PEELINGS

TCA PEELING - GENERAL INFORMATION 

Chemical peeling with trichloroacetic acid (TCA) is an outpatient surgical procedure that involves applying a trichloroacetic acid solution at varying concentrations (15-50%) on the skin, which results in the destruction of the epidermal layer and, depending on the solution concentration, of part of the derma, and of the subsequent stimulus to dermo-epidermal regeneration. The purpose of peeling is therefore to produce a uniform and controlled exfoliation of the skin layers and regenerate a new epidermis. All areas of the body can be treated with this procedure, which is particularly effective for face, neck, legs, back of the hands The better the skin is prepared and subsequently treated with home treatments, the better the result of the peeling itself. Trichloroacetic acid is a non-toxic substance, is not absorbed by the body and have no systemic effects. Trichloroacetic acid has the power to destroy the epidermis, and possibly the derma, thus producing a lesion that heals with regeneration of the skin layers. A trichloroacetic acid peel results in a sort of chemical burn with a more or less intense full exfoliation of the skin, depending on the concentration of the acid and application time. This type of peeling determines total skin exfoliation and re-epithelization takes about 7 to 10 days to complete.

Chemical peel candidates:
The main indications are photoaging skin, superficial stains, not complicated acne lesions, fine wrinkles, stretch marks, freckles. TCA peel is the very outpatient peeling technique for the treatment of photoaging. For optimal results several treatments may be necessary. The application of the exfoliating agent determines a controlled injury that causes skin renewal. The depth of exfoliation depends on three factors: the concentration of the acid solution, time of application, and the amount of acid applied.

Results:
Chemical peeling with trichloroacetic acid is therefore able to grant an improvement of photoaging and skin texture, a reduction of discoloration and other pigmented lesions, reduction of wrinkles and some superficial scars. This procedure can temporarily change the size of the pores, improve skin laxity and mask stretch marks. It cannot improve wrinkles and deep scars, couperose or racial pigmentation. Over the two weeks preceding the treatment, any exposure to sunlight and UV rays, electric hair removal, cosmetic face clearing is to be avoided. On the other hand, it is recommended to fully and strictly follow such instructions as the preparatory use of a Retinoic Acid or Glycolic Acid cream to apply in the evening, in combination with a moisturizer during the day. Patients who suffer from herpes should follow an antiviral prophylaxis as the peeling treatment is able to reactivate a herpetic infection.

Surgery procedure steps: 
The area to be treated is prepared with a good detergent solution to eliminate the superficial hydrolipidic film and to allow a more uniform penetration of the acid. During the application the patient will experience a stinging and burning and heating sensation, which will disappear within a few minutes. The application takes place per zones to reduce the discomfort of the patient. The acid is left in place for as long as to obtain the desired effect and then rinsed away. After applying the solution, the face or the treated area, will appear whitish due to the coagulation effect of the surface layer. This whitish complexion will vanish within half an hour making room to rosy complexion.
After treatment an ointment medication is applied.

Post-operative treatment: 
The face should be gently cleaned twice a day with cold water. The water used can be added a teaspoon of cooking vinegar. The face, or the treated area, must be left to dry naturally or by blotting but never rubbing and must be always kept protected by means of a medication in the form of ointment. We recommend a mix of racy white soft paraffin and antibiotic ointment (Bactroban ®, Gentalyn ®), to be applied gently on the treated area. The application of these medications must be repeated so as not to allow the skin to dry (on average every 3-4 hours). The continued maintenance of a moistirising medication allows the skin to dry out and heal without forming scabs. This type of medication can develop millions of miles grains that will be deleted later.
Starting from the second day after the treatment, the surface layers of the skin show dark-brownish coloring and dead skin comes off. The stains may appear larger and darker at this stage. In the days following the peeling treatment, the patient may develop a edema affecting the treated tissue. Swelling should not alarm the patient even though it can sometimes cause discomfort (such as difficulty to open one's eyes). We strictly recommend not to try to reduce the edema with ice, because this would accelerate the exfoliation, which will impair the final result. Over this period, it is useful to minimize any face movements, especially those of the mouth, and try to sleep on the back, with the head slightly raised to avoid damaging the treated area. Exfoliation must take place in a natural way. The dead skin acts as a safeguard for the regenerated skin; the longer this natural protection remains within, the better peeling results are obtained. It is absolutely forbidden to try to accelerate exfoliation by pulling away dead skin. This may cause pigmentary or scarring complications which may result impossible to correct.
Any crusting should not worry and should be left to heal spontaneously in order to avoid risking residual hyper-or hypopigmented lesions. If the dead skin comes off partially, we suggest to take off the already detached portion with scissors. Healing is painless, but some itching may frequently be experienced. Should it be fastidiously persistent, then the patient will be prescribed a medication to relieve it.

Throughout the healing period all physical efforts that may cause sweating must absolutely be avoided. Intense physical efforts may cause redness of the treated area even relatively long after the peeling treatment has been performed. Once exfoliation is completed, the skin will appear rosy-reddish, shiny and extremely sensitive and should be treated with moisturizers and restructuring creams. A moderate use of cortisone creams can help reduce both redness and itching. After 2 to 3 days from complete re-epithelization, provided that the skin is not too sensitive, the patient can wear makeup. Redness will disappear completely within 2 to 4 weeks. Direct sunlight or UV rays exposure is strictly to avoid and the use of sunscreen creams is absolutely imperative over the following 8 weeks. Later on, the patient will always have to apply high protection sunscreen creams (at least 30 SPF). Once recovered its normal appearance, the skin will have regained its color and its natural texture.

Possible risks and complications:
Sometimes, a few patients may experience a very strong burning sensation during the application of the acid. In any case this sensation will disappear spontaneously within a few minutes after the application of the acidic solution. Some acne lesions can appear more evident initially, but then they gradually improve. Sometimes the patient may experience a bullous rush which will heal spontaneously. Sometimes bacterial or herpetic infections may develop, the latter more being frequent in patients who often suffer from it. When an infection occurs, it appears as a tense and more flushed area. Infections can be treated with antibiotics and antiviral medications. Sometimes scar reactions may develop in the treated area. They often involve excessive movement areas, such as the mouth or jaw. All these infections can be easily treated at an early stage. Sometimes the result is the presence of hyper-or hypo-pigmentation. In most cases these are related to a bad post-operative management, especially due to UV radiation exposure. In this case a depigmentation cream (hydroquinone-based) will help.