost with no pink background showing through. This is a peel that extends into the papillary dermis and takes 5 to 7 days to heal.
These levels of frost are guidelines, they vary a bit from patient to patient.
You should expect certain things when healing from a TCA peel:
The skin will look and feel tight, as if it were covered
with a sheet of plastic.
Any area of epidermal hyperpigmentation will darken
considerably as part of its reaction to the peel.
Varying degrees of swelling can occur. It is rare to see
such edema with superficial peels, but some edema is common with papillary
dermal peels. The edema usually peaks 48 hours after the peel.
The first areas to begin peeling will be the areas with the
most muscle movement.
The forehead and hairline are usually the last areas to
peel.
Strict rules for the healing phase:
Avoid all sun exposure.
Avoid exercise and sweating.
Avoid having the shower spray strike directly on your face.
Do not pick, rub, or unnecessarily touch your face.
Minimize facial expression.
Try to sleep on your back, this is particularly important
for medium depth peels.
If you shampoo your hair, it should be done with your head
tilted backwards into the sink so no soap runs down your face.
The Pros of TCA peels:
TCA causes no systemic toxicity.
It can be used to create superficial, medium, or deep peels.
It is inexpensive.
It is stable.
Peel depth correlates with intensity of skin frost.
There is no need to neutralize the TCA peel.
The Cons of TCA peels:
Higher concentrations (over 40%) seem more apt to create scarring.
