TCA Chemical Peels

TCA chemical facial peels have been used for years to rejuvenate the skin.  They are excellent for skin tightening, softening fine lines, and smoothing out skin color and texture. The TCA (trichloroacetic acid) peel is a medium-depth peel, and is very popular for skin of all colors and imperfections. TCA chemical peels can vary in strength from 10%-50% depending on the skin tone, imperfections, wrinkles, etc. that are in need of improving. TCA chemical peels at higher concentrations produce deeper peeling, as does the number of applications (layers) of TCA applied to a given area.

Properly preparing your skin beforehand along with proper aftercare are all important to getting the most out of the treatment. Here are the 5 most important things to know and do before and after a peel.

Chemical peel

1. Prepare your skin:

Patients undergoing TCA chemical peeling should pre-treat the skin with an alpha hydroxy acid (AHA) product for 3-4 weeks prior to the peel. Products containing AHA encourage exfoliation and faster skin cell turnover. This will result in a more even peel and reduce the risk of hyperpigmentation after the peel. Patients that have any potential for hyperpigmentation (i.e. darker skin tone, history of dark scars) are asked to use a product containing 2% hydroquinone, a “fading cream”, in addition to the AHA product for 3-4 weeks. This will further reduce the risk of hyperpigmentation after the peel. You can get AHA online or at certain pharmacies.  We really like the product from Palmers Skin Success Fade Cream (2% hydroquinone) can be purchased online or at most Walmart, CVS, Rite Aid, Walgreens stores.

Alpha hydroxy acid cream

Alpha hydroxy acid cream

Palmer's Skin Success Fade Cream

Palmer’s Skin Success Fade Cream

2. Prevent complications:

TCA chemical peels may cause an individual to develop a cold sore if they are prone to getting them. Prescription anti-viral medication will be prescribed for a couple days before and after the peel to prevent a cold sore outbreak for all patients with a history of cold sores. Please tell your physician if you have a history of cold sores.

3. Let the skin heal:

In the days immediately following the TCA chemical peel, your skin may take on a dry, brown appearance after the initial redness has faded (usually around days 3-5). This is normal. This is the stage right before the skin begins to shed. Do not force the peeling process by attempting to peel any skin that has lifted.  It is very important that the skin stays intact until it’s ready to slough off on its own, as it is acting as protection to the fresh new skin underneath. Twenty-four hours after your peel, use a very mild cleanser (such as Cetaphil) to wash your face gently with your fingertips. Gently pat your face dry and reapply the antibiotic ointment put on right after the peel. You can also use Aquaphor, Eucerin, or similar thick moisturizer. Do not use abrasive scrubs, cleansers, or cloths on your skin for at least 14 days.

 4. Protect your skin:

After the peel, it is absolutely essential to protect yourself from the sun. The TCA chemical peel makes you very vulnerable to sunburn, which can also cause discoloration of the skin. You must commit to wearing a zinc-based sunblock of 30 SPF or higher everyday in the weeks prior to the peel, and for at least two months after the peel is done. This step is absolutely crucial in terms of your outcome after the peel. Failure to wear sunblock after the peel will result in scarring and hyperpigmentation (dark patches).Make sure the sunblock you purchase contains zinc as one of the active ingredients, as zinc provides a “barrier” protection against sun damage, and is also nourishing to the skin. A few brands that contain zinc: Blue Lizard, Clinique “City Block SPF 40”, ECO Logical Skin Care “Green Screen”.

5. Repeat the treatment:

TCA chemical peels can show good results with only one treatment, but often a few treatments spaced 6-12 weeks apart are necessary to stimulate long-lasting change in the skin.  Many offices, including ours, offer deals when several peels are purchased together.  Once the skin texture has improved and you are happy withe the result, doing a peel once or twice a year may be all you need to maintain the appearance.

If you have questions about TCA chemical peels, call our office for a free consultation at (801)264-4420.  Thanks to Katrina Poulsen, RN for contributing to this article and helping to establish our office protocols for TCA chemical peels.



It has often been debated what if any effect our diet has on our skin.  Does chocolate lead to acne?  We’ve all heard these sorts of questions.  Well several studies have recently shown that a diet rich in certain nutrients can give your skin a healthier glow.  Other foods, when avoided, may prevent break outs or poor skin appearance. Here’s a short list (put together by the authors of Eat This, Not That) of skin friendly nutrients and the best foods in which to find them.

Vitamin E: Almonds are packed with vitamin E, which is a powerful anti-oxidant which scavenges free radicals which can cause skin breakdown.  In one study where participants consumed 14mg of vitamin E (about 20 almonds), they had less evidence of UV skin damage after sun exposure.

Omega 3 fatty acids: The omega 3’s are essential fatty acids, meaning you don’t make them on your own and have to get them through the diet.  They are linked to lower triglycerides and have several beneficial effects for the heart.  Flax seeds are packed with omega 3’s. In one skin study, participants that consumed a half teaspoon of flax seed for 6 weeks had more plump and hydrated skin with less redness and irritation.  Salmon is also a great source of omega 3’s.

Almonds for better skin

Lycopene: This free-radical found most commonly in tomatoes can also give extra protection from UV radiation.  Cooking tomatoes will concentrate this nutrient.  Lycopene is also found in watermelon.

