Does TCA Chemical Peel Hurt
What Is a Trichloroacetic Chemical Peel?
TCA is derived from acetic acid, a derivative of vinegar, and is available in concentrations ranging from 15–70%. It is applied to remove the top layer of skin from the face, neck, hands or other parts of the body.
A TCA peel chemically exfoliates the skin and reduces the appearance of fine lines, hyperpigmentation, melasma, acne scars and sun damage; it improves skin texture.
1 second of 34 secondsVolume 0%
TCA peels can be performed at a variety of strengths—from light to medium—and can be customized by the number of layers applied and any prepeel agents used.
How Does a TCA Peel Work?
TCA breaks up keratin, a protein found in the skin. This causes the keratin to stop functioning properly, lighten in color and peel away from the skin over the course of several days. As the layers of damaged skin are removed, healthier, smoother skin is revealed beneath.
While a light peel only affects the topmost layer of skin, the epidermis, a medium peel can penetrate the papillary dermis below to treat deeper damage.
Strengths
The concentration of TCA used determines the depth of the peel. Lower concentrations provide more subtle changes in the skin, while higher concentrations significantly improve overall skin tone and texture while removing scars, wrinkles and hyperpigmentation.
Light peels of 10–15% concentrations can treat hyperpigmentation, while 20% peels treat sun-damaged or aging skin and minor scars. Medium peels of 30–35% treat deeper wrinkles, deeper scars and precancerous growths.
Although TCA in higher concentrations was used for deep full-face peels in the past, it is no longer recommended due to the risk of postprocedural complications. In concentrations up to 70%, TCA can be applied to very small areas of skin to treat individual scars or lesions.
While peels of lower concentration can be performed on the face, neck, hands or any part of the body with sun damage, peels of 20% or higher should only be performed on the face as other parts of the body are more likely to scar.
Tca chemical peel treatment
TCA chemical peels offers many noticeable improvements to the skin, to include a reduction in the appearance of scars, signs of aging and sun damage.
Acne and acne scars
TCA can temporarily reduce blemishes by deeply exfoliating the skin. However, it cannot address the root causes of acne such as hormones and overproduction of the skin’s natural oils. Because of this, and the long recovery time in comparison with other peels, TCA is not usually recommended to treat acne.
However, TCA is an effective treatment for post-acne scarring. It simultaneously smoothes the skin’s texture while removing postinflammatory hyperpigmentation, the dark spots of discoloration that appear after a blemish has healed. One study found that TCA was more effective than microdermabrasion, microneedling and glycolic acid at removing acne scars.
Atrophic acne scars, commonly called icepick or boxcar scars, can be effectively treated with high concentrations of TCA (70%) using the CROSS technique. In this study, patients reported they were very satisfied or satisfied in 81% of cases, with better treatment outcomes associated with more severe pretreatment scarring.
The CROSS technique involves the targeted application of TCA into each individual depression to reconstruct scar tissue and even out the skin. This treatment is repeated every few weeks over the course of several months.
The CROSS method is more efficient at treating atrophic scars than a full face peel because only small amounts of the chemical are applied to targeted areas, reducing the amount of recovery time needed.
Sun damage
TCA is effective in any concentration to reduce sun damage, and does so by removing sunspots—flat, brown spots that develop due to sun exposure—and improving skin tone and texture. It has been proven particularly effective at increasing skin elasticity and hydration, two signifiers of healthy, undamaged skin.
Hyperpigmentation
TCA can be successfully used to lighten all types of hyperpigmentation, including freckles, age spots, dark patches and melasma.
TCA peels vs. other chemical peels
Even at low concentrations, TCA is stronger than other common peeling agents such as salicylic acid and glycolic acid. It therefore has a greater ability to resurface skin with just one treatment.
A single light peel brightens skin and reduces large pores, however multiple peels are usually necessary to see significant changes in the appearance of skin. Conversely, TCA can substantially reduce hyperpigmentation and sun damage with a single treatment. With multiple treatments, it can effectively treat acne scars. However, the risk of complications from a medium peel is higher and recovery time is longer than for a light peel.
Extensive skin damage can be effectively treated with deeper peels. Deep peels can be performed with TCA, but phenol is more commonly used as it carries a lower risk of complications.
As an alternative to a single deep phenol peel, a series of medium TCA peels can significantly improve the skin without the extensive downtime, risks and permanent skin changes of a deep TCA peel.
