TCA Peel: Everything You Need To Know

by Dr. Tishya Singh

Don’t you wish that there was an instant way to get brighter looking skin or get rid of those pesky zits and pigmentation? Well, there just might. Say hello to chemical peels!

Chemical peels have been used for thousands of years to obtain beautiful skin. Early records show that they were used by Egyptian women who used to apply sour milk to their skin. This sour milk contained lactic acid, which is used in facial rejuvenation treatments even today. Even in India, women used pumice stones to exfoliate the top layers of their skin. Since then, chemical peels have become much more sophisticated and an indispensable procedure in the dermatological practice (1).

Chemical peels are a means of rejuvenating the skin by removing the superficial dead skin cells and stimulating new and healthy epidermal cells. They are designed to introduce a controlled injury to the skin at a specific depth. As it heals, it improves the skin’s texture and appearance (2).

Trichloroacetic (TCA) peel is a light chemical peel that is either alone or in combination with other chemicals to treat numerous skin conditions. It can be used to achieve a number of depths in the skin, which is why it is known as the “workhorse” of chemical peels. In this article, we’ll discuss all you need to know about TCA peels.

What Is A TCA Peel? Is It Good For Your Skin?

Trichloroacetic acid (TCA) was first discovered as a peeling agent by a German dermatologist in the 19th century. Since then, it has been used in a myriad of combinations and concentrations to treat many skin conditions (3).

TCA occurs naturally as colorless crystals, which are mixed with distilled water to obtain a liquid. According to its concentration, TCA peel can fall under the category of either superficial or medium-depth chemicals. It is great for treating various dermatological conditions.

Who Is A Good Candidate For A TCA Peel?

A TCA peel may not be suitable for everyone. Here is are some things you can take note of to figure out if you are a good candidate for a TCA peel:

  1. Only patients with realistic expectations from the procedure should get it done.
  2. Patients with keloidal tendencies should avoid TCA peels.
  3. Pregnant and lactating women should not get TCA peels.
  4. People who are allergic to TCA should (obviously) avoid chemical peels.

You are likely to be pleased with the results of a chemical peel if your goal is to alleviate acne, smoothen out wrinkles, improve skin texture, eliminate age spots, or reduce the effects of sun damage (4).

What Are TCA Peels Used For? 

TCA peels are used to treat a number of skin conditions.

  1. 10% TCA peel is used for facial rejuvenation and resurfacing. It is also used to treat pigmentation, active acne, fine lines, and wrinkles.
  2. 15-25% TCA peel can be used on different regions of the body to reduce acne and post-acne pigmentation.
  3. 100 % TCA peel (called TCA cross) can be used for acne scars as well as xanthelasma palpebrum (fat deposits on the eyelids).

How Does A TCA Peel Work?

Chemical peels are divided into three different categories depending on the depth of their penetration. Depending on the concentration of TCA used and the number of coats applied, TCA peels can be labeled as superficial, medium-depth, and deep peels. Deeper the peel, greater the result.

However, deep peels are a more aggressive form of treatment and require a longer downtime for healing. They also have an increased risk of complications as compared to superficial or medium-depth peels.

TCA peels work by two mechanisms:

  1. They cause coagulation of the proteins present in the superficial and deeper layers of the skin.
  2. They cause controlled destruction of the collagen of the skin.

When this skin peels off, it leads to the formation of a layer of brand new skin cells. Once the TCA penetrates the skin, it cannot be neutralized. Instead, it self-neutralizes once it coagulates a certain amount of protein. Therefore, a subsequent application will continue to drive the peel deeper until it is used up by coagulating proteins deeper down in the skin (5).

Now that we know how these peels work, let us understand how they are applied.

How Is TCA Peel Applied? (Procedure)

TCA chemical peels are applied in the following manner:

  1. Your dermatologist will first de-grease your skin with acetone to remove all the dust and dirt on it.
  2. They will then use a brush or gauze to apply the peel on the skin. Since TCA peel works on the principle of self-neutralization, they will not neutralize it separately.
  3. You may experience a little bit of burning or itching on application. The doctor may use cold water or a handheld fan to provide relief.

You need to be diligent with applying sunscreen after getting chemical peel as it leaves your skin extremely delicate and vulnerable to damage. Remember, 10% TCA peel is suitable for the face, and 15-25% TCA peel is suitable for the rest of your body.

Let us now look into the benefits of TCA peels.

What Are The Benefits Of TCA Peels?

