Jessner TCA Peels At A Glance
- Best Results1-2 sessions
- Treatment Recovery6- 9 days
- Procedure Time30 minutes
- Skin SpecialistDermatologist. Dr Davin Lim
- Duration of Results3-6 years
- AnaestheticSedation, numbing gel
- Back to Work5-8 days
- Cost$$$
Jessner TCA Peels
TCA/ TCA Jessner peels are still relevant in dermatology, despite the event of advanced lasers. Chemical peels can address minor skin concerns such as acne, blemishes, and congestion, whilst deep peels can address wrinkles, sun damage, and pigmentation. This peel is best suited for fair-skin patients with a downtime of just over one week. For darker skin types, I prefer pico or fractional laser resurfacing.
FactsFacts on Jessner TCA Peels
- Chemical peeling is a tactile art form that address different layers of skin
- Superficial peels include salicylic acid peels, lactic, glycolic, citric, retinoic & mandelic acid
- Medium depth peels include TCA 25-35% with or without Jessner solution
- Deep peels include TCA, Jessner TCA & phenol croton oil peels
- Downtime following a chemical peel is proportional to the depth of peeling
- I often combine lasers with chemical peels to get better outcomes
Medium Depth Jessner TCA Peels
What conditions can be treated with Jessner TCA Peels?
Medium to deep chemical peels including TCA or Jessner/ TCA can treat the following skin conditions-
- Sunspots and precancerous lesions such as solar keratosis/actinic keratosis.
- Fine lines, wrinkles & elastosis (broken collagen – sun damage)
- Smoker’s lines, upper lip wrinkles (often in combination with lasers)
- Superficial skin scars from acne pox
- Freckles
- Brown spots – liver spots – lentigos (not melasma)
- Enlarged pores
I often combine lasers with chemical peels to deliver better results; wrinkles and acne scars are examples.
How do I perform Jessner- TCA peels?
This procedure is performed under partial sedation. In some cases, I do initiate a pre-peel prep followed by a pre-procedure de-greasing scrub. The procedure takes approximately 2 hours to perform- this includes 1 hour anaesthetic time. Throughout the procedure you will be kept comfortable with skin directed cooling.
Is this peel painful?
This peel is well tolerated as I perform medium to deep peels under mild sedation, topical numbing creams, & skin cooling. I frequently perform nerve blocks (especially deep peeling – laser for lip lines – smoker’s lines).
How long does it take to recover following this peel?
Downtime (defined as time taken to reform new skin) is approximately 7-14 days following a medium-deep chemical peel. Redness can last 4-8+ weeks, depending on the depth of the peel.
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How does chemical peeling compare to laser resurfacing?
Peels can be more effective than certain types of lasers, in particular fractional laser resurfacing. This is because chemical peeling removes ALL of the surface area of skin compared to fractional lasers that remove a portion of skin (usually 5 to 70%).
In the context of fully ablative laser resurfacing (Co2 or Erbium laser), deep peels have recently been shown to be more effective in the generation of new collagen.
The decision to opt for a peel or a laser has a complex algorithm based upon the clinical presentation (pigment, sun damage, age warts, extent of wrinkles, type of wrinkles), patient factors (ethnicity, sun exposure, expectations), co-existing skin conditions (melasma, rosacea) as well as prior experiences with lasers-peels. I will guide you through the decision as well as the pros and cons of each procedure pertaining to your history, examination and end goals.
I often combine medium to deep peels with ablative CO2 fractional lasers as the end results are better compared to delivering each modality separately.
What are the potential side effects of chemical peels?
Medium – deep peels remove ALL of the upper layers of skin (epidermis) in addition to the mid to upper layers of the dermis. Potential side effects are proportional to the depth of peeling, these include-
- Infection 3% risk. All patients with a history of HSV- cold sores will require antiviral until the skin completely heals
- Dyspigmentation 5% risk. More common in darker skin types, infinitely higher if exposed to UV within 4 weeks of peeling.
- Skin scars are uncommon; < 2%. Majority related to picking, poor compliance with post op care, infection & idiosyncratic reactions.
