| Trichloroacetic Acid Peeling |
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Chemical peeling with trichloroacetic acid
This is one of the older and more reliable methods of resurfacing the skin, and is very versatile, being used to produce anything from light exfoliation to medium depth peeling. It causes no toxicity to the body, and does not require neutralisation. In fact it has become the gold standard of chemical peeling agents, and has been well studied.
It is used to cause a significant shedding of the skin surface, with peeling rather than flaking of the skin. It is not uncommon to perform these peels to the papillary dermis, which will treat a large range of problems including many wrinkles, pigment abnormalities and skin surface problems such as sun damage and keratoses.
Many practitioners are choosing to use laser resurfacing instead of chemical peeling for deeper peels, but in experienced hands a good strong acid peel can deliver similar results at a fraction of the cost.
How is it done?The peel solution is painted onto the skin in layers until the skin forms a whitish speckling called frosting. There is no need to neutralise or remove the solution and the skin becomes pink instead of frosted gradually.
Side Effects Whatever method is used, the deeper the peel, the longer will be the healing phase, and those patients undergoing a peel must be prepared to spend several days with a dark red/brown discolouration (due to the pigmented areas drying out), followed by the peeling off of sheets of brown dry skin. The skin will look and feel tight, and varying degrees of redness or swelling may be present. This can render the patient not presentable to the public eye for an average of 5 - 7 days.
Being a strong peel the TCA peel can cause some side effects, such as loss of pigment, persistent redness, and occasionally scarring. However, the lighter the peel, the lower these risks. If preferred the peel can be done in sections to minimise inconvenience, risk and discomfort.
Aftercare Because most patients feel that their skin is tight and masklike, frequent use of creamy emollients is helpful. The peeling skin may be a little red and sensitive, so staying with bland, fragrance free moisturisers is best. A mild topical steroid cream or ointment can be used 2 - 3 times a day to calm the skin. During the healing phase of the peel, patients can attempt to wear makup (after applying a moisturiser) but definitely cannot use scrubs, masks, astringents, toners, or retinoic acid or alpha hydroxy acids. These products can be resumed 48 hours after the peel has fully healed. Care must be taken with the skin for a couple of months, and a sunscreen used at all times.
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