Trichloroacetic (TCA) peels are a popular type of chemical peel to treat a wide range of skin concerns including signs of aging, sun damage, laxity, texture hyperpigmentation , large pores and scarring. TCA is best known for its rather drastic results.
TCA peels require some downtime but … significant improvements to the skin’s appearance will be seen! It’s one of my favorites and I do it once a year like clock work!
Professional TCAS in CA can range from $500-$1200 each session !
What Is a Trichloroacetic Chemical Peel?
TCA is derived from acetic acid, a derivative of vinegar, and is available in concentrations ranging from 15–30%. 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.
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.
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 and laxity or sagging areas!
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 Benefits
TCA chemical peels offers many very beneficial noticeable immediate 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 post inflammatory hyperpigmentation while shrinking pores and tightening . The dermis is thickened due to collagen induction . L
One study found that TCA was much more effective than Microneedling , microdermabrasion and glycolic acid at removing acne scars.
Atrophic acne scars called icepick or boxcar scars, can be effectively treated with high concentrations of TCA 30% using the Cross toothpick 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.
TCA is effective in any concentration to reduce sun damage, and does so by removing age and sun spots . These are flat, brown spots that develop due to sun exposure—and improving skin tone and texture. It has been proven extremely effective at increasing skin elasticity and hydration, two signifiers of healthy, undamaged skin.
TCA can be successfully used to lighten all types of pigment issues including freckles, age spots, dark patches and stubborn 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 ; Sometimes as little as one peels is necessary to see significant changes in the appearance of skin.
With multiple treatments, it can effectively treat severe 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.
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 those with very light and dark skin to mitigate the risk of further 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, salicylic acid peels and microneedling.
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.
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 (2-3 weeks prior to peel) if your provider determines it will shorten your treatment time and improve your results. This same principle applies for bleaching agents such as hydroquinone. Any of these are stopped 3 days before peeling.
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.
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 50% Spf During the recovery phase. Do not pick at or peel the skin, as this can lead to scarring.
Avoid vitamin C serums , BHAS moisturizers and all actives & retinoids and at-home exfoliating products until the skin has fully healed as they can damage your fragile skin.
After a light TCA peel, your skin appears firmer, brighter and more even in texture and tone. Hyperpigmentation, melasma , fine lines and shallow scars are lightened.
After a medium-strength peel, these imperfections are further reduced or fully erased. Wrinkles and skin looseness are improved, while scars are minimized or eliminated entirely.
If you’ve had TCA applied to individual scars using the CROSS technique, several applications distributed over the course of several weeks are necessary to see results. The treated scars continue to reheal over time with further improvement observed in most people 3 months their final treatment.