- TCA peels are used to treat acne scars, hyperpigmentation, melasma, fine lines and sun damage.
- These peels are performed at light or medium strengths and require days or weeks of downtime.
- TCA is safe for all skin types when the appropriate precautions are taken.
- At-home peeling kits carry the risk of damaging skin and should be used with caution.
Trichloroacetic (TCA) peels are a type of chemical peel used to treat a wide range of skin concerns including signs of aging, sun damage, hyperpigmentation and scarring. TCA peels are most commonly performed at medium strengths which require some downtime, but offer significant improvements to the skin’s appearance.
What Is a Trichloroacetic Chemical Peel?
TCA is derived from acetic acid, a derivative of vinegar, and is available in concentrations ranging from 15–70%. 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. Medium peels of 30–35% treat deeper wrinkles, deeper scars and precancerous growths.
Although TCA in higher concentrations was used for deep full-face peels in the past, it is no longer recommended due to the risk of postprocedural complications. In concentrations up to 70%, 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 noticeable 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 postinflammatory hyperpigmentation, the dark spots of discoloration that appear after a blemish has healed. One study found that TCA was more effective than microdermabrasion, microneedling and glycolic acid at removing acne scars.
Atrophic acne scars, commonly called icepick or boxcar scars, can be effectively treated with high concentrations of TCA (70%) using the CROSS 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 sunspots—flat, brown spots that develop due to sun exposure—and improving skin tone and texture. It has been proven particularly effective at increasing skin elasticity and hydration, two signifiers of healthy, undamaged skin.
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, however multiple peels are usually necessary to see significant changes in the appearance of skin. Conversely, TCA can substantially reduce hyperpigmentation and sun damage with a single treatment. With multiple treatments, it can effectively treat 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.
As an alternative to a single deep phenol peel, a series of medium TCA peels can significantly improve the skin without the extensive downtime, risks and permanent skin changes of a deep TCA peel.
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 for those with very light and dark skin to mitigate the risk of permanent 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 or salicylic acid peels, microdermabrasion and microneedling. More severe skin damage and signs of aging can be treated with laser skin resurfacing.
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 if your provider determines it will shorten your treatment time and improve your results. This same principle applies for bleaching agents such as hydroquinone.
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 high SPF throughout the recovery phase. Do not pick at or peel the skin, as this can lead to scarring.
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 patients three months after their final treatment.
How many TCA peels does it take to see results?
Your skin’s overall appearance will be improved after one peel. However, to address severe scarring, hyperpigmentation or sun damage, a series of peels is usually necessary to obtain fully clear skin.
You can schedule another TCA peel a few weeks or months after the first, depending on your skin’s reaction to the procedure. Once you’ve obtained your desired results, you can schedule maintenance peels every one to two years.
Before and after
Safety and Side Effects
Although chemical peels are generally considered safe, medium peels carry higher risks of complications than light peels do and require downtime.
Expected side effects include swelling, itchiness and burning. You may experience redness or changes in skin color that last for several months after the peel. Very light and darker skin tones have a higher risk of postpeel hyperpigmentation and skin discoloration.
How Much Do TCA Peels Cost?
The cost of this procedure depends on where you live, the surface area being treated and the strength of the peel. The provider’s experience and the desired results desired can also increase costs.
While day spas and medical spas may offer lighter TCA peels at comparatively low costs, medium-strength peels should only be performed by a board-certified dermatologist or physician. With those factors in mind, full-face TCA peels range from $300 to $1,000.
At-Home TCA Peels
If you are interested in a TCA peel, it is best to contact a dermatologist to assess your skin’s needs and eligibility for a peel rather than proceed on your own and risk damaging your skin.
While TCA solutions in professional strength concentrations are readily available for purchase online, it is strongly advised to avoid these products. Improper use carries a high risk of chemical burns, skin discoloration and permanent scarring.
If you do choose to perform a TCA peel at home, start with a low concentration of 10–15% to test your skin’s reaction. Do not attempt a peel of 20% or higher outside of a dermatologist’s supervision.
Alternatively, you may also try glycolic acid, lactic acid or salicylic acid products designed for at-home use. These products are much safer for your skin and can achieve good results over time.
TCA peels can treat many skin issues, including sun damage, acne and acne scarring, and hyperpigmentation. Although substantial improvement may be seen after just one peel, multiple peels may be necessary based on the severity of your skin issue, and to obtain your desired results.
TCA peels involve a recovery period of a few days to several weeks, depending on the strength of the peel. Side effects include redness, swelling and peeling.
TCA peels are best performed by a board-certified dermatologist. If you choose to administer a TCA peel at home, use a product from a reputable source and avoid any solutions containing more than 10–15% TCA.
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