• Superficial wrinkles of the face, neck, upper chest, or arms
• Fine wrinkling around the mouth/eyes

Only a physician can do moderate (20% trichloracetic acid, or TCA, solution) and deep peels (35% TCA).

When should I consider a TCA peel (20% or 35%) for resurfacing to the full face?

• Deep facial wrinkling
• Uneven pigmentation problems caused by sun exposure, prescription drugs, or disease or uneven texture changes
• "Age Spots"
• Enlarged facial pores
• Superficial acne scars of the face 
  
  
  Anticipated Results:
  
  TCA peeling is a procedure for rejuvenating facial skin.  It restores a healthy, rosy glow to the skin, eliminates fine facial wrinkles, diminishes cross-hatching of the lower eyelids, improves pigmented areas on the face and other regions of the body due to sunlight damage, and promotes skin contraction.  Complete removal of wrinkles and correction of facial pigmentation should not be anticipated.  The degree of response to TCA peeling varies with each person.
  
  

  BEFORE TREATMENT

  Preparation of the skin before peeling is critical to the success of the procedure.  The skin is conditioned by applying Retin-A and hydroquinone for 4 to 6 weeks prior to peeling.  Dr. Short recommends using her own formulation or Retin-A to obtain the best results called PSBM cream.   PSBM Cream contains the following formulation:  .05% Retin-A, 5% Hydroquinone, and 0.5% Hydrocortisone cream.  This special combination of agents will exfoliate the skin and prepare the skin surface for a resurfacing procedure. You should apply this cream evenly over the entire area that is to be peeled at least once a day.  Dr. Short also recommends one to two skin care treatments prior to the TCA peel to maximize the results after the procedure.

  DURING TREATMENT

  A degreasing agent will be applied before the peeling process begins.  When the TCA is applied, most individuals experience a flushing or reddening of the skin followed by a frosting of the skin that usually lasts for less than an hour.  The slight stinging from the application can last up to 10-20 minutes.  The staff will apply cool compresses and fan the area to help reduce the discomfort.  Any minor discomfort will be over by the time you are discharged.  Aquaphor will be applied following the procedure.  Bandages are not necessary.

   

  AFTER TREATMENT

   

  If you have been sedated, you will need to arrange for someone to drive you home from the office.  There is usually very little discomfort associated with the TCA peel.  Healing should be complete in 5 to 7 days, depending on the depth of the peel.

  Initially the skin is slightly red.  Eventually it becomes dry, often brown in pigmentation, and a crust will form.  You will be instructed to perform cleansings to the skin every 4-6 hours depending on the exudate/peeling formed utilizing saline and 4 x 4 gauze.  You will receive the saline and gauze from the office on the day of your procedure.  You will moisten the gauze and/or a Q-tip to gently cleanse the skin, working off the peeling skin and exudate.  Following a cleansing, you will apply aquaphor to the skin to keep the skin moist. You will then re-apply the lubricant known as Aquaphor at least four times a day; preventing the skin from drying out.  This daily routine is followed until the peeling is complete. You will continue this process of cleansings and application of aquaphor until the skin is resurfaced at 5-7 days. Wash the face prior to each application of ointment. 

   

  The redness of the skin may slightly intensify or become brown until the flaking is completed.  After this, a standard facial moisturizer can be substituted for the greasier emulsions. The new skin should be evident within 5 to 7 days.  By the end of 1 week, the pink color should have faded to a light pink and have the appearance of a mild sunburn.  The coloration usually fades completely within 2 to 3 weeks.  You may use cosmetics as soon the peeling process is finished and skin is resurfaced.  Please do NOT exposure your skin to any sunlight especially when healing for the first 4-6 weeks.  Please be careful with riding in the car, keep a scarf or hat on to keep the skin protected.  Please do not sit in front of an open window at home for extended periods of time.

  A sunscreen that has at least a 20 SPF (SHADE-UVA/UVB) must be used as soon as the skin is resurfaced; usually at 5-7 days.  And you must continue to use the sunscreen every day to protect the skin.  Establish the habit of applying the sunscreen in the morning before you leave your home.  The use of sunscreen will prevent the risk of hyperpigmentation or discoloration following the procedure and maintain the results from the TCA Peel. 
  
  TCA Peel Examples:
  
  Patient 1 and Patient 2 had a TCA peel for skin resurfacing.  The patients are pictured before and after at 5 weeks.  Note the patient's significant improvement with the skin texture, hyperpigmentation, and overall appearance of the skin.
  
  

  Patient  1
  Before	After
  Patient  2
  Before	After