Universal Trichloroacetic Acid Peel Technique for Light and Dark Skin

Despite their great potential, medium and deep trichloroacetic acid (TCA) peels are underused in light-skinned patients and are rarely used in darker skinned patients because of the widespread fear of pigmentary complications and scarring. This concern has led many physicians to opt for the use of lighter types of peels (glycolic acid peel, Jessner peel, etc) and different lasers and intense light technologies.

TCA peels have been described in numerous publications. However, no study to date has described the precise technique and the practical pearls of a successful TCA peel approach in a clear, detailed and reproducible manner.

Dr Nabil Fanous and Dr Shadi Zari from McGill University in Montreal clarified a practical approach to universal TCA peel using data from a case series of 923 peels in 803 female and 120 male patients in an academic setting.

Patients were followed for a period ranging from six months to 13 years.

The researchers found that the incidence of complications was low and, when properly applied, TCA peels are efficient and safe for light and dark skin. The technique can be an easily implementable addition to a physician’s cosmetic practice.

The key point is to determine if the TCA peel is a safe and efficient treatment modality for light and dark skin types.

This case series demonstrates that the use of a novel genetico-racial skin classification and a standardised ‘strip’ technique of acid application allows for decreased peel risks and enhanced results.

In conclusion, when based on proper guidelines for preoperative evaluation and acid application, TCA peel is a helpful and efficient tool for the enhancement and rejuvenation of light and dark skins.

Source: Nabil Fanous, MD, FRCSC1; Shadi Zari, MD, FRCPC2, JAMA Facial Plast Surg. Published online January 12, 2017.