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Medium Skin Peels Trichloroacetic acid (TCA) at a concentration of 35% is used when a medium depth peel is indicated for skin that has moderate sun damage with superficial wrinkles, precancerous lesions, moderate acne, acne scars, abnormal pigmentation, moderate weathering, blemish-prone skin or general poor skin quality. Medium peels have the same benefits as light peels, & in addition remove larger wrinkles & precancerous skin lesions because of deeper penetration. TCA penetrates the epidermis & upper dermis, (0.45-0.6mm), resulting in the removal of thin surface layers of aged & damaged skin. Layers of dead skin cells exfoliate & are replaced by healthier ones allowing the skin�s own clarity & tightness to resurface. To varying degrees, medium peels cause remodeling of the collagen in the dermis & an increase in the elastic fibers. These are the main structural proteins in the dermis. With aging, the dermal collagen & elastin content decreases & the skin becomes thinner. This is accelerated by sun exposure & is the major external factor associated with wrinkling. What to expect from the treatment A medium peel helps rejuvenate the skin surface, by causing a controlled shedding of layers of skin cells. This allows new layers to be exposed, & produces a "fresh" appearance. Also, new cells & collagen are stimulated, creating a more even skin tone. Shallow lines are softened, & the skin will be noticeably smoother & younger looking. A medium peel improves the skin's natural ability to rejuvenate itself. The number of peels required will depend on the problem being treated, how long you have had the problem, how deep the problem is & what you are hoping to achieve. TCA peels can safely be repeated at 3-6 month intervals, but dramatic results are often seen after only one peel. TCA destroys the epidermis & upper dermis & causes the skin to slough or "peel" usually within 5-7 days. The drawback is that a medium peel makes the skin on the face look like a severe sunburn for 7-10 days, however you should not expect more than minor discomfort, if any. You will be given detailed instructions regarding pre- & post-peel care, & we encourage you to contact us at any time if you have any queries or concerns. The rate of peeling varies according to your skin�s response. Usually your skin will begin to peel within 2-3 days & should be healed in an average of 7-10 days. This peeling should not disrupt your regular lifestyle, although you should allow 2 weeks off work & public appearances. The procedure is done as a day case under light intravenous sedation. Immediately after the treatment a white frost forms on the skin. The white frost quickly disappears as the treated area takes on a red, burned appearance, occasionally accompanied by swelling. You may experience some mild stinging or burning, which we minimize by applying a fan to your face. You will be given mild painkillers to take if necessary. Within 2-3 days the skin is brown in color, & will feel tight & look more wrinkled. After several days a scab or crust forms. Peeling usually starts on days 4-6, initially around the eyes & mouth, chin, cheeks & forehead. Peeling usually occurs at different rates on different parts of the face. This is quite normal. Peeling may continue beyond 7 days, but the complexion will continue to look better as old skin is replaced by new skin which is tighter, smoother & younger looking. Initially this new skin is very pink but usually fades within another couple of weeks. The procedure itself takes approximately 60 minutes, but you should expect to be at the hospital for the large part of the day. You will be contacted by our staff early in the week that you are having the treatment, & they will ask you to come to the hospital at a particular time. Please arrange transport home as you will not be able to drive after sedation Side Effects True side effects to a 35% TCA peel are rare. 35% TCA peels can sometimes cause persistent redness of the skin The most common side effect after a peel is brown discoloration of the skin. This is usually reversible but can rarely be permanent. This side effect usually occurs only in those who have had sun exposure after a peel. For the 1st week after the peel the skin will be red & swollen. The skin will also burn & there may be some weeping Allergy to TCA is very rare. If you get coldsores a peel can cause them to flare. If you have a tendency to coldsores, then antiviral medication will be prescribed for you to take before & after the treatment. Scarring is very rare using TCA at a concentration of 35% when applied by an experienced medical practitioner. Contradictions If you have any of the following then a peel should not be done at this time:
How the peel is done Your doctor will review the possible side effects of a 35 % TCA peel with you & give you a consent form to sign. You will also have pre-treatment photographs taken. You will be taken into theatre where a small needle will be inserted into your arm, & intravenous sedation will be given. During this time we will be monitoring your heart & lungs. Then a layer of TCA 35% will then be applied to one area of the face at a time. Immediately after the treatment a white frost forms on the skin. The white frost quickly disappears as the treated area takes on a red, burned appearance, occasionally accompanied by swelling. You may experience some mild stinging or burning, which we minimize by applying a fan to your face. You will be given mild painkillers to take if necessary. What to do before your peel It is important to use the glycolic products recommended for at least 2 weeks prior to your first peel in order to prepare the skin.
On the day that you are to have the peel, cleanse in the morning & if possible, do not apply any product to the skin, especially after shave, perfume, or any product containing alcohol. What to do after your peel For 7 days after your peel, (day 1 is the 1st day after your peel), do not apply any products to the skin at all. You may clean the skin gently with lukewarm water. Use your fingertips as your skin is very sensitive at this time. Avoid the use of abrasive or exfoliating sponges. After washing, pat dry with a soft, clean towel. To avoid the possibility of scarring, please do not peel, pick, scrape or scratch the skin. On the 8th day, apply a thick layer of paraffin, which we will supply. Then leave the skin for 2 hours. Fill your basin with lukewarm water & add 2 tablespoons of salt. Then bathe the skin gently. Do not rub. The skin that is ready to come off will do so with gentle bathing. Your 1st post-peel appointment will be made on the 8th day. At this time any remaining skin may be removed by your doctor or nurse with fine forceps. They will assess whether or not the remaining skin is ready to be removed. If the skin hasn�t finished peeling completely, you will be instructed to carry out the same procedure as before, ie the next day, apply paraffin, leave for 2 hours then gently rinse. This is to be done daily until the skin has peeled completely. Once the skin has peeled completely you are to use�specific products for 3 weeks, which will be supplied to you. Use the ultra gentle cleanser twice daily, morning & night. Wet the face then gently massage a small amount of the cleanser into the skin, then rinse off with lukewarm water & pat dry. Then apply the resurfix recovery complex after cleansing, & anytime during the day if the skin feels a little dry. Avoid sun exposure, this includes tanning beds. Sunlight on the skin after a peel can cause brown discoloration of the skin. You must use a sunscreen, which is supplied, of SPF 30 or higher, every morning, at least 20 minutes before going outdoors. Apply the sunscreen� & reapply during the day if necessary. After 3 weeks of using the products, you may resume your pre-peel skin care regimen, introducing the glycolic products gradually, as tolerated by your skin. If you wish you may alternate the glycolic products with the products. The use of any skin product including make-up after a peel relies on some commonsense on your part. Some products may irritate at first, so that means it is a little too early to use them. It doesn�t mean that you will never be able to use these products, just that your skin is still a little too sensitive to tolerate them. Your skin will "tell" you. Scarring & brown discoloration of the skin is unlikely unless you go to a tanning salon after having the peel, or lie out in the sun. Daily sunscreen use should continue indefinitely to prevent new photo damage from occurring. You may start wearing make-up once the skin has peeled completely, providing you do not have any crusting or tenderness. The skin will be pink for a few weeks, occasionally longer, but is usually only mild. If you wish to wear a camouflaging make-up, this is okay.�We recommend Glo minerals�makeup which is available in several shades. If you have persistent redness, please inform your doctor, who may prescribe some anti-inflammatory cream or ointment. This is usually not necessary. For at least 6 weeks after your peel, you should not have hair removed by any technique because it can cause severe irritation of the skin. Do not take Accutane for at least 6 months after your peel, as it can cause scarring. If you have any queries or concerns at all, please do not hesitate to contact us. |