Precare – TCA Peel Information Sheet

What is a TCA peel?

TCA (trichloroacetic acid) is a type of chemical peel used to improve skin tone, texture and signs of ageing. It involves application of an acid solution to the skin, encouraging the removal of damaged surface cells and stimulating the skin’s natural renewal processes. This can help to improve pigmentation, smooth the skin and restore a brighter, more even complexion.

Depending on the strength of acid used and the number of layers applied, some chemical peels, including TCA, can penetrate beyond the outer layer of the skin and stimulate deeper skin remodelling. These peels should only be performed in a controlled clinical setting by a trained medical professional.

What can a TCA peel treat?

– Melasma and hyperpigmentation
– Sun damage and uneven skin tone
– Fine lines and wrinkles
– Dullness and surface roughness

Can a TCA peel treat melasma?

TCA peels are not a first-line treatment for melasma. Dermatologists usually trial topical treatments to improve the pigmentation first before considering procedures like chemical peels.

A TCA peel may be recommended if pigmentation has not responded sufficiently to these treatments.

Melasma is a chronic (long term) condition and may recur over time. Ongoing topical maintenance treatment and strict sun protection are essential for long term control.

How is the procedure performed & does it hurt?

As your skin will be more sensitive to sunlight after a peel, treatments are ideally carried out in autumn or winter.

Your skin will be cleansed and the peel solution applied. A stinging sensation is expected. The peel is neutralised after a few minutes, and the stinging may briefly intensify before settling.

The appointment usually takes 20–30 minutes.

What is the downtime after a TCA peel?

Immediately after the peel, your skin may look flushed, pink or red (similar to sunburn) and may feel warm or tight.

Over the following days, dryness and peeling are common. In some cases, the skin may appear slightly darker before it starts to peel.

In the first 1–2 days, you may experience:

– Redness
– Tightness
– Sensitivity

At around days 3–7, you will typically develop peeling or flaking

The peel system we use is designed to minimise surface disruption. Peeling usually start a little later than other TCA peels. If there is little or no visible peeling, this does not mean the treatment has not worked.

That said, you should plan this treatment when you can limit social or work commitments for around a week, as peeling can sometimes be noticeable and hard to disguise.

Results:
Most people notice brighter, smoother skin after 1–2 weeks after a TCA peel, with continued improvement over several weeks.

How many treatments are needed?

We usually recommend an initial course of 2 treatments, spaced approximately 4 weeks apart.

For best results, one or two further treatments may be performed the following year (ideally in autumn or winter).

Maintenance treatments are then carried out as needed, for example every 1–2 years.

What strength peel will I have?

We usually start with a 25% TCA peel.

In some cases, a 40% TCA peel may be used subsequently or we might combine a TCA peel with a different type of peel. This is expected to be stronger and associated with more downtime.

The strength or combination used will always be tailored to your skin and concerns.

Can it be performed on all skin types?

This treatment is most suitable for lighter skin types (Fitzpatrick I–II).

It is generally not recommended for darker skin types due to an increased risk of post-inflammatory pigmentation.

Is there anyone who is not suitable for treatment?

You should not have a TCA peel if:

• you are pregnant, breastfeeding or trying to conceive
• you have an active skin infection (including cold sores) or open cuts
• you have a history of eczema, rosacea or psoriasis in the area to be treated
• you have had recent sun exposure or tanning
• you have had surgery, dermabrasion or laser in the area to be treated within the last 6 months
• you have taken isotretinoin within the past 6-12 months
• you have ever had radiotherapy in the area to be treated
• you are immunosuppressed e.g. organ transplant recipient, cancer treatment, HIV etc
• you have a personal or family history of developing keloid or hypertrophic scars
• you have a personal or family history of developing post inflammatory hyperpigmentation (pre-treatment evaluation and skin preparation may mean a peel is possible)
• you are a smoker (poor healing)
• you have a history of body dysmorphic disorder or dissatisfaction with cosmetic procedures

If you have a history of frequent cold sores, please let us know in advance, as preventative oral antiviral treatment may be required.

NB if we combine your TCA peel with a Jessner peel, you will need to let us know if you are allergic to salicylates e.g. aspirin.

What precautions should I take before my treatment?

To reduce the risk of complications and improve the treatment outcome, particularly when we are treating hyperpigmentation, you will likely be advised to use pigment-regulating topical treatments for 4–6 weeks before your peel, such as:

– retinoids
– hydroquinone
– azelaic acid

You will need to stop retinoids, scrubs and exfoliating acids for at least 7 days before and after your peel

What should I do after my treatment?

Head home after your peel and avoid sun exposure, as sunscreen cannot be applied immediately afterwards.

From the next morning, follow the guidance below:

Cleansing

• Cleanse gently twice daily using a soapless cleanser or lukewarm water
• Use your hands only — no cloths or exfoliating tools
• Pat dry with a soft towel — do not rub
• Do not wash your face or apply products (other than moisturiser) on the evening of your peel

Moisturising

• Keep your skin well moisturised at all times
• Use a simple non-comedogenic barrier-repair moisturiser (e.g. Avene Cicalfate+ or La Roche-Posay Cicaplast Baume B5)
• Reapply as often as needed to reduce dryness, tightness or itching

During the peeling phase

• Do not pick, peel or rub the skin — this is important to avoid scarring or pigmentation
• Avoid heat (saunas, steam rooms), swimming and strenuous exercise
• When washing your hair, avoid direct water pressure onto your face

Skincare and make-up

• Avoid all active skincare (retinoids, acids, exfoliants) until the skin has fully healed (usually 2 weeks)
• Avoid make-up while the skin is actively peeling or scabbing

Sun protection

• Avoid direct sun exposure for at least 2 weeks
• Once able to, apply SPF 50 daily
• A wide-brimmed hat is helpful, but does not replace sunscreen

What are the risks?

This is a medical procedure and, while generally safe, may involve:

• redness
• dryness
• itchiness
• tenderness
• peeling
• swelling

Less commonly:

• prolonged redness or burning
• blistering
• increased or long term sensitivity
• infection e.g. cold sore reactivation
• scarring
• milia
• altered pigmentation

If preparation and aftercare advice are not followed, there is a risk of pigmentation worsening (particularly in darker skin tones).

When to seek advice

If you develop significant swelling, blistering, increasing pain, signs of infection (e.g. yellow crusting) or a cold sore following your peel, we would want you to contact the clinic promptly.

If you have any questions after reading this, please don’t hesitate to contact us.

Kind regards
Dr Justine Kluk & team