Jessner TCA peel, one session
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👉This is a medium depth peel. Occasionally I prep with retinoic acid beforehand, but thin skin like this patient, RA is not needed. I scrub with acetone, then coat with 2-4 layers of Jesser. I then have a cup of coffee then come back to finish off with TCA at 35%
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😁Was having a friendly banter with my mentor & close friend @aprofphilipbekhor last night. Peels vs lasers. Why do I like peels? My chill out time. No loud noises apart from the patient's muffled screams 😱😱(joking). Despite the tech of lasers, I still like looking carefully at end points from peels. It is tactile, much like driving a manual car vs an automatic. Sure the latter is easier, but sometimes it’s the challenge to get the downshift perfectly matched, or the epidermis so evenly gray that the entire sheet slides from the dermis. It’s old school cool
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👊🏻Disclaimer: You do need to watch your peel patients more closely cf. NA laser patients, that is fact💯
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😎Davin Lim
Dermatologist
Brisbane🇦🇺
#tca #jessner #jessnertca #chemicalpeels #dermatologist #dermatology #drdavinlim #skinrejuvenation
TCA peels are a simple way to rejuvenate skin. This picture is over a decade old, but I still enjoy peels over lasers (more tactile). It’ much like driving a older vintage car, it’s slower to get to your destination but the drive is more enjoyable🚘
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🔬Skin science: TCA can be applied as a superficial, medium (most common) & deep peel. In this case I employed it as a medium depth peel, to the upper papillary dermis. In some cases I combine it with Jessner for deeper penetration
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👉Downtime: 5- 8 days depending on the strength and coats
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😢Pain: Tolerable with topical application of numbing and skin cooling. I do give oral conscious sedation if deeper peeling
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👍🏻Good for: Skin type 1-2+, pigment, freckles, sun damage, solar keratosis, mild to moderate wrinkles, lentigos/ age spots
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👎🏼Not good for: Darker skin, deep wrinkles, melasma
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😎Davin Lim
Dermatologist
Brisbane🇦🇺
#chemcialpeels #TCApeel #jessner #jessnerTCA #skinrejuvenation #skinlightening #skinbrightening #davinlim #dermatology #skinscience
Chemical peels are an excellent way to improve skin texture & quality. A recent publication in the Journal of the American Academy of Dermatology has shown that deep peels create more collagen than fully ablative CO2 laser resurfacing
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🔬Skin Science: Peels are classified according to the depth. #AHA, #BHA & retinoic acid peels are superfical, #TCA 15-40+% are medium depth as are #Jessner TCA peels. Deep peels include phenol croton oil & super-saturated TCA
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🍌🔫Peels & lasers: I combine medium depth peels with CO2 lasers. This combination improves skin quality and remodels dermal collagen. It reduces the risks of deep lasers & peels. Healing time approximately 8-10 days
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👉Suitable patients; Skin type 1-2, moderate to severe sun damage, solar keratosis, elastosis & wrinkles. Darker skin types best treated with #picolasers, RF, RFM, #HIFU & conservative short PD fractional CO2 lasers
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👍🏻Don’t forget: volume changes. Lasers & peels can stimulate #collagen production, but they do not replace age related fat loss. Dermal fillers or fat transfer indicated, based upon clinical examination
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😎Dr Davin Lim
Dermatologist
@drdavinlim
Brisbane🇦🇺
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#dermatology #dermatologist #drdavinlim #davinlim #dermatologybrisbane #chemicalpeels #tcapeels #jessnerpeels #laserresurfacing #co2laserresurfacing #fractionallaserresurfacing #skinrejuvenation #jessnertca
One of my favorite procedures are chemical peels, yup, old fashioned Jessner & TCA
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🔬Skin science: Peels are classified according to the depth. Superficial peels include AHAs including lactic, glycolic & mandelic acid peels. BHA & retinoic acid peels are also superficial, TCA can be superficial, medium or deep, depending on the concentration, layering & prep
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👉This Patient: had an acetone scrub, followed by Jessner (lactic, salicylic & resorcinol) then TCA with 2 ish coats at 35%.
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📆Downtime: about a week
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🔫Peels vs lasers: Comparison of super deep peels like phenol croton gives better outcomes compared to even fully ablative CO2. In this patient, the peel is equal to a medium density fractional CO2 laser, the advantage of the peel is that it treats the entire surface of the skin, down to the mid papillary dermis
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👍🏻I like peels because they are tactile, with a wee bit of finesse. Laser are great, but it's seriously watching the dot then stepping on the accelerator. Medium to deep peeling is a dying science & art
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😎Dr Davin Lim
Dermatologist
@drdavinlim🇦🇺
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#chemicalpeels, #ahapeels #retininoicacid #glycolicpeels #lacticpeels #skinscience #dermalscience #dermatologist #dermatology #skin #cosmeticclinic #drdavinlim #lacticpeels #TCA #TCApeels #jessnerpeels #skinrejuvenation #skinscience
How does TCA- Jessner peel compare to ‘lunchtime peeling’?
Medium to deep chemical peels, as the name suggests, targets both the superficial layers of skin (epidermis) as well as the deeper dermal layer of skin. By addressing the deeper reticular and papillary dermis, collagen can be stimulated.
Lunchtime-shopping center peels are classified as very superficial peels, namely treating the upper most layer of skin, known as the stratum corneum. As a guide, lunchtime peels go to a depth of 5-10 microns, whilst TCA-Jessner & phenol croton oil peels penetrate 250- 400 microns and beyond. This accounts for the extended healing time with deeper peels.
Superficial peels can address ‘superficial’ skin concerns such as blackheads, acne, mild pigmentation and general skin congestion. Deeper peels address superficial concerns in addition to dermal concerns such as wrinkles, elastosis, and deep sun damage. The deeper the peel, the more dramatic the results, albeit a longer downtime-recovery phase.
What restrictions will I require post peeling?
Restrictions will depend on the depth of peeling. As a guide-
- No makeup until the skin has fully healed. The exception is Lycogel makeup.
- No exercise for 5 -7 days post peel.
- No direct sun exposure for 4-6 weeks post peeling.
- If you have a history of cold sores, you MUST take prophylactic antiviral medication for up to 7-10 days after a medium to deep chemical peel.
Davin’s Viewpoint on medium - deep chemical peels
Jessner TCA is one of my favorite skin resurfacing procedures. Unlike laser resurfacing, the art of chemical peeling is tactile, going with pressure and the squeeze of the applicator, as well as the number of coats. The art is to ‘feather’ the peel towards the periphery and the hairline so as to not leave streaks or demarcation lines. With alterations of connections, and pre-peel preps, I can tailor a peel according to the patient’s clinical examination. I also combine peels with ablative lasers such as erbium or CO2. I do think that the art of chemical peeling should still be taught to dermatologists, as there is a time and place for this procedure.
