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Trichloroacetic Acid

About TCA Peels

The facial peel performed in our office does not use phenol. The main ingredient is trichloroacetic acid (TCA). This creates a peel that offers less risk of scarring and pigmentation changes than the phenol chemical peel. Because this peel is not as deep as a phenol peel, it is not as effective in improving deep wrinkles, but it can make marked improvements in blotchy pigmentation, freckling, sun damage, fine wrinkles, and some types of acne scars. When you have healed after a TCA peel, you should have skin that is your own natural color and texture.

The peel is an outpatient procedure performed in the office. It consists of the application of one or several layers of medication to your skin to create a controlled chemical burn. There is normally a few minutes of stinging and burning after the medication is applied. This usually stops within 2 or 3 minutes, and there is no more discomfort during the rest of the time you are peeling, although most people experience itching during the healing process. During the next several days, your skin turns darker, feels tight, then cracks and peels off, leaving you with a new fresh layer of skin. There are no scabs, bleeding, or bandages.

Post Treatment

After the peel, sunscreen must be used to protect the skin from the rays of the sun. You need to use it even if you are wearing a hat, since the reflected rays may also cause damage. Please request sunscreen samples if they were not given to you before your peel.

During healing, you should have no pain. Most people look strange during peeling, but if you don't mind your appearance, you are able to go out and even go to work. However, you will not be able to be in the sun or do anything that would cause you to perspire heavily.

The average peel takes 5 or 6 days to complete. Deeper peels, for heavily sun-damaged and wrinkled skin, may take 8 or 10 days. There are specific medicated creams you will need to use during peeling. You will be supplied all of this information on another sheet.

You may have some swelling during the first 2 or 3 days after your peel, particularly if it is a medium or deep peel. In extreme cases, your eyes may swell almost closed during the first two mornings. This is a normal response and will resolve on its own, but sleeping with an extra pillow to elevate your head may help to decrease swelling in the meantime. Do not apply ice packs or cold compresses to your face to decrease the swelling. The moisture from these may cause the skin to peel prematurely.

Do not expose your face to sunlight at all during healing. If you have to do some exercise, you may go out for a walk in the early morning or late evening when the sun is barely out.

Be sure and minimize facial expressions during your peel. Excessive facial movements will cause the skin to crack prematurely. This is not a good time to see a funny movie, visit your dentist, or eat a hero sandwich.

Home Treatment

Use the recommended soap to wash your face gently for 20 to 30 seconds twice a day. Lather the soap in your hands and gently pat it onto your face, then splash lukewarm water onto your face to rinse. Dry your face by patting it gently with a clean towel. If you have been instructed to use 3% hydrogen peroxide (which reduces the chance of getting an infection), use it diluted (mixed half and half with clean water) after washing your face twice a day. Gently dab it onto your face with cotton balls or gauze. It will bubble and may turn white. If hydrogen peroxide is too irritating and stings, you can dilute it even more with clean water.

After washing and patting your face dry, apply the daily lotion in the morning and at night. After the daily lotion has soaked in, apply ointment as instructed. Apply the ointment gently; don't rub it in hard. You should use the ointment as often as necessary to keep your skin from getting dry and cracked. We'd rather you be too greasy than not greasy enough. Don't let yourskindry out, it will pull on the new tissue underneath and may cause red, irritated areas. You can apply your ointment 10 times a day if you want! This will reduce the tightness and will make you more comfortable. Don't worry if all the ointment doesn't come off when you wash your face; it won't harm you to leave some on. You may develop occasional whiteheads because of all the ointment on your skin. This is normal , do not be alarmed since they will resolve over time. Also, be aware that some mild itching and burning is normal at this time.

Do I Have To Continue Treatment?

Most patients require more than one peel to achieve their best improvement. For most skin types, two peels are needed to give the best results, but some skin problems, such as excessive pigmentation from pregnancy or birth control pills, may require multiple peels for maximum improvement. Everyone's skin is different, so each person's peel program is tailored to his or her individual needs. Your skin will be examined and we will tell you what needs to be done for your skin to accomplish what you desire.

Some Tips After A TCA Peel

Don't pick or rub your skin at all. If you must wash your hair, wash it with your head tilted backward in the shower or in the sink. Do not wet your face in the shower, too much water will cause you to peel prematurely and will leave you with red, sore areas that may lead to scarring or need to be treated again. If large pieces of peeling skin are hanging from your face, they may be cut off carefully with a pair of blunt-nosed scissors. Do not sit in a sauna or jacuzzi or do strenuous exercise at this time. Sweating will make your face sting and it will cause you to peel too soon.

It is important that you try to sleep on your back so you don't rub your peeling skin against the pillow. This could create an area of prematurely peeled skin.

Makeup may be used 1 or 2 days after peeling is complete. We will recommend when you can wear it.

If you have unexpected irritation or possible infection, call the office immediately! Do not wait until your next appointment. This is especially important if you think you may be developing a cold sore on your lip. If you are experiencing a lot of itching, be sure you use plenty of Hytone ointment. You may also try using your daily lotion four or five times a day. (Refrigerating your lotion will make it feel more soothing.)