TCA peels are used to treat a multitude of dermatological conditions.

  1. They help in smoothening the skin and giving it a uniform texture.
  2. They also help in reducing different types of pigmentation, like melasma, freckles, post-inflammatory hyperpigmentation, and pigmentation caused by acne.
  3. TCA peels help in reducing acne scars (specifically ice pick scars).
  4. They help in decreasing fine lines and wrinkles caused by aging and photoaging. They also create an anti-aging effect by stimulating the production of collagen and elastin in the skin, giving your face a youthful glow (6).

Though TCA peels can do wonders for your skin, they also come with their own set of side effects. Check them out in the next section.

What Are The Possible Side Effects And Complications Of TCA Peels?

The complications caused by TCA peels can be divided into immediate side effects and delayed side effects.

The immediate side effects are:

  • Common side effects like irritation, itching, and pain.
  • Less common side effects like persistent redness and mild swelling.

Delayed complications that may occur within a few days to weeks include:

  1. Infections (bacterial, fungal, or herpetic)
  2. Hypopigmentation or hyperpigmentation

3 Scarring or textural abnormalities in worst care scenarios

These complications may be avoided if the skin is primed properly before the procedure, doing the first sitting with a low concentration of TCA peel, and diligent application of sunscreen and moisturizer after the treatment (7).

You can also follow the aftercare tips listed in the next section to avoid these side effects.

TCA Peel Aftercare Tips

After a TCA peel, you will be advised to do the following:

  1. Wash your face with plain water or a gentle cleanser. Don’t rub your face excessively. Pat it dry with a soft towel.
  2. Apply a fragrance-free moisturizer at least three times daily.
  3. Sunscreen application is a must. Wear a broad-spectrum sunscreen (SPF 30 or above). If possible, cover your face with a scarf or wear a hat while out in the sun.
  4. Avoid picking on the skin that is peeling off as it could lead to pigmentation.

Remember, the procedure can cause swelling, redness, crusting, dryness, skin sensitivity, itching, and obvious peeling that may last for 12 weeks. In the days immediately after the peel, your skin may also feel and look tight. These are expected reactions and completely normal (8).

Reading about all the amazing benefits offered by TCA peel, you may be wondering…

How Much Does A TCA Peel Cost?

A light chemical peel, like a TCA peel, can cost anywhere $150 to $300, depending on the proficiency and experience of the doctor as well as the cost of living in the area where the clinic is located. If TCA peels are done in combination with other peels in one sitting, they will be more expensive.

TCA is considered to be the gold standard in chemical peeling agents. It has been studied extensively and is versatile in its ability to create superficial, medium-depth, and deep peels. It is inexpensive and causes no systemic toxicity. It is easy to perform as the peel depth correlates with the intensity of skin frost, and there is no need to neutralize a TCA peel.

All in all, if you are looking to get a chemical peel, a TCA peel is a good place to start. If you have any more questions about this procedure, leave them in the comments section below, and we’ll get back to you.

Expert’s Answers for Readers Questions

How often can you get a TCA peel?

You can get a TCA peel done every 3-4 weeks after all the superficial layers of the skin from the preceding peel have fallen peeled off.

How long do the effects of TCA peels last?

When it comes to a lower concentration TCA peel, the skin remains red and irritated for a few days and may start peeling off from anywhere between the second day to the seventh or eighth day. It may take 2 weeks to see the final results. Bear in mind that if you are looking to achieve a particular level of results, multiple sessions at regular intervals may be required.

What is the recovery time for a TCA peel?

TCA peel has a downtime or recovery time of around 7-8 days.

What is the strongest TCA peel?

Don’t go beyond 10% TCA peel for the face and 25% peel for the rest of your body.

Can a TCA peel be performed at home?

Never attempt to do a TCA peel at home. TCA peels have the potential to cause deep burns and scars if used in the wrong concentration and manner. They should always be done under medical supervision as they have a number of side effects.

Can pregnant and lactating women get this procedure done?

TCA peels should be strictly avoided by pregnant or lactating females. So, hold off on such cosmetic procedures till post-lactation.

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Dr. Tishya Singh

Dr Tishya Singh is a consultant dermatologist and cosmetologist based in Chandigarh. She completed her post graduation (DNB) in dermatology from Mumbai in 2017. She has a number of publications in national and international journals. She has a keen interest in acne, anti-aging modalities, and hair revival procedures. In her spare time, she loves to read and sketch.