Body Recon Plastic Surgery

(03) 5221 3739 (03) 5221 3739

Body Recon Cosmetic Clinic

(03) 5221 1747 (03) 5221 1747

Body Recon Clinic Epworth

(03) 5280 8042 (03) 5280 8042

TCA Chemical Peel

What is TCA?

The TCA peel (Trichloroacetic Acid ) is a reticular dermal (medium depth) skin peel. It is a very popular and powerful skin resurfacing treatment. At Body Recon we provide TCA peels in varying strengths though most facial peels performed by Dr Rahdon is with 35% TCA. Determining the peel that is most suitable for you will depend on your skin tone, depth of damage, severity of photodamage and the result you are seeking.

Deeper peeling is achieved by using a higher concentration of TCA or multiple applications of TCA, or both. TCA is unique because of its penetration; it continues to penetrate until it reaches water within the layers of the skin therefore is safer than some other resurfacing modalities.

TCA can be combined with different surgeries such as facial rejuvenation or as a stand-alone treatment at Body Recon Cosmetic Clinic.

What will TCA treat?

TCA will address many extreme cases of photoageing such as pigmentation, fine lines and wrinkles, texture, tone, scaring and visible pores and thickening of the skin. TCA is what we call a collagen induction therapy; therefore results continue to improve over a 6-12 month period.

Dr Rahdon also commonly uses TCA as a modality to treat seboric keratosis lesions and to ward off more skin cancers that can cause disfigurement such as BCC’s that are increasingly common amongst Australians.

Dr Rahdon also uses TCA on almost all of his facial rejuvenation patients as this helps to correct the skin once any surgical treatment has been performed to address any sag or excess skin. The peel is performed before the surgery and after the patient is put to sleep.

How does TCA work?

When TCA is applied to the skin, a controlled wounding of the skin takes place. This allows the skin to regenerate and stimulates cellular turnover. TCA peels can improve wrinkles by stimulating fibroblast activity thus stimulating the production of collagen and elastin fibers in the skin. This strengthens the skin and improves elasticity. The peel will penetrate down to the dermal/epidermal junction where the entire epidermal layers will separate causing the skin to scab, flake and peel resulting in new fresh skin. TCA peels can also improve the appearance of acne scars, fine lines around the eyes and mouth, hyperpigmentation, photodamage, as well as extrinsic and intrinsic signs of ageing.

Is TCA right for me?

The points we take into consideration when deciding if you would be a suitable candidate for TCA is…

EXPECTATION-TCA is as a rule of thumb, the best modality we can offer for those seeking the biggest and most dramatic change in their skin.

RECOVERY- TCA is the most powerful form of remodelling we offer at Body Recon, therefore also provides greater downtime compared to modalities such as laser resurfacing or lighter chemical peel. 7-10 days downtime is standard for most patients. During this time you will not be able to leave the house as you will skin will form a large scab and flake considerably.

COST- TCA is a cost effective solution because it is a once off treatment. In comparison you would require more sessions of laser resurfacing than TCA, therefore will cost you more in the long run. Your TCA package will also include your prep and post care.

PRE EXISTING- TCA is generally reserved for those that require moderate to severe improvement for their skin. It is not suitable for anyone who does not have mild imperfections of their skin- laser or clinic peels may be a better option in this case

SKIN TYPE – Caucasians or lighter European skins are generally the only suitable candidates for TCA. Darker skins pose too much risk with complications such as hypo or hyperpigmentation and even scaring.

Why would I not be a good candidate?

TCA is an intense treatment and is painful if done as a clinic treatment rather than in a surgical environment (where you would be asleep), therefore you need to be prepared to experience discomfort. This may be difficult for people with low pain thresholds or even people with anxiety disorders.

As mentioned above- darker skins are not suitable for TCA as they pose too much risk.

People who are not suncomplient- following a TCA you MUST refrain from excess UV exposure to prevent reoccurrence of pigmentation lesions. Following a TCA you will be more photosensitized and much more prone to sunburn or developing these lesions should you have excessive exposure. This is why TCA is only performed during the cooler months when UV is lower, and if a tropical holiday is in the near future, the TCA is best postponed. A topical tyrosinaise inhibitor should be used indefinitely following TCA to prevent further mutations.

People that cannot afford to have 7-10 days of not leaving the house, if downtime is not an option, laser or lighter chemical peels may be better option.

Poor health or poor healing can cause difficulty and a prolonged healing time.

