Dermatologists Swear by TCA Peels—Here's What You Need to Know

The term “chemical peel” evokes various emotions and facial expressions from my patients. For some, the term brings back memories of glowing, freshly exfoliated, hydrated skin. For others, the term conjures a previous bad experience or dramatic images they’ve previously seen on the internet and the thought “not for me.” In this article, we’ll demystify TCA chemical peels. I’ll explain what they are, who they're best for, what it feels like to undergo one, and the potential benefits.  

What Is a Chemical Peel? 

A chemical peel is a procedure that chemically exfoliates the skin. Chemical peels range in depth from superficial, medium, and deep chemical peels. Superficial chemical peels exfoliate only the top layer of skin, while medium and deep chemical peels exfoliate into the upper and mid dermis, respectively. 

Superficial chemical peels are effective for texture irregularity and evening of the skin tone, while medium to deep chemical peels are effective for skin tightening and diminishing fine lines and wrinkles. 

In general, the time to heal and potentially adverse reactions increase with the depth of the chemical peel. For this reason, medium and deep chemical peels are typically avoided in darker skin tones, due to increased risk of scarring and hyperpigmentation. 

What Is a TCA Chemical Peel? 

TCA stands for trichloroacetic acid. 

The term TCA chemical peel is somewhat vague because TCA peels can vary from very light to deep chemical peels, depending on the concentration of TCA and whether it is combined with another type of chemical peel. For reference, 10%–30% TCA provides a superficial peel, while 30%–40% TCA provides a medium-depth chemical peel, and 50% or above TCA provides a deep chemical peel. 

Benefits of a TCA Chemical Peel 

The benefits of the TCA peel will depend on the depth of the chemical peel. Superficial TCA chemical peels provide improvement in skin texture, a decreased number of whiteheads and blackheads, and evening of skin tone. Medium-depth TCA chemical peels provide improvement in fine lines and wrinkles.

TCA is not the best agent for deep chemical peels, as it can become somewhat unpredictable, but deep TCA peels would provide improvement in wrinkles and skin tightening.

How to Prepare for a TCA Chemical Peel

It is, of course, important to follow the specific directions given to you by the person who is to perform your chemical peel. I would caution against having medium-depth chemical peels performed outside a dermatologist office. Deep chemical peels should be performed only by a board-certified dermatologist or a plastic surgeon.

It is important to review your calendar before scheduling a chemical peel. Skin will typically peel for 4–10 days with a chemical peel. Check your calendar and make sure you don’t have any important events or dates within your peeling window. Although you can wear makeup during your recovery, peeling skin is sometimes difficult to hide. 

It is also important to avoid sun exposure as the skin is healing. So don’t plan to get a peel right before vacation. It’s also advisable not to have a fresh tan on the day of your procedure. 

Your aesthetician or physician will likely want you to hold your nightly retinol or retinoid a week before your treatment, but this should be confirmed. For superficial peels, it is sometimes useful to prime the skin with retinol or a retinoid before. 

If you have a history of cold sores, your physician will prescribe you a prophylactic medication to minimize the changes of an outbreak for medium-depth chemical peels. 

What to Expect During a TCA Chemical Peel

The actual treatment process is fairly quick. It’s best to show up to your appointment without makeup. If you are coming from work and tend to wear heavy makeup, it’s a good idea to bring your favorite effective makeup remover so that you can remove your makeup yourself. 

As the first step, they will degrease your face with acetone, which smells a lot like nail polish remover. This feels a little cold and weird, but it’s an essential step, because it allows the peel solution to interface with your skin effectively. 

Next, they’ll apply a protectant to the corners of your eyes, nose, and lips. Since these areas naturally dip down, there’s a risk of peel solution accumulating in them. So, a thick ointment is applied to protect them. 

In the next step, the actual peel will be applied to the face with either a cotton tip applicator or a gauze pad. This is usually accompanied by tingling and warmth in the treated areas. Often, one area may respond more vigorously than another. A fan is typically enough to mitigate discomfort in a superficial peel. Oral or inhaled analgesics may be used beforehand for medium-depth chemical peels.

The number of layers applied will depend on the desired depth of the chemical peel and your skin’s reaction. The person applying your peel will watch carefully for the desired end point. 

Once the desired end point is reached, usually within 3-5 minutes, the skin is cooled with cold water. A thin balm is applied to protect the skin, and the procedure is over. 

Aftercare

Aftercare will be explained in detail after your procedure, but in general it’s important to keep it simple and gentle. You’ll cleanse your skin with a gentle cleanser, and moisturize with a bland ointment or moisturizer. It's important to also practice diligent sun protection.

Depending on the depth of the peel, the skin will likely peel between four to 10 days. It’s important not to attempt to speed up the peeling process by picking at the skin, as this can increase chances of infection, poor healing, and dark spots. Regular skincare can be resumed once the skin has been fully repaired from the chemical peel and feels back to normal (normal but better).

TCA Chemical Peels vs. Other Chemical Peels 

TCA peels are the most versatile chemical peels of all chemical peels. From a professional standpoint, that makes it a great tool, because it can be used at various concentrations and application techniques to treat almost any condition. However, from a patient perspective, the only thing that matters is if it is the right procedure for you. In general, the most important step in selecting a chemical peel is choosing a provider who knows what they’re doing. My colleagues and I all have different go-tos for treatment of similar conditions.

At-Home vs. In-Office/Professional

In general, TCA peels should be performed by a professional. The number of layers and pressure of application affect that depth of penetration for this peel, so it should not be performed at home. Medium-depth chemical peels should be performed only by a board-certified dermatologist.

For your reference, the depth of penetration is what differentiates an at-home chemical peel versus an in-office/professional treatment. At-home chemical peels are very superficial in order to make them fool-proof. It will take several at-home treatments used at routine frequency to equate to one superficial in-office peel. However, at-home peels typically do not have noticeable peeling compared with in-office treatments, and therefore have little to no downtime. There is no at-home equivalent to a medium-depth peel; no amount of at-home peels will create the same effect, because in-office medium-depth peels penetrate much deeper than at-home treatments. 

Potential Side Effects

The potential side effects for a TCA chemical peel include the risk of hyperpigmentation and the risk of scarring. Risks are minimum with superficial TCA peels, but become more substantial in medium to deep peels. Darker skin tones should proceed with caution when it comes to medium-depth chemical peels, and should have this procedure performed only by an expert familiar with treating darker skin tones. 

TCA peels are moderately reactive, so those with eczema and rosacea should proceed with a test spot before moving forward with full treatment.

The Cost

The cost of a chemical peel is variable depending on where the peel is performed and the expertise of the person performing it, but it is typically comparable to or cheaper than a superficial laser treatment. 

The Final Takeaway

Chemical peels have been around for a while but are still a very effective treatment option for most skin concerns, including acne, hyperpigmentation, melasma, uneven skin texture, and fine lines and wrinkles. TCA chemical peels are among the most versatile type of chemical peel, with a wide range of depths and treatment options. Superficial treatments are effective for treating whiteheads, blackheads, uneven skin texture, and pigmentation, while medium-depth peels are more effective for fine lines and wrinkles. Since the risk of adverse events increases with the depth, it’s important to have this peel performed by a knowledgeable professional.