Chemical Peels Lesson 5: Sample Experience with a 20% TCA Peel

This section is for informational purposes only. It does not replace the instructions that will come with your peel solution, which you should read thoroughly and follow exactly.

Jen is trying to reduce pitted acne scarring on her face. She has been using AHA products for a year. She started out using a 5% glycolic acid cream daily for about a month. After gradually increasing the strength of her products, she is currently using a 40% glycolic acid peel every month. Jen also uses Retin-A daily and tolerates it well. She’s seen some improvement, but isn’t getting the results she’s looking for, and notices that her skin is more resistant to peeling than her friends. Since her skin has gone through the adjustment process and is more resistant than usual, Jen thinks she’s ready for a 20% TCA peel.

Preparation

Preparing your skin for a chemical peel is a necessary step that will enhance your results. The preparation routine varies depending on the peel you’re using. Most peels will come with instructions to help you prepare your skin. In general, you want to use a skin lightening cream to reduce the risk of skin tone changes. Using a mild alpha hydroxy acid product like a 10% lactic or glycolic acid lotion daily will remove dead skin and help the peel penetrate evenly. You should also use sun protection daily. Many people also use Vitamin C and/or Retin-A before a peel to enhance collagen production, but this can be irritating if you aren’t used to the ingredients. The proper diet will also enhance your results. Try to maximize nutrient intake from both food and supplements. Keeping carbohydrate intake at 100 grams or less should also help control excess inflammation. Discontine hair removal methods like waxing or depilatories like Nair. Shaving is acceptable. Most people follow this routine for 2 to 4 weeks before the peel.

You should stop using active ingredients like Retin-A, Vitamin C, skin lightening creams, etc. and avoid shaving for at least 48 hours before the peel.

For 4 weeks before the TCA peel, Jen followed up skin regimen designed to prepare her skin for the peel. She uses sunscreen with full UVA and UVB protection with a minimum SPF of 30 every day. She also uses a skin lightening cream containing Kojic Acid and Alpha Arbutin once a day to reduce the chance of experiencing discoloration. Jen continues with the daily use of Retin-A, and adds a 10% glycolic acid cream. She generally has a good diet, but decides to eat more fresh vegetables and fatty fish to prepare for the peel.

Chemical Peel Process

Individual instructions should accompany your peel, and you should follow them. Read the accompanying instructions entirely before starting the peel. The following guidelines are for informational purposes only and are here to help you decide if you’d like to do a strong chemical peel at home. They may not be exactly right for the peel you’ll use, but are a general overview of the process.

Patch Test – 24 to 48 hours before the peel, perform the patch test near the skin you’ll peel. If you are peeling your face, apply the peel solution to a dime-sized area of cleansed, defatted skin behind the ear. If you are peeling body skin, choose a skin patch near the target area, but not on it so it isn’t peeled twice. You are trying to test skin that is similar texture and thickness to the skin you will be peeling.

Wash the Skin – Cleanse the skin thoroughly with a deep cleaning face wash. Products formulated for oily skin work well, but make sure they do not contain actives like hydroxy acids or exfoliants.

Defat the Skin – Defatting the skin is a process that removes any skin oils left after washing. It will help the peel solution absorb evenly. Many peel kits come with a defatting or prep solution that may also numb the skin. Other kits recommend that you use plain isopropyl alcohol that you can find at the drug store.

Protect Surrounding Areas – Apply petroleum jelly/Vaseline to any surrounding areas that you do not wish to peel, such as the eye area, hairline, lips, normal skin surrounding a scar or stretch mark, etc.

Protect Your Fingers – You can protect your fingers from the peel solution by wearing disposable gloves, but check your peel instructions for any possible interactions with vinyl, latex, or other materials.

Saturate Pad with Peel Solution – Wet one half of a sterile 2” gauze or cotton pad with the solution. Hold the dry half to keep the solution off of your fingers. Make sure the solution does not drip off of the pad, as this can allow it to run down to areas you don’t want to peel, such as your eyes. Add more solution as needed to ensure even coverage. Using a sterile plastic dropper is helpful to add just enough peel solution to the gauze or cotton pad.

Apply One Layer to Target Area – Gently apply the solution in a horizontal motion over the entire area. Some instructions will also direct you to go over the same area in a vertical motion to ensure even coverage. The first entire application as directed counts as one layer.

Leave on Skin, Check for Color Change – Wait approximately 2 to 5 minutes after applying the first layer. Use a timer to be precise. At this point, you want to check for frosting or erythema. Frosting indicates that an area will peel well. The skin turns white and looks “frosty”. Erythema is an intense redness. Once the skin is showing signs of either of these conditions, the peeling process is complete. You should not reapply peel solution to frosted or reddened skin. If neither of these occur you can apply another layer of peel solution if you desire. The safe number of layers varies, so consult the directions of your product. There is also a safe amount of time the solution can be left on the skin, even if there is not frosting or erythema. The more layers you apply, the more likely you are to run into complications. It’s best to start off with only one or two layers for your first peel, and add one additional layer with each subsequent peel if needed.

Rinse and/or Neutralize – The instructions with your peel will tell you how long to leave the solution on your skin before it should be removed. Some products, such as TCA, are self-neutralizing after a few minutes. Others, mainly very low strength peel solutions, are left on the skin for several hours. Many peel kits will instruct you to rinse the solution off with plain water. Some peels need to be neutralized with a separate solution to deactivate them. This solution may come with your peel kit, be purchased separately, or made at home with ½ to 1 teaspoon of baking soda dissolved into 1 cup of distilled water. Many skin care enthusiasts no longer consider neutralizing beneficial because the rapid pH change can be very uncomfortable. Rinsing is usually sufficient, but consult your peel instructions.

