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Chemical peel for rejuvenated skin

Blog post - chemical peel skin care TCA model

Skin care can be thought of as the foundation to many other cosmetic treatments for facial youth and beauty. We’ve discussed basic skin care in a previous blog post, including topical ointments such as tretinoin. Once you’ve done all the basics, what is the next step for improve skin tone and smoothness? Other than wrinkle relaxers (ex. Botox®, Dysport®) and facial fillers (ex. Juvederm®, Restylane®, etc), it’s skin resurfacing!

What is skin resurfacing?
Skin resurfacing removes the top layers of skin to promote newer, fresher, and younger appearing skin. By exfoliating the skin, resurfacing can help improve skin surface irregularities, either from wrinkles or scars. Resurfacing can be applied to many skin types: young/old, oily/dry, etc.

Skin resurfacing is performed through a variety of methods, including chemical, mechanical, and light based. The specific resurfacing method is often not as important a factor, as compared to the actual depth into the skin of the resurfacing method. Generally, the deeper one goes into the skin, then the more profound and dramatic the aesthetic results. However, there is also higher risk of complications and longer recovery time with deeper skin resurfacing.

  • chemical – glycolic acid, alpha-hydroxy acid, TCA, phenol
  • mechanical – microdermabrasion, dermabrasion
  • light based – CO2 laser, erbium laser

What are the different types of chemical peels?
Chemical peels are a popular option for skin resurfacing. Chemical peels don’t have a single depth for resurfacing, but rather can vary from very superficial to deep. The specific chemical agent (i.e. TCA, glycolic acid, etc), concentration (i.e. 15% vs 30%, etc), method of peel, skin preparation, and skin type are some factors that determine the depth of skin peel.

Superficial chemical peels only treat the outer most layers of skin, with faster recovery but less aggressive results. Superficial peels are good for gentile skin refreshing and include the fruit peels and salicylic / glycol acid peels. These superficial peels are typically performed by aestheticians and at many med spas and can be repeated frequently. Results are temporary.

Medium depth peels are typically the TCA or Jessner peels. Medium depth peels are generally better for deeper wrinkles and skin irregularity. Initial recovery is generally within the first week after treatment, with continued improvement over time. Board certified physicians are performing such peels, which can repeated periodically Results are long-lasting.

Deeper peels are with phenol or similar agent. Deep chemical peels can dramatically improve one’s skin. Many plastic surgeons we’ve spoken with have commented how such deep chemical peels can produce the best aesthetic results, as compared to other resurfacing methods. However, there is much higher risk of complications and a much longer recovery period with such deep skin peels. Patients can only have one deep peel in their lifetime. Results are permanent.

Are TCA peels the safest and best peels?
There isn’t one best skin resurfacing procedure for all patients and skin types. However, generally speaking TCA is considered safe for chemical peel for essentially all skin types, when performed by a board-certified physician.

TCA, trichloroacetic acid, is a common agent used for chemical peels for the face. It comes in various concentrations (ex. 15%, 30%, etc) to allow for various depths of peeling. Chemical skin peeling with TCA is a quick cosmetic procedure and performed in the physician’s office. Downtime and initial recovery ranges from a few days to a week or so, mostly depending on the depth of the skin peel.

Redness of the skin is normal after chemical peels. Weeping, flaking, and irritation is also common in the early phases of healing. Many physicians will recommend a bland topical ointment, such as petroleum jelly, to keep the skin moist. One should always follow the strict pre and post peel guidelines of your cosmetic physician.

In future posts, we’ll review some light-based devices (i.e. laser resurfacing) and show some before/after patients in the healing process of chemical peels and long-term results. Have you considered a skin resurfacing procedure? What questions do you have?

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    Houtan Chaboki, M.D.