Deep Peels At A Glance
- Best Results1 session
- Treatment Recovery5-10 Days
- Procedure Time40 min
- Skin SpecialistDermatologist only
- Duration of Results4-10+ years
- Back to Work6-10 days
Deep Chemical Peels / TCA Peels
Deep chemical peels can remodel collagen, improving scars, wrinkles, sun damage & resistant pigmentation. Downtime following deep peels range from 7 to 14+ days. My favourite peeling agents include phenol croton oil & modified TCA. Recent scientific papers show that deep peels outperform lasers when it comes to collagen stimulation.
FactsFact on Deep Chemical Peels
- Deep peels reach the mid layer of the dermis
- At this depth peels can address wrinkles, elastosis, pre-cancer skin cells & scars
- I frequent combine peels with laser resurfacing as a compromise between downtime & best results
- This peel is conducted under partial sedation
- For extensive areas cardiac monitoring is required for phenol croton oil peels
- Recovery from this peel is prolonged, sometimes reaching 4 weeks or more
What is a deep chemical peel?
Chemical peels can be classed according to the depth of skin penetration.
- Very superficial peels: include retinoic acid- retinoid peels, enzyme peels, & majority of skin clinic peels
- Superficial peels: include AHA peels such as glycolic acid peels, lactic, mandelic, citric acid & BHA peels such as salicylic acid peels. Stand alone Jessner peels.
- Medium depth peels: These peels remove the entire top part of skin, known as the epidermis. TCA 20-35% peels are classic medium depth peels that penetrate to the papillary dermis.
- Deep chemical peels: These peels penetrate into the deeper dermal layers. Jessner – high strength TCA as well as Phenol-Croton Oil peels are examples of deep peels.
What conditions can deep peels/ TCA peels / Phenol Croton oil treat?
Medium to deep chemical peels can treat-
- Sun damage including pre-cancer solar keratosis & sunspots
- Skin pigmentation including age spots, freckles & age warts
- Fine lines, & wrinkles
- Sagging skin & decreased elasticity
- Crow’s feet & under eye skin laxity
- Dark circles
- Enlarged pores
- Superficial acne scars (ice pick, box car)
- Dull skin
How is this peel performed?
In some cases, I prepare the skin weeks before peeling. Twice daily use of sunscreen is a must. Pre-peel prep is not mandatory for deep peels, I will guide you according to your skin type & concerns.
Day of Peel: Numbing cream is applied 1 hour prior to the procedure, at the same time anaesthesia consisting of a sedative & pain medication will be given by a nurse. Medium to deep peels are always conducted under partial sedation.
*Cardiac monitoring is mandatory during deep phenol croton oil peels exceeding 25cm2. *Not required for focal deep peels, such as Phenol Paint for acne scars.
Peel itself: Skin prepped with degreasing, then disinfected. The chemical of choice will then be applied with either a gauze applicator & or cotton tips. This process will take between 20 to 40 minutes to perform.
After care: There will be no pain post procedure. My nurses will go through the post-peel after care & an instruction sheet given after the event. All patients who undergo medium to deep peels are followed up within 24-48 hours post procedure.
Depending on the depth of peel, skin healing will take between 8 to 14 days to fully heal.
How long does it take to recover from deep chemical peels?
7-14 days, depending on the strength & depth of the peel. TCA / Jessner TCA peels are medium to deep peels, whilst Phenol-Croton Oil peels are deep peels. An accurate down time will be predicted based on the clinical examination & planned peeling agent.
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Is this peel painful?
For this type of peel, I sedate all patients. The use of topical anaesthesia, chilled air, nerve blocks (in some cases) & sedation makes this peel well tolerated by all. Post procedure recovery is painless.
Some patients experience mild to moderate itching around day 3 to day 7 post peeling. This itch is due to a combination of new skin formation as well as sweat gland occlusion. The use of saline soaks & antihistamines can alleviate the itch.
What is a Jessner TCA chemical peel?
Jessner TCA is a medium to deep chemical peel which consists of two peels in the one session. Jessner contains AHA & BHA (lactic & salicylic acid) with another keratolytic known as resorcinol. The first step of the peel primes the skin for the second peel, namely TCA. This allows more uniform & deeper penetration without the risks of employing a higher TCA concentration. In the context of TCA, I perform 1-4 coats depending on clinical features.
