Light Chemical Peels
Many people don’t relish the idea of two weeks in hiding while waiting for their new skin. Less drastic types of peels were introduced in the 1980s, using trichloroacetic acid (TCA). This procedure hurts when performed, but peels more superficially than when phenol is used. The epidermis and superficial dermis peel, healing in five to eight days. The more superficial the peel, the fewer wrinkles are removed.
TCA concentrations range from 15 percent to 50 percent, alone or in combination with other chemicals. Higher concentrations result in deeper peels. The TCA peel is useful for pigmentation irregularities, such as sun-damaged skin and discoloration from pregnancy. It helps wrinkles and other sun damage. Acne and large pores are improved. Even some premalignant conditions can be corrected.
Literally dozens of factors can be altered in the TCA procedure, resulting in different levels of peeling. The thickness of the skin, the pre-peel use of creams, the type of cleansing the day of the peel, the TCA concentration, how hard the chemical is rubbed in, how many strokes the surgeon uses to apply the peel, and how the peel is cared for afterward all affect the result. The TCA peel is part art and part science.
To try and achieve better results, TCA has been combined with dry-icepeels, Jessner’s solution (resorcinol, salicylic acid, lactic acid, and ethanol), methyl-salicylate, and glycolic acid. None of the combinations is better than TCA alone.
In the 1990s, Zein Obagi, M.D., the Beverly Hills dermatologist, added a blue dye, glycerin, a thickening base, and soap to the TCA. He could better judge the depth of this ‘‘blue peel.’’ In the hands of experienced doctors, the results became more predictable.
Many people do not want any downtime. Not only does it take nearly a week for the TCA peel to heal, but there can be two weeks of redness afterward.
TCA Peels Are the ‘‘Long Weekend Peels’’
TCA peels require extensive preparation. Patients must ‘‘reprogram their DNA’’ with at least two weeks of tretinoin in order to achieve an even peel. In addition to the tretinoin, two weeks of a pigment reducer (hydroquinone) is helpful. You won’t actually see any lightening of the skin, but the drug turns off brown pigment production in the skin. Without it, the pigment-producing cells can go wild after the peel, leading to splotchiness. These two drugs remind me of the chemicals used on lawns to get the grass all growing the same way!
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