What happens to the skin after a TCA peel?

Having a TCA peel means you will have considerable downtime (usually 7-10 days).

The initial process the skin goes through is INFLAMMATION. In this step opening of blood vessels occurs and white blood cells migrate to the wound and begin the healing process. This stage usually lasts 2 days. The appearance of the skin will be red, with some swelling. The skin feels tight and stuck on. This is because the outer layer of skin (the epidermis) has separated from the deeper layers below.

The second stage is RE-EPITHILIALIZATION. Cell migration and maturation begins as wound healing takes place. The skin may begin to scab in places and may darken in certain areas. This usually happens day 3-7; you will feel very dry and tight. From here you will begin to flake and shed for a couple of days, often sheets of old skin coming off at a time. This is a normal process allowing dead cells to be removed. DO NOT force this process or peel away any skin that is NOT ready to come off on its own. It is important that this skin stay intact until ready so it can act as a protection to the underlying skin during this time. As the skin is shedding, it will lift, giving a dry, dark appearance that will resolve once it begins to peel.

The third stage is REMODELING. This usually occurs after the shedding. The remodeling is occurring in the deeper layers of the skin (the papillary and reticular layers of the dermis.) During this time the skin may still feel slightly tender but will look very clear and have an underlying light redness. This redness is from the higher blood flow to the healing and regenerating skin. It will subside over a few weeks.

What will I look like?

Day 1- slightly red
Day 2- red, tight and possibly some swelling
Day 3- begin to scab, the skin will develop a big dark crust
Day 3, 4, 5, 6- flaking will occur and will come away in sheets. Dry and itchy.
Day 7,8, 9, 10- flaking will still be visible but lessened. Skin underneath with be red.
Day 10-30- Skin will still be red but will look clear. The pigmentation will look clearer and texture and tone of the skin will be visible. It is normal to sometimes have blind pimples occur.
Day 30- Day 180+- the skins elasticity will continue to improve as larger wrinkles appear less obvious. TCA is a collagen induction treatment therefore will continue to improve in time as we are attempting to grow new collagen in the skin.

How can I prepare myself for a chemical peel?

Skin preparation is usually commenced several weeks prior to peeling, and helps by allowing uniform penetration of the peel and accelerated healing. It may also reduce post-peel complications such as post-inflammatory hyperpigmentation.

HOMECARE – Your dermal clinician will prescribe you the correct homecare for your upcoming peel. Often this is in the form of a kit that involves active ingredients to help exfoliate and prep the skin. This will assist the peeling agent to achieve evenness of penetration. The longer you are on actives the better but 2-4 weeks minimum is required.

CLINIC PEELS – Often for patients that present with a lot of cell build up we would recommend a single or course of clinic peels to encourage rapid wound healing and to refine the skin prior to TCA. Consider clinic peels training for you TCA.

MEDICATION – should we advise them to take pain meds before?Also should we advise to stop taking any blood thinning medications.

How are chemical peels performed?

Experience is key with chemical peels. Plastic Surgeon Dr Rahdon is highly trained and has many years of hands-on experience with medical grade peels.

The skin is thoroughly cleansed and degreased with an appropriate cleanser first. A Zimmer cooler device will be used to blow very cold air onto the skin during the procedure, as the main sensation during the peel is intense heat. (Of course if your peel is being performed in conjunction with surgical procedures, such as a facial rejuvenation or even breast or body surgery, you will have no discomfort at all- the anaesthetic will take care of it!) Once the TCA is applied to the skin, we look for an “end point” of frosting of the skin. Sometimes multiple layers in sections may be required for adequate penetration. We do not need to neutralise the peel as TCA has a unique ability to only penetrate until it reaches water stores in the skin. The period of intense heat lasts for 10-20 minutes, after which there is no discomfort at all.

The peel is completed by applying antibiotic ointment on the face. Following your peel, the skin will be slightly red as if you have been for a jog around the block. You will be in no discomfort.

What is required of you.

SUN EXPOSURE – You will require absolute sun protection during the entire time pre and post peel to prevent rebound hyper- or hypo-pigmentation.
TOPICAL OINTMENTS – As part of your peel package you will receive a prep kit and post care kit that you are expected to use regularly.
COLSORES – TCA peeling may cause an individual to develop a cold sore if they are prone to getting them. This may require the use of antiviral ointment (Zovirax) and/or tablets to prevent these following your peel. Application before and then as soon as you feel a tingle should be undertaken. If a cold sore is starting to develop during the week post your peel you should contact the rooms immediately so appropriate treatment can be undertaken.

