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What should I expect during a trichloroacetic (TCA) peel?

Arthur W. Perry, MD
Plastic Surgery
The trichloroacetic acid (TCA) peel hurts. I often prescribe a mild narcotic such as codeine, and the anxiety drug Valium, to be taken an hour before the procedure. Prior to the peel, the face is washed with soap. I then remove the oils from the skin with nail polish remover (acetone). I apply the TCA with a fine gauze pad, stroking the skin repeatedly until the chemical soaks in. I carefully observe the skin as the chemical causes frosting -- a reaction of the acid with keratin, a protein in the skin.

I peel the forehead first, then allow the patient a few minutes until the pain lessens. Next, I sequentially peel the cheeks, the nose, the lips, and the chin. Last are the eyelids. The neck can be peeled with a lower concentration of TCA. Cool saline compresses are applied to the skin for about 10 to 15 minutes, until the frosting subsides. Once this happens, there is usually no more pain.
Straight Talk about Cosmetic Surgery (Yale University Press Health & Wellness)

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Straight Talk about Cosmetic Surgery (Yale University Press Health & Wellness)

The public’s recent exuberance toward cosmetic surgery has spurred an unprecedented demand for appearance-changing procedures. But how can an average consumer discern the hype from solid truth? ...

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