Medium Depth Acid Peel

What is TCA Peel?

TCA (Tri-Chloric-acetic Acid) is a strong acid made of chlorinated acetic acid which is widely used as a chemical skin peel. This type of peeling aims to improve the skin’s appearance by removing the outer layer of damaged skin and thickening and remodeling of the underlying layer of the skin leading to a smoother, clearer, more firm and tight, rejuvenated skin, free of blemishes.

What is Blue Peel?

Blue peel is a TCA peel. Dr. Obagi created a blue solution that we can mix it with our TCA before applying the acid to the skin. It slows down the acid penetration into the skin and it helps the doctor to monitor the depth of acid penetration more accurate. For deep acid peel of the face we use higher amount of TCA 30% and we apply multiple coats of acid on the skin. TCA with the blue color (Blue peel) helps the doctor to judge the depth of acid penetration and she or he can know when to stop further acid application to the skin because not every skin needs the same number of acid applications. The plain TCA is colorless and makes monitoring of the acid penetration depth more difficult. For more superficial TCA peel we can use plain TCA if we want to save the cost of the peel.

Each blue peel application removes a thin surface layer of damaged skin, restoring tighter, smoother and clearer-looking skin, regardless of age, color or skin type, and is suitable for those who do not need a full cosmetic facelift, but want to remove minor skin blemishes and improve skin tone.

How does TCA / Blue Peel differ from Glycolic acid and Salicylic acid peel?

Glycolic acid or Salicylic acid peel are used for a “superficial peels” as a “lunch time peel” to aim a more fresh rejuvenated skin.
TCA generally is used as a “medium depth” chemical peel which can be used for deeper, more aggressive and effective than others. With medium depth peel we can not only correct superficial blemishes but also effect deeper skin tissue inducing skin tightening and scar improvement.
The advantage of the TCA peel is that the degree and depth of penetration within the skin can be controlled accurately according to specific parameter. The concentration of TCA and the amount of acid used for one session chemical peel are the important factors that alter the depth of the peel. Concentration can vary from 15% to 50%, with the higher concentrations leading to a deeper peel as well as higher amount of acid used penetrates deeper in the skin. The out come of this procedure is very much technique dependent therefore expertise of the physician performing TCA peel is a very important factor. Medium and deep chemical peels are only performed by physicians.

What can be improved after TCA or Blue Peel?

In general after a TCA Peel your skin is going to look clearer, fresh, rejuvenated, and youthful especially after multiple peels and deeper chemical treatment. TCA peel especially medium depth peel and multiple treatment results similar to those of laser treatments.
Following skin blemishes improve after different depth TCA peel:

• Superficial TCA peel: unwanted pigmentation and skin discoloration, fine wrinkles, sun damage, age spots, acne (close and open commedons), Rough skin lesions, skin tags, oiliness and dryness of the skin improves.
• Medium depth TCA peel: All of the above plus skin tightening, wrinkles, large pores, deeper acne scar, Deeper patchy pigmentations such as Melasma, age spot and sun damages.
• Deep TCA peel: Deeper acne scare and skin leveling, deeper wrinkles, skin tightening and firming of the skin.

Is there any medical benefit of chemical peels?

Yes, Many skin cancer such as Aktinic keratosis (very common) is early skin cancer (Squamous cell carcinoma). Frequently these early cancer lesions are not visible and we might be able to touch it by tip of our fingers. This type of cancer does not need biopsy. Diagnosis of Actinic keratosis is made clinically. Treatment is to dystroy the superficial layers of the skin to get rid of skin cancer and just watch the skin for recurrence. With chemical peel we are able to destroy all visible or touchable cancer cells with the best medical and cosmetic outcome.

Why pre-peel consultation is very important?

• Type of you skin must be determined.
• Type of problems is your concern will be discussed.
• Your expectation from treatment will be reviewed.
• Realistic expectation from chemical peel and alternative treatment will be discussed.
• Previous treatment with the outcome, success of failure.
• Pre-conditioning of the skin prior to the chemical peel which can be a week to a few month pre treatment.
• Level of the acid peel will be determined.
• Pre-procedure evaluation and education.
• Post procedure education and follow up, what is expected and what to watch for off of work and limitations.
• Recovery time
• How to maintain the result and options to enhance the result?

How is TCA or blue Peel performed?

Medium peels are generally performed as office procedures on an out-patient basis. After initial consultation visit and preconditioning of the skin a few weeks prior to TCA peel procedure, you will be scheduled for one hour actual TCA peel visit. Initially the skin is going to be degreased with alcohol or acetone. Subsequently as planned before a 15%, 20% or 30% TCA is going to be with a sponge or a brush applied to the skin. During this stage you will start feeling a burning sensation on the skin. This sensation usually subsides spontaneously after a few minutes.

With your report of burning we stop further application of TCA for 2 minuets to cool down your skin in order to keep you comfortable and evaluate the skin reaction and judge the depth of the acid penetration. This cycle is repeated several times based on the amount of acid is planned to be used and your skin reaction to meet the endpoint for the procedure
During consultation visit we will discuss that for sensitive patient we can offer pre-pain control and conscious sedation if patient desires in order to make you a tolerable experience. When the desired depth has been achieved, further application of TCA will be stopped. This type of acid does not need to be neutralized on the skin.

Can TCA peel / Blue peel be used for neck and body?

The TCA Peel ( including the blue peel ) and in general any acid peel can be performed on both facial and non-facial areas, including the neck, chest, hands, back, arms and legs, i.e. anywhere that one has marked or damaged skin however, the strength and the technique of the procedure is different.

