Medium Face Peels – TCA Peel

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In my previous entry I talked about how chemical peeling has been one of the oldest but most effective (and economical) ways to keep skin looking healthy and tackle some of the superficial signs of ageing. Being in Malaysia, where there is 12 hours of sunlight daily, and constant heat of 27-35 degrees year round, a lot of the deeper peels like Phenol peels and Obagi Blue Peels are banned from being used here. The weather and skin type of most asians do not allow the usage of these medium to deep peels. But they really do wonders.
So we are stuck with the light peels and some light to medium peels that doesn’t really give much difference, especially if you are a hard core peeler like me. Ironically, the medium depth peels get banned, but the rampant use of Lasers do not. But then again, my country is pretty funny when it comes to policies. And then there are TCA peels. TCA peels in Malaysia are strictly in clinic procedures and must only be done by the doctor and not a nurse.


So what are TCA peels?
TCA stands for trichloroacetic acid. When we talk about TCA peeling, it is meant for superficial-medium peeling of the skin. Unlike the AHA peels, it goes beyond the epidermis,and thus encroaching the upper dermis which allows a much more skin peeling to occur. Because of this, it has a downtime of between 5-14 days depending on the strength of the TCA used and the method and duration applied on to your skin. Usually it is more painful than your standard glycolic peel, and water is enough to neutralise the peel.


What are the benefits?
It peels deeper than the conventional superficial peels. So it does help to reduce fine lines, pigmentation and other epidermal issues. It lightens up melasma and previous hyperpigmentation due to various reasons and may remove some of your age spots.
What’s the catch?
The main catch is the down time. It will be pretty obvious if you peel, and usually would last a couple of days. The dead skin will appear darker and thus it is difficult to hide. In my case, I did the peel on Monday and although it has been a week, I still see some peeling areas especially laterally. I suffered during the second to the fifth day, as it was obvious I was peeling, but I had to go out and see patients and attend social events. I did try covering it with make up, but it became more obvious, so lastly yesterday, I did not wear any foundation, but rather enhanced the eye make up around my eyes instead. What would you feel? The first day, the skin would feel super tight. By day 2 and 3, the peeling would start and it usually starts from the midline. The skin that is going to peel would be scaly and turn darker and sometimes it looks like you have more pigments on your face. However, once it falls off by itself, you get pink fresh skin from below with less pigmentation seen.
It doesn’t look too bad on the photographs especially with all these new phone apps that make you look flawless, but it took a lot of confidence to just act normally although I know my face was peeling away.Plus, I had a tendency for post-inflammatory hyperpigmentation, so I had to be very careful not to accidentally peel off any of my skin by force that would cause PIH instead.
TCA-LP is a product from enerpeel, that is used in the clinic for TCA peeling. I’ve tried a few TCA peels in the market from Skintech, Obagi and others and I find that TCA-LP has some good points.
For starters, true to its name, it is less painful than your usual TCA (LP means Less painful). During this experiment stage, I was applying the TCA to my own face since my nurse and supplier was too afraid to do it. It came in single vials with a brush tip, and was for single use. I applied few layers on until frosting, and was left for 2 minutes before neutralizing.
The only thing I was a bit sad was that the suppliers cannot bring the 40% TCA-LP in as that would do wonders for more aged skin. Another thing is, you will need around 3-4 sessions to be done monthly to achieve the best results that can last for a year depending on your expectations. The good thing is, you can use superficial peels to maintain the results, although it may be every 2-3 months.


Suitable candidates
Since it is a medium peel, only for skin types I-IV . On a general rule, I try not to do medium peels on anyone darker than me, and for those with PIH tendencies like me unless they are a seasoned face peeler who really understands the complications and limitations. SO in English, it means caucasian skin, fair chinese and some other fair races. If you are chocolate milk come in for a consult. If you are darker than that, stick to superficial peels only and preferably by an experienced dermatologist or aesthetic doctor. Also if you are the type of person who cannot afford any social downtime, better stick to the superficial peels.
Still think that this is a home based procedure? The complications of a TCA peel may not be as bad as the deep peels but can cause a lot of distress to the patient.
1. Even though it removes hyperpigmentation, there are chances it can cause hyperpigmentation. Especially if the dead skin is forcibly removed and you have a PIH tendency.
2. Hypopigmentation – sometimes it can cause hypopigmentation especially if the TCA concentration is too deep and it was not neutralized properly or the person has skin types IV-VI. This is why we err on side of caution in darker skins. HYpopigmentation is harder to treat than hyperpigmentation.
3. Infection – sometimes you may get infection of the skin as it peels off but this is rare. Maybe in some cases of severe acne where the source of infection is already there or in immunocompromised people.
4. Scarring – scarring is always a risk especially if the procedure was not done properly or neutralisation part was not complete.
Doing this procedure in a proper medical doctors office can help reduce chances of complications. If your doctor does not know how to handle the complications, better find a more experienced one.
So in summary, the TCA peel is a very good skin rejuvenation method that is fast but requires downtime. The cost for a session of TCA-LP is RM 350 and you will need 3-4 sessions every 3-4 weeks for the best results.
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