Apply Healing Ointment or Moisturizer – Using a moisturizer or ointment the skin post peel is very helpful. If the peel is strong, an occlusive ointment with healing properties such as Neosporin or Bacitracin can reduce the chance of infection. Other helpful products contain copper peptides or hyaluronic acid. Some people prefer natural Emu oil or plain petroleum jelly. Consult your instruction for recommendations and timing. Some peels require you to wait a few hours before applying a moisturizer, while other instruct you to do so immediately after the skin is rinsed and dried. For some formulations, you aren’t supposed to apply anything to the skin until the day after the peel.

Avoid Sun Exposure – Avoid the sun completely for at least 24 hours after a peel, and longer if possible. This includes sunlight through windows while indoors, and going outside on cloudy or overcast days. Protecting your skin from the sun is critical while it is healing. When you do resume outdoor exposure, use a sunscreen with at least SPF 30 or higher.

Jen read the directions that came with her 20% TCA peel kit thoroughly before starting the process. Her patch test didn’t show any reaction, but stung more than she’d expected. Jen washed with her normal cleanser and defatted her skin with the prep solution in her kit. She used petroleum jelly to protect the area around her eyes and on her lips. The first layer went on smoothly. After 5 minutes, she noticed that much of her face looked frosty. She then reapplied the peel solution to the areas that didn’t frost. After 5 additional minutes, there were still some areas that hadn’t frosted, but were looking quite red. Since this was her first TCA peel, she had only intended to use 2 layers. Jen rinsed her face thoroughly with cool water and let it air dry before applying the healing ointment included in her kit.

Chemical Peels as a Spot Treatment

Using chemical peel solution as a spot treatment is done in the same way, except the solution is only applied to target damaged areas such as a wrinkle or acne scar. Cleanse and defat the skin as you would normally, and use petroleum jelly to protect the skin around the damaged areas. Use a cotton swab to swipe a thin line or small spot on each mark you want to treat. Check for frosting/redness, apply additional layers if needed, then rinse, and moisturize. The treated marks should crust over with dead brown skin and peel off over the following weeks.

Sometimes pitted or depressed scars do not absorb the peel solution by just lightly swiping it across the marks. You may need to gently press the solution into the scars. You can use a cotton swab for this application by pressing it firmly into the scar and holding it there for a few seconds. Another option is the “cross” or “toothpick” method. Soak one half of a toothpick in peel solution for 30 to 60 seconds. Then use it to apply the solution the interior of the scar. Use extreme caution with this method. Do not break the skin or use excessive pressure.

After Care

Caring for your skin after the peel is just as important and the actual peel process. Keeping it moisturized will enhance healing. Protecting the skin from the sun is extremely important. Use a good sunscreen daily and avoid going out altogether if possible. You should ideally avoid wearing makeup until the skin has completely healed. Most superficial peels heal rather quickly with minimal discomfort and unsightly flaking. Stronger peels require more downtime and moisturization, frequently requiring multiple applications of ointments for several days. Consult your instructions for proper post peel care. Some will require you to wash your face at least once a day and others will instruct you to avoid contact with water completely.

Most people will begin to flake 2 to 4 days following the peel. Most of the dead skin will typically peel off within 7 days, but can it take longer. Many users report some areas of the body, such as the forearms, continuing to flake for up to 3 weeks. Do not pick at peeling or flaking skin. If skin flakes are large, snip them off at the skin surface to avoid tearing. Peeling skin is often uncomfortable and itchy, but touch it as little as possible. A cold compress may be used to help with the discomfort unless otherwise directed.

Pink or red skin is expected during the process. For the first day or two, your skin may appear red and feel tight. Over the next few days, the dead skin may turn brown and leathery before it starts to peel off. This layer is important for the healing process. It may crack prematurely from movement, so keep it moisturized and try to minimize skin movement when eating or laughing. Once it starts peeling, the treated area will look very uneven with dark brown dead skin on areas that have yet to peel and bright pink skin on peeled areas. Continue to moisturize and protect the area from sunlight.

After all the dead skin peels off, the redness should subside over the next few weeks. Makeup use is generally fine at this point. Consider switching to natural mineral make up that contains zinc oxide, which provides additional sun protection and has healing properties. The new skin is very delicate and vulnerable to damage. Do not resume using strong actives like retinoids, Vitamin C, or any form of exfoliation until redness subsides. Sun protection is essential for at least a month after a peel. Using a skin barrier restoration cream is also recommended.

Maintaining a healthy diet and drinking enough water will enhance your results. Most of the improvement you’ll get from a chemical peel is from stimulating your skin’s healing processes. Make sure you are giving it the nutrition it needs to rebuild.

The first two days following her peel, Jen’s skin was bright pink and tight. She noticed brown coloration starting on the end of day 2. On day 3, the skin was very brown and inflexible. She used a good moisturizer several times a day, but it was still uncomfortable, especially around the mouth. Jen was very self-conscious once the skin started peeling. She hadn’t expected it to look so bad because she’d done so many peels before. It was bad enough that she decided to call in sick to work for a few days. The skin began peeling off on day 4. Jen was excited to see how smooth the new skin was and started to feel better. By day 7, it had entirely peeled off and her face was very pink, but in much better condition. She continued to moisturize it at least twice a day and started going outside wearing sunscreen with an SPF 45 even though it was cloudy. It was still a little pink even with makeup, but not so bad that anyone noticed when she went back to work. It took two and a half weeks for the redness to subside. Jen was very happy with the results. She decided to use the peel as a spot treatment on some deeper lines and scars in a few months, but didn’t want to take the time off for another full-face application.