You will be required to complete a confidential consultation form to outline your general health and suitability for this procedure. Please inform us of any medications you are taking or if you are affected by any of the following conditions prior to your TCA peel:

- Recurring facial warts
- Prior history of any cosmetic surgery, botox, fillers, peels, dermabrasion, etc.
- History of cold sores
- History of keloid formation
- Pregnant or breast feeding
- Use of retinoids over the last 12 months
- Previous use of Roacutane
- Recent sunburn or significant sun exposure within the last month
- Cryosurgery or Liquid Nitrogen treatments
- Skin Cancer history
- Present skin cancer treatments
- History of pigmentation problems- hyper/hypopigmentation

What are the complications or side effects of TCA peels?

As a rule, the deeper the peel, the higher the rate of complications and the longer the recovery. This is why TCA is performed as a specialised medical peel. We class TCA as a Surgical Peel and is only performed by Dr Rahdon either in conjunction with a surgical procedure or as a stand-alone treatment at Body Recon Cosmetic Clinic. TCA requires more experience from the operator and more careful pre-peel preparation and post-peel care.

The deeper the peel, the longer it will take to recover generally 7-10 days for a 35% TCA peel. Some people will heal more quickly than others- age, skin type, intensity of the peel and how well the skin is prepped all impact on your recovery time.

On the day of your peel

TCA peel solution application will cause a stinging, burning sensation that will resolve within a few minutes. Your skin will initially have a “whitening” effect (known as frosting) which is due to protein denaturation. The skin will then turn red and you may experience heat and swelling in the treatment area. This is a normal tissue response.

Upon completion of your peel, you will be required to wear a UV protective hat or clothing over the areas treated to avoid any UV exposure to your freshly peeled skin. In addition it is advisable to wear UV protective sunglasses.

Your skin will be covered with a thick ointment, so make sure your hair can be put back from the face to avoid getting it in your hair.

TCA POST TREATMENT CARE

Do NOT use abrasive scrubs, active skin care/ cleansers or cloths on your skin for the next 10 days.

Do NOT apply any retinoids, benzoyl peroxides, AHA’s or BHA’s to your skin until you have been reviewed.

Do NOT color or dye hair for 2 weeks post TCA.

Do NOT undergo any laser treatments, waxing, microdermabrasion or facial treatments for one month after your TCA peel.

It is important for you to increase water intake and maintain a healthy diet.

Do NOT peel, scratch or rub the treated skin even if you feel that it itches – use a mild over the counter hydrocortisone cream if necessary for the itching. The itching is a normal part of the healing process, and it will resolve on its own.

AVOID UV exposure at all costs. This includes tanning beds. Do NOT use any tanning solutions for at least 2 weeks post treatment to insure the area is healed. It is best not to expose the peeled areas at all, by wearing a hat or protective clothing that can shield the newly peeled skin from the sun.

Home care

Please follow these steps unless instructed otherwise by your dermal clinician or Dr Rahdon himself.

AM

  1. Cleanse- Sensitive Skin Cleanser- Gently use your fingertips ONLY, not a wash cloth to cleanse your skin. GENTLY pat your face dry with a clean cloth.
  2. Bactroban- apply with a patting motion over the peeled skin
  3. Enirodefence SPF- apply a pea size amount, warm up in palms, pat into skin.

**** During the day you are able to use Restorative Ointment as many times as you need to. We want to keep the skin protected and moist. 2-4 times a day is standard.****

PM

  1. Cleanse- Sensitive Skin Cleanser- Gently use your fingertips ONLY, not a wash cloth to cleanse your skin. GENTLY pat your face dry with a clean cloth.
  2. Bactroban- apply with a patting motion over the peeled skin

You must continue to use a daily sunscreen for 6 months after your TCA peel to insure the highest level of improvement and lowest incidence of any sun exposure resulting in hyper- or hypogipmentation.

Contact the rooms on 5221 1747 or 52213739 IMMEDIATELY for any signs of infection, abnormal signs or symptoms such as discharge, pus formation, swelling, an increase in pain, so that you can be evaluated immediately and any appropriate care given.

You will be reviewed at 7 days post your peel and then again in 2 weeks time when you will be prescribed post care treatment to ensure the best results from your peel.

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