TCA Chemical Peels: It's a 50/50 Relationship

Interview with Amber Lewis, Owner & Lead Aesthetician / Cosmetic Injector / Surgical Assistant / Medical Assistant

Chemical peels can look deceptively simple. You put a solution on the skin, the skin peels, and fresh skin appears underneath. But when we're talking about a medical-grade TCA chemical peel, there's a lot more happening below the surface.

The concentration of the peel, your skin type, pigmentation, family history, sun exposure and even whether you're willing to follow your aftercare instructions can determine whether you're a good candidate. This is one of those treatments where I really consider the provider and client a 50/50 partnership.

Can you really buy a medical-grade TCA chemical peel and do it at home?

Just being frank, we live in a world where we can buy almost anything we want. Anybody can get their fingertips on almost anything. So, yes, I suppose somebody could get ahold of something considered a medical-grade chemical peel and do it at home.

We see it on TikTok all the time, and it usually doesn't end well. Obviously, there are exceptions—maybe it's a nurse or someone who does this professionally and is demonstrating it—but for the average DIYer, there are a lot of things they don't know about their skin that can make doing a medical-depth peel at home dangerous.

What are the dangers of doing a TCA chemical peel at home?

Burns and scarring absolutely can happen, and they happen more frequently than people realize.

Chemical peels are tough because somebody who is very light-skinned and has pigmentation, melasma, acne scars, rough texture or enlarged pores could potentially be a great candidate for a TCA peel. Depending on their skin, they may even be able to tolerate a deeper peel.

But even with someone who appears to be a great candidate, I still have to watch their skin while they're in the treatment room because they can start having a reaction. No two people's skin responds exactly the same way.

Are you having an allergic reaction? Is your skin frosting or turning white? Do you have a family history of hypo- or hyperpigmentation? Do you have a history of keloids? There are all kinds of things we have to consider.

I can look at your skin and say, wonderful, you have hyperpigmentation we can address. You have melasma, lines, enlarged pores or texture. But at what depth do we start? Are you prepping your skin before you come in? What's your family history? And do I trust you to follow your aftercare?

That's where doing a medical-depth chemical peel at home becomes a much bigger risk than people realize.

Why is aftercare so important after a chemical peel?

Aftercare is just as important as what happens in my office.

Even as a professional, I can perform a beautiful chemical peel and then have somebody leave my office and not wear sunscreen. They can go tanning the next day. They can go right back into heavy sun exposure.

I've actually had somebody come back to me after a couple of years concerned about pigmentation. They weren't using sunscreen and were avid mountain climbers. Of course we're going to have pigmentation. You have to protect your skin.

After a chemical peel, your skin is very vulnerable because we've removed that outer layer and, depending on the depth of the peel, we're working down into the areas involved with pigmentation.

A lot of people think, “I'll put on a little SPF and it'll be fine,” or, “This skin is peeling, so I'll just pull it off.” You can't do that.

It seems like an easy process because we put the peel on the skin and you're done, but it's actually a very intricate process. You need to be cautious both inside and outside of the treatment room.

How much responsibility does the client have for getting a good result?

It's really a partnership.

We all fudge things sometimes. We tell our provider, “Of course I'll follow the instructions.” Then we go home and our best friend has planned a pool day.

Things happen, but you have to be honest with your provider. If you know you have a big outdoor weekend coming up, tell me. If you aren't going to be able to stay out of the sun, tell me.

You also have to take responsibility for your own care. I can choose the appropriate peel and concentration and do everything correctly in the treatment room, but you still have to take care of your skin afterward.

Are any at-home chemical peels okay to use?

Sure. There are lighter peel pads and products you can buy for home use that I think are great.

Those aren't reaching medical depths or trying to create structural changes in the tissue. They're basically helping remove some of the dry skin on the surface and giving you a nice exfoliation. I love those kinds of products between professional peels.

But if you're doing something intended to actually target structural changes in your tissue or the melanocytes involved in pigmentation, that's different. You need medical advice, you need appropriate post-care, and you need to have somebody available for follow-up if you're having a reaction.

What does a professional TCA chemical peel feel like, and how much downtime should someone expect?

That all depends on your consultation and the appropriate concentration of trichloroacetic acid we're using.

Sometimes somebody comes in thinking they need microneedling and I determine they're actually a better chemical peel candidate. Someone else may come in asking for a chemical peel and I decide they're a better candidate for microneedling.

That's what we figure out during the consultation.

I'm determining whether you're a candidate for a TCA chemical peel, what concentration makes sense, what form is going to work best for your skin type and what we're actually trying to accomplish.

Sometimes I combine chemical peels and microneedling in a treatment plan because they can work really well together. We're stimulating collagen, encouraging new skin and addressing things like scarring and texture from different directions.

So, particularly in my office, I don't necessarily look at a chemical peel as a single, isolated treatment. I'm creating a treatment plan and a partnership with you.

What kind of follow-up do you do after a chemical peel?

I want to follow up with you. I want to see you again. I'm probably going to send you a text the next day to make sure you're following your post-care and check whether you had any type of reaction overnight.

I'm also probably going to remind you not to pick your face when it starts peeling, because that's incredibly important.

Depending on the concentration we use, your skin is going to start peeling and you're going to be tempted to help it along. Don't.

When you pull skin off instead of allowing it to naturally slough off, you can create scarring. You can potentially create hypopigmentation or hyperpigmentation depending on your skin.

That's another reason choosing your provider matters. Who is going to be available if you have questions? Who can accommodate you if you need to come back into the office? You want someone who is going to be there throughout the process rather than simply applying the peel and sending you on your way.

What does your skin actually look like in the days after a TCA chemical peel?

This is where people can get a little nervous.

You may look great for the first two or three days, depending on the peel and your skin cycle. Then you may suddenly notice that the dark spots you came to me to treat look darker.

And you're thinking, “What the heck? I didn't ask for this.”

But that's part of what's happening. The chemical peel is working on the pigmentation we're trying to address, bringing it toward the surface so that it can eventually peel and slough away.

With a deeper peel, your skin can look a little scary for a few days. Then it begins to peel. That's when it's really important to moisturize, follow your instructions and leave that peeling skin alone.

Again, chemical peels aren't one-size-fits-all, and neither is the post-care. Sometimes we do a peel once. Sometimes it's part of a package. Sometimes we combine it with microneedling. That's something we determine during your consultation based on your skin and your goals.

So the success of a chemical peel really comes down to that 50/50 partnership?

Absolutely. You have to trust that your provider is choosing the correct peel and concentration for your skin, and your provider has to trust that you're going to follow your post-care.

A chemical peel may seem simple, but there are a lot of decisions behind doing it safely and getting the result we actually want.

How much does a professional chemical peel cost?

Our chemical peels are usually around $350.

We also have some lighter PCA peels that use different formulations and aren't the deeper compounded TCA peels. Those can be an option depending on what your skin needs.

Again, it comes back to the consultation. Rather than choosing a peel because you saw it online or your friend had one, let's look at your skin, what you're trying to correct, the downtime you're comfortable with and what you're realistically willing to do for aftercare. Then we can choose the treatment that actually makes sense for you.

I'd love to talk to you about how we can get you looking fresh and fabulous. Book a complimentary consultation.