What happens after TCA peel?

After care is utmost important part of patient responsibility. If you underwent superficial peel you just need to stay away from direct sun exposure and use sun block. If you had medium depth TCA or blue peel you might need to keep treated area your skin covered with an oil-based ointment with or without steroid to keep your skin moist and promote the healing. Post-operative pain medication is normally not required. Within a few days, your superficial layers of skin will turn dark, become stiff, and leathery. The skin will then flake and peeling usually complete in four to seven days. Once your old skin has sloughed, your new skin will be bright and flushed.

Is there any downtime with TCA Peel or Blue peel?

TCA peel or Blue peel can be performed for seven different level of acid penetration into the skin. With the first few levels you will see superficial skin peeling called exfoliation which starts a few days after acid peel. Peeling lasts for 3 to 5 days and you can use make up. It should not interfere with your daily activities. When we plan for medium depth peel or blue peel your peeling is deeper or more that can last to 10 days. During this period of time we prefer to see you in the office every other day for post procedure care. This stage is pain free and you can work from home but you might prefer to stay away from public.

What are the possible complications with TCA peel or Blue peel?

In general the deeper peeling and the darker the skin, the higher risk for complications.

For superficial TCA peel: you can have light swelling and redness of the skin followed by skin flaking which is temporarily.

For medium depth TCA or Blue peel: there are a few temporarily symptoms during recovery period anticipated which are:

1. Erythema- Usually mild, short lived, often no treatment required.
2. Post inflammatory hyper-pigmentation- Occasionally occurs in dark skin color and responses quickly to treatment.
3. Acne flare ups Occurs in acne-prone patients and usually disappears with prompt treatment.
4. Infection of the skin- can result from picking or peeling skin, poor hygiene. Responds to antibiotic treatment easily.
5. Fever blister flare-up if you have history of fever blister. This can be prevented by prophylactic treatment.
6. Irritation of the skin- is caused by excessive moisturization, facial expression or skin rubbing.
7. Keloid, skin scaring and permanent skin discoloration are side effects of deep peel such as phenol peel and the risk is extremely rear with medium depth peel in the hand if experienced physician.

Can I perform TCA peel myself at home?

You can use products that contain very low strength TCA at home. However, over using of such a product at home can be damaging to certain type of the skin. The best is to consult a physician for initial evaluation of your skin and based on type of your skin, skin problems treated, and duration of the treatment will be determined what the best product is for you.

Can I use 50% TCA that I can buy on line sold by a “real licensed esthetician”

The highest strength TCA we use in the office even for deep acid peel is 30%. We cam use multiple applications of TCA 30% but we know that higher strength does penetrates the skin too fast and we are dealing with higher risks that benefit. As a Physician ,with 20 years hands-on experience with chemical peel, when we are dealing with acids we are very particular about the quality and reliability of the acid provider ( we buy). If we receive acids from unreliable supplier we can be in big trouble because with a weak acid we don’t obtain expected result and with a too strong acid we can run in unexpected complications. If you call our medical office reliable acid supplier such as “Delasco” you will see that they do not sell acids to even every licensed physician except Dermatologist and Plastic surgeons.

Does TCA Peel hurt?

In general TCA peel preparation stage (4 to 12 weeks of skin conditioning with topical treatment before TCA peel) and recovery stage (1 to 4 weeks after TCA peel) are completely pain free. During actual TCA peel a mild burning sensation develops as the solution is applied to the skin . This burning will start to subside 2 to 3 minutes later and it is tolerated by most patient.

The discomfort or pain level with TCA peel procedure varies and it is very much depends on the depth of the peel and overall patient individual pain threshold. In general cooling off the skin with a hand held fan or a cooling device is sufficient tool to control the discomfort. If needed for sensitive, apprehensive patients, conscious mild sedation can be offered. These options will be discussed in the consultation visit.

How long does the effect of TCA peel last?

The corrective effect of the medium deep peel on the skin is permanent. However, aging of the skin generally continues. Therefore, recurrent aging signs can be retreated based on the level of skin damage and the patient’s goal. In general, TCA peel can be repeated after three months if desired to achieve more skin tightness and rejuvenation. As a rule, it all depends on how you maintain your skin. If you use skin care products regularly after your peel, you will maximize the duration of improvement. Most people who choose medium chemical peels as the mainstay of their facial rejuvenation have a repeat peel every six to twelve months.

Who is a good candidate for TCA peel?

TCA chemical peels provide an intermediate level of improvement at an intermediate cost and recovery period. They are ideal for individuals who want more than a superficial peel, but cannot afford the expense or recovery time of a deeper treatment or alternative treatments such as laser and surgery.

Deep Chemical Peel

What is Phenol Chemical Peel?

When people talk about “deep” chemical peels, they are referring to phenol chemical peels. Phenol, also known as carbolic acid, is the strongest chemical peel solution available on the market.

Phenol is a relatively toxic chemical, with exposure to high concentrations leading to considerable health risks, such as corrosion of the mucus membranes. Unlike the other chemical skin peels, phenol requires sedation and local anesthetic as well as proper cardiac monitoring during the procedure. Generally, phenol peels are performed at a surgery center as an outpatient procedure. The procedure takes approximately one hour. A longer post-operative recuperation (normally 2 weeks) is necessary.

Phenol chemical peels present a greater risk of complications because of strength and deep penetration, and it also can cause more noticeable side effects therefore we do not offer Phenol Acid peel now that we can achieve similar result with multiple medium depth peel along with laser treatments.