: Therapeutic, III.

Background: Chemical facial peels are common cosmetic procedures that have gained in popularity over the last decade. Objective: The aim of this study was to compare the efficacy and morbidity of a series of superficial glycolic acid (GA) peels with those of a midlevel trichloroacetic acid (TCA) peel. Methods: We conducted a split-face study of 7 female patients, comparing the benefits of a single 35% TCA peel with those of a series of 5 30% GA peels performed at monthly intervals. Throughout the study, we performed noninvasive biophysical measurements, optical imaging, and expert and naïve image evaluations and conducted subject-group discussions so that we might objectively quantify and compare the treatments over time. An additional objective of the research was to use quantitative objective measurements of skin condition and actinic damage to establish these techniques as biologically based standards for treatment evaluation. Results: Skin elasticity and hydration increased during the course of the study but were not significantly different between the 2 treatment modes. Overall improvement with both treatments was relatively small as judged by expert evaluations of digital images taken at baseline and 3 months after treatment. No important differences were perceived when naïve judges were asked to evaluate the images. Digital-image analysis of wrinkles in the cheek region revealedsignificantly greater improvement in wrinkles with the TCA peel. In patient-group discussions, TCA peels were associated with greater improvement but also with more discomfort; GA peels were associated with a high degree of satisfaction, although their effect on quantitative technical measures of actinic damage was not dramatic. Conclusions: Although a single TCA peel produced more improvement than a series of superficial peels, the differences were small, and the TCA peel was associated with significantly greater discomfort. (Aesthetic Surg J 2003;23:339-344.) Comparison S c i e n t i f i c F o r u m T he chemical face peel is among the 5 most common cosmetic procedures performed for individuals in the 35-to 50-year age group. 1 Various chemical peeling agents and strategies are used to repair the effects of photodamage, such as wrinkles, dyschromia, and actinic keratosis. 2 The 35% trichloroacetic acid (TCA) peel is an accepted means of treating pathologic conditions of the skin localized to the epidermis and uppermost portion of the dermis. 3 Although generally safe and predictable, this peel has a significant period of 5 to 7 days during which visible peeling of the skin occurs. This morbidity is a deterrent to many prospective patients because it can interfere with work and social interactions.During the past decade, superficial glycolic acid (GA) peels have become a popular addition to a healthy skincare regimen because they improve the characteristics of the skin more gradually and without the inherent down time of TCA peels. No available data are available directly comparing the efficacy and morbidity of a series of GA p...