The majority of my medium to deep peels are conducted under mild sedation. In some cases I employ the use of lasers to treat deeper areas of pathology; around the lip or eyes for example. The entire procedure takes approximately 20- 40 minutes to perform.
Do chemical peels remove acne scars?
Medium to deep chemical peels can treat certain forms of acne scarring, classically ice pick & box car scars. This type of chemical peel is called ‘focal or regional’ peels, as the peeling agent is applied to the skin scars with little or no collateral damage to normal skin. CROSS or Chemical Reconstruction of Skin Scars is an example of this peel. I use both TCA (80 to 100%) as well as Phenol (88%) Croton Oil to treat suitable scars.
Can melasma be treated with strong chemical peels?
No. In the past, dermatologists employed medium to deep peels for the management of melasma. The results from week 2 to 4 were spectacular! The downside was that the majority of patients rebounded, with melasma coming back equally as severe, and in some cases worse than the pigmentation pre-peel.
The only exception I make to this rule is potentially dermal melasma resistant to conventional therapy. Dermal melasma is resistant to all forms of treatment. Careful consideration and consent will be taken if deep peels are contemplated as the chances of rebound & post inflammatory hyperpigmentation is significant. I prefer to employ novel peels for melasma.
How does this peel compare to laser resurfacing?
In some situations, chemical peels are actually better than laser resurfacing, hence why all procedural dermatologists will have the knowledge and skill sets to perform medium to deep chemical peels.
In the context of on label fractional lasers such as Fraxel & Clear & Brilliant, deep peels will give better results compared to lasers. Even if one takes into consideration cumulative downtime & sessions required with fractional lasers. The flipside is that the risks of post inflammatory hyperpigmentation is higher with medium to deep peels.
How do deep peels compare with microneedling?
Medium to deep peels give much better results than microneedling, even RFM or radiofrequency based microneedling. Peels treat the entire surface of skin, unlike microneedling, which can be classed as a fractional procedure. Scientific papers have shown that peels generate more collagen than lasers or microneedling.
How do chemical peels compare with Picosure - Picosecond Lasers?
For patients with lighter skin type (Type 1 or 2) with skin quality-textural issues I firmly believe that medium depth chemical peels can give much better results in one treatment compared to pico lasers. For patients who have olive skin-ethnic skin, Pico lasers can give better results with less risks compared to chemical peels.
What are the risks associated with deep peels?
The main risk is post peeling skin colour changes known as post inflammatory hyperpigmentation. This is more common in ethnic skin types and can be mitigated with strict sun protection & in some cases the use of bleaching creams pre & post peel.
Infection risks can be markedly reduced with post-peel skin care in addition to antiviral medications (if you have a history of cold sores).
Scarring is extremely rare. In most cases it is secondary to cold sore infections or abnormal production of collagen.This can be slowed down with vascular lasers, silicone gel & dilute anti-inflammatory injections. Scars are more common if deep peels are used on the neck, chest & decolletage areas.
How do I maintain the results after a chemical peel?
Maintaining the result is equally as important as achieving the result. My top 3 tips are-
- Sunscreen, Sunscreen, Sunscreen. Twice a day, regardless of sun exposure. Once before work, another reapplication at midday or before travelling home in the afternoon. Hats as adjunctive UV protection.
- Retinol post peel can help maintain collagen as well as reduce skin pigmentation. Start off with a good over the counter retinol before prescription retinoids.
- Antioxidants can reduce UV induced damage. Depending on your skin sensitivities, skin care actives such as tocopherol, ascorbic acid & ferulic acid should be used post peel. In some cases I prescribe skin care acids including glycolic, citric, mandelic or lactic acid.
Davin’s viewpoint on deep chemical peels
Recent scientific studies have shown that deep peels, performed correctly, can generate more neocollagenesis (a term to describe new collagen formation) compared to CO2 & or erbium ablative laser resurfacing. My favourite deep peels include modified Jessner TCA, as well as phenol croton oil.
Combination treatments that I frequently employ include segmental peels, coupled with laser resurfacing. Treating the upper lip is one example. Segmental or focal peels can be performed on acne scars. 100% TCA or 88% phenol peels can safely & effectively treat ice pick & boxcar scars in skin types 1-5.
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