A Form of Resurfacing: The TCA (trichloroacetic acid) peel is one of the oldest forms of skin resurfacing. Skin resurfacing refers to use of an agent or device to remove layers of skin, thereby allowing newer, refreshed skin to grow in its place. Dermabrasion and lasers are also used for skin resurfacing. Chemical peels such as TCA and phenol have been around for many years and have a long track record of success.
A TCA peel can be used as a mild, medium, or deep chemical formulation; this relates to the depth of penetration of the acid. The depth of penetration correlates to the percentage of TCA in the solution. In my hands, a medium depth TCA peel (35%) is usually used. Prior to application of the TCA, I use a light chemical peel known as the Jessner's peel, which is salicylic acid based. This cleans epidermal cells down to the layer of the stratum corneum, allowing the TCA to penetrate more deeply and more evenly.
Safety: Is a TCA peel safe. The answer is yes if used by an experienced Physician; it is a serious treatment and requires a practitioner with superb training and experience. TCA penetrates the skin via a process known as coagulative necrosis; it can only penetrate to a specified depth based on its concentration. The key is to make sure the peel is formulated correctly. Most Facial Plastic Surgeons will have a Pharmacist who formulates the peel in a consistent, specified fashion.
Downtime: Much less downtime than a CO2 laser treatment, but more downtime than a Dermabrasion or a Portrait Plasma Skin Regeneration (PSR); there is a week of initial recovery followed by moderate redness for 4 weeks or so. However, since TCA is relatively inexpensive to formulate, it gives a great result for less patient cost than most of the other treatments mentioned.
Conclusion: TCA chemical peel is a treatment I have always used in my practice as part of the armementarium of skin resurfacing, and something I will probably continue to use based on the consistency of results, acceptable downtime, and cost factors involved.