The Art of the Trichloroacetic Acid Chemical Peel

Trichloroacetic acid peels

“…The single most prevalent risk of TCA and other peels is patient dissatisfaction. In a survey of patient satisfaction after TCA peel, as many as 30% of patients expressed some disappointment with their results (9). Younger and darker‐skinned patients expressed an even lower satisfaction rate—down to 33% satisfaction in some cases.…”

“…A dense, white, uniform frost is indicative of deep papillary to reticular dermal injury and is the endpoint for medium‐depth peels with 50% TCA alone. This deeper frost usually clears in 40–45 minutes (9). A yellow‐gray frost represents deep injury to the mid‐ to deep reticular dermis and forecasts a prolonged healing time.…”

Resurfacing of the face: choices of therapy

“…As the depth of injury increases in hopes of more substantial improvement with medium‐depth resurfacing, the likelihood of attendant morbidity and potential adverse effects increases. Examples of medium‐depth resurfacing modalities would include combination chemical peels involving Jessner's solution and glycolic acid, combination Jessner's solution and TCA, a medium‐depth Er:YAG laser resurfacing, combination CO 2 and Er:YAG resurfacing, and short‐pulsed or scanned CO 2 laser resurfacing (6–9). Dermabrasion can be modified to achieve any level of resurfacing, but it is most commonly used as a medium‐depth resurfacing modality (10).…”

“…Patients with moderate rhytides thus are faced with the choice of a more substantial moderate‐depth wound produced by medium‐depth resurfacing techniques. Such techniques include the range of TCA and Jessner's solution combination chemical peels, medium‐depth dermabrasion, short‐pulsed or scanned CO 2 laser resurfacing, or newer combination short‐pulsed CO 2 and Er:YAG laser resurfacing (6–10). Substantial benefits can be obtained, but only after a papillary to upper reticular dermal injury, which is associated with significant morbidity (11).…”

“…The combination of hyperpigmentation, hypopigmentation, and telangiectasias characteristic of poikiloderma can be managed much in the same way as solar elastosis. Poikiloderma responds nicely to medium‐depth resurfacing modalities such as TCA/Jessner's solution chemical peels, dermabrasion, or CO 2 laser resurfacing (6–10). Papillary dermal ablation will often result in more homogenous coloration and texture, and eradication of linear telangiectasias which characterize poikiloderma.…”