Are TCA Chemical Peels Right for Your Skin?
All skin types are able to tolerate TCA chemical peels, although not necessarily at high concentrations. Caution must be taken for those with very light and dark skin to mitigate the risk of permanent skin discoloration or other unwanted side effects.
Contraindications for chemical peels include the tendency to form keloid scars, taking medication that makes your skin light sensitive and any active bacterial, fungal or viral infections.
If your skin cannot tolerate a TCA chemical peel, alternatives for treating minor skin issues such as hyperpigmentation include glycolic acid or salicylic acid peels, microdermabrasion and microneedling. More severe skin damage and signs of aging can be treated with laser skin resurfacing.
Does TCA Chemical Peel Hurt
The peel goes something like this. When you arrive, you will be put in a room and be asked to get comfortable on an exam table. Your skin will be cleansed several times with liquid cleanser, alcohol and possibly acetone. It’s important that all the oil be off the skin so the peel solution will penetrate evenly. Then the peel solution is applied and sometimes this is done in two stages. There is some stinging and a sensation of heat while the peel solution is active. Sometimes a small handheld fan is used for cooling in this stage. Then an ointment is applied to speed healing and post care instructions are given.
What to Expect During a TCA Peel
Although the procedure itself only lasts a few minutes, a TCA peel involves more than one appointment. A pre- and postprocedure skin care regimen is also required to obtain the best results.
Preparation
The weeks or months leading up to your procedure usually require a prepeel regimen as determined by your dermatologist, to improve the outcome of your treatment.
If you regularly use retinoid creams or medications, you will be asked to discontinue them because they can cause the TCA to penetrate too deeply into the skin. Conversely, if you do not use retinoids, you may be prescribed one for a short duration if your provider determines it will shorten your treatment time and improve your results. This same principle applies for bleaching agents such as hydroquinone.
If you experience frequent cold sores, you will be prescribed an antiviral to avoid a flare-up after treatment.
In the week before treatment, stop using hair removal products, facial scrubs and any skin lightening products on your face.
Application
Before the procedure, the provider will clean your face and protect your hair and clothes. You may be given a sedative or painkiller depending on the depth of the treatment.
During treatment, the TCA is applied with a cotton-tipped applicator or gauze. The treated skin might begin to whiten or frost, causing a burning sensation. After about five minutes, additional layers can be applied to increase the depth of the peel.
Once the desired number of layers have been applied, the provider will remove the TCA from the skin and apply a cool compress for several minutes, followed by a protective ointment. A TCA peel does not require a neutralizing solution.
Recovery and aftercare
After your TCA peel, your skin will be red and swollen for several days. This will transition into darkening, crusting and peeling of the skin. You can take over-the-counter (OTC) pain medication to ease any discomfort.
Your skin will take 7 to 14 days to heal, but redness can persist for several months. You’ll likely schedule a follow-up visit with your clinician to ensure the healing process goes smoothly.
Your provider will provide you with specific instructions for aftercare such as the application of ointment or a prescription for antiviral medication; during the healing process follow all instructions to avoid complications.
Use only mild cleansers and other skin care products and meticulously wear a broad-spectrum sunscreen with a high SPF throughout the recovery phase. Do not pick at or peel the skin, as this can lead to scarring.
Avoid vitamin C serums and moisturizers, retinoids and at-home exfoliating products until the skin has fully healed as they can damage your fragile skin.
TCA Peel Benefits
There are multiple TCA peel benefits that can help patients improve the visible appearance of their skin. TCA peels are most commonly used to treat the skin on the face and neck, but they may also be used on the chest, back, arms, and legs, or other areas of the body frequently exposed to sunlight. Depending on the strength of the chemical peel, those containing TCA can help you achieve the following benefits with noticeable improvements to the skin.
- Reduced brown spots and age spots
- Improved texture of leathery, sun-damaged skin
- Reduced appearance of certain types of acne
- Fewer fine lines and wrinkles
- Improved appearance of skin with melasma
- Increased skin elasticity and hydration
TCA Peel For Hyperpigmentation
This hyperpigmentation is the result of inflammation in the skin, commonly spots and skin injuries like cuts or burns. Additionally, sun exposure can cause this type of hyperpigmentation to worsen. TCA peels are a great option for treating this type of hyperpigmentation as well. It even breaks up the pigmentation in deeper layers of the skin and encourages those cells to migrate to the surface where they can be shed away.