TCA Peel

The function of a skin peel is to create an evenly controlled shedding of several layers of the damaged skin. This exposes a new, fresh layer of skin with a more even colour and smoother texture. In addition, the peel stimulates new cells to grow, thereby tightening the skin, which decreases wrinkling.

There are several types of peel, each using a different chemical to create this peeling effect. Light and medium depth peels use the chemical TCA (Trichloracetic Acid) to create the peel. TCA peels can effectively improve many conditions, including:

• dull, weathered skin
• freckling
• blotchy pigmentation (including the mask of pregnancy)
• sun damage (including pre-cancerous lesions)
• fine wrinkles
• shallow acne scars

TCA is a non-toxic chemical which has been used to perform skin peels for over 30 years. Unlike other types of peels, TCA peels have the additional advantage of creating a fresh, natural appearing complexion, whilst preserving the skin colour. For this reason, they are often referred to as “refreshing peels”. Although one peel can significantly improve the appearance of the skin, some skin problems are deeper than others. It is possible that you may require more than one peel to achieve your best results.

Is a TCA peel a painful procedure?

Yes. Chemical peels are acids. When applied to the skin there is a burning sensation. This is quite intense for 2-3 minutes and then gradually subsides over 15-20 minutes. You will be offered the two alternatives of having the peel performed with or without intravenous sedation.

When performed without sedation, it is helpful to take 1-2 Aspirin one hour before the procedure. This will help relieve the burning to some degree.

If you select to have the procedure done under intravenous sedation, you will be completely unaware of the procedure and have no recollection of it afterwards. However when you do wake up in recovery, you will still have some mild residual burning. When performed under intravenous sedation, you will be interviewed prior to the procedure by our visiting anaesthetist. He will go through a health questionnaire which you will have already filled prior to the procedure. It is particularly important that you have not eaten anything within six hours and not had anything to drink within two hours of the procedure, otherwise the anaesthetist will cancel the peel.

Assuming the anaesthetist is satisfied, you will be taken to the operating theatre where an intravenous line will be inserted into your arm. You will then drift off to sleep and you will be kept asleep or very drowsy, throughout. When you awake, you will be either still in the operating theatre or in the recovery room.

Whether the procedure is performed with or without intravenous sedation, it will be necessary for you to remain in the recovery room for at least half an hour to ensure that you are totally comfortable before leaving.

What happens to my skin during a TCA peel?

When TCA is applied to the skin, it causes the top layer of the skin to dry up and peel off over several days. When the old skin has peeled off, it exposes a new layer of undamaged skin which has a smoother texture and more even colour. This peeling process usually starts on day 3 - 5 and is preceded by facial swelling. The amount of swelling varies and can be quite profound. It will not however, be painful during this period. The peel generally commences around the mouth and extends over the remainder of the face, over a period of 5 - 10 days. It is very important that you do not manipulate the skin while it is peeling. A cleanser and ointment will be provided to keep the skin moist. Skin which dries out tends to crust and this will slow up the healing process. It is therefore very important that you keep the growing new skin moist with your ointments. You will be able to shower or bathe, but it is important to keep the water from splashing directly onto your face.

Once the old layer of skin has peeled, the underlying exposed skin is pink and sometimes bright red. This redness will subside over the next few days and generally disappears within three weeks. There will initially be a line of demarcation from where the peel extends to the angle of your jaw, as compared with the remainder of your neck. Once again, this line of demarcation will disappear over the next 3-4 weeks and can be camouflaged with a cream, once the peel is complete at 7 -10 days.

How much time will I miss from work?

Most people take 5-10 days to heal from an average TCA peel. During the healing process there is no pain but the skin is pink to red. Therefore, most patients choose to stay home during this healing time. However if you are not too self-conscious about your appearance, you may be able to work during part of your peel.

How soon can I resume my normal outdoor activities?

Anyone who has had a TCA peel is more sensitive to sunlight for at least a 6-8 week period after their peel. During this time it is very important to protect your new skin with sunscreens, hats and the avoidance of strong sunlight, however most people are anxious to protect their new improved skin from the damage of sunlight and they continue to wear sunscreen daily, even after they have healed completely.

Are there any possible complications following a TCA peel?

Most people suffer no complications following a TCA peel. In some instances however, it is possible that you may suffer from delayed healing, persistent erythema (redness), secondary infection, perioral dermatitis, acne, milia, skin sensitivity, hyperpigmentation or hypopigmentation. Generally these complications are mild and are readily treatable.

Are there restrictions on who can have a TCA peel?

As with any procedure, not everyone is a candidate for a TCA peel. Unlike other peels, those done with TCA usually do not permanently lighten the skin. Therefore they can be performed on patients with darker skin types.

Can TCA peels be performed on other areas besides the face?

Most people have similar ageing and sun damage changes on their neck, chest and hands as are present on the face. Fortunately TCA peels can be performed successfully on other non-facial areas as well. This is however, not without the risk of scarring. If this is of interest to you, you must discuss the possibility of a peel on these sites in greater detail with the Surgeon.

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