Vitamin C: This is a key ingredient in collagen and is found in lots of foods, including citrus fruits and carrots.  Sweet potatoes are an excellent source.  One study showed that consuming 4mg daily over time can reduce the formation of wrinkles by as much as 11%.

Folic acid: Leafy green vegetables are a great source of this nutrient, which is integral to DNA repair.  Studies have shown that those who eat a diet rich in green vegetables including folic acid have half as many skin tumors as those who have diets sparse on these vegetables.

Omega 6 fatty acids: Described as the ultimate moisturizer, omega 6 fatty acids have been shown to reduce scaly, itchy skin and may be of great benefit to people with eczema.  Safflower oil is an excellent source.

Vitamin A: This fat soluble vitamin helps reduce the overproduction of surface skin cells, reducing skin oils and clogged pores.  Carrots are a great source.

Catechin: This anti-oxidant is prominent in hot green tea. It has been shown to have anti-inflammatory and anti-cancer properties.  It has been shown to reduce the effects of sun damage in people drinking 2-6 cups daily.

green tea for good skin

Flavanols: Dark chocolate is rich in this anti-oxidant shown to reduce the roughness of skin and prevent skin cancer.

A good rule of thumb is to eat a diet high in vegetables, incorporating as many colors as possible.  Avoiding foods with a high glycemic index has also recently been associated with clearer skin.  In addition, dairy has been recently linked to acne and anecdotal evidence has spurred a number of new studies.  Bottom-line, a healthy diet will be evident in a brighter, healthier countenance.



This past week I took a basal cell skin cancer off the eyelid of a man younger than I, and I’m in my mid-thirties.  Remember when skin cancer was something your grandma and grandpa dealt with?  Well those days are past and we are ushering in a generation of young people who will be dealing with skin excisions, biopsies, deforming surgeries and possibly early death due to their love of the sun, tan skin, and refusal to believe they are causing themselves harm.  On a recent trip to a sunny locale, I was applying sunscreen before going out on a  morning of boating.  A friend repeatedly scoffed at my use of sunscreen, insisting I needed more color and couldn’t understand what I was worried about.  Everyone in this person’s circle of friends was tan, young and feeling great, but what will the next few years hold for them.  Here are a few tanning myths that you need to get by right away to avoid being a shriveled up raisin of skin cancer in your golden years.

Myth #1: “I have to get a base tan so I won’t burn on my vacation. Many believe they need to achieve a “base tan” early in the spring, usually at a tanning booth, so they won’t get sunburned later.  Some even think this is protective against sunburns and thus skin damage.  Don’t buy into this farce. Any sun or tanning bed exposure that causes a tan is damaging your skin, end of story.  UV rays are still blasting away at your DNA and collagen no matter the color of your skin. Spray tans are no help either. Some believe that these will somehow protect you from a burn or damage.  Not true.

Myth #2: “I only need sunscreen if I’m going to the beach.”  Most people don’t think to put on sunscreen, unless they are expecting to be outside for an extended period of time.  A recent New England Journal of Medicine article showed a man who drove a delivery truck for 28 years. He developed dramatic changes to the left side of his face, which was bombarded by UVA rays, while the right side of his face was protected from the shade.  Check out the difference between the sides in the picture below.

Facial aging from sun exposure

Myth #3: “I’ve got dark skin so I don’t get sunburned.”  Many people born with naturally darker toned skin think they don’t need to protect their skin as they don’t burn as easily.  Whether or not you get a sunburn, the UVA and UVB rays are still bombarding you, causing mutations in your DNA and ruining your skin’s elasticity.  Olive skinned people don’t look any better in their old age than fair skinned people. Very dark skinned people are also at risk for sun damage.  Acral lentiginous melanoma accounts for 50% of melanomas in dark skinned individuals and is often missed as it develops on the palms and soles of the feet. Bob Marley died of this form of melanoma.

Myth #4: “It’s cloudy, so I’ll skip the sunscreen. ”  UV rays are still present on cloudy days. If you are going to be outside, apply sunscreen.

Myth #5:  “I wear sunscreen, so I’ll never have skin problems.”  I wish sunscreen was that good. The mistake most of us make is not reapplying it often enough and not realizing that it doesn’t block all UV radiation.  When possible, wearing hats, sunglasses and longer clothing will block out more UV radiation and further reduce your potential skin damage. Sunglasses are especially important to reduce early cataracts and surface damage to the eyes, including unsightly yellow spots on the eyes called pinguecula (see photo).
















Myth #6: “Tanning beds are a safer way to tan.”  And O.J. Simpson is innocent.  The tanning bed industry is constantly working to convince people that tanning beds are safe or even healthful.  Some claim their bulbs emit lower UVB and other say tanning is a great way to get your vitamin D. Both of these claims are misleading.  All tanning beds cause accelerated skin damage.  Multiple studies have shown that people who use tanning beds have a higher rate of melanoma.  And regarding vitamin D, you need about 2-10  minutes a day of sun exposure a day to produce plenty. If you drink milk regularly or take vitamin D supplements you don’t need any extra sun exposure.

Myth #10: Vitamin E reduces scarring – Vitamin E is an antioxidant, which are agents that neutralize the oxidant effect of free radicals (molecules that damage collagen and cause skin dryness, fine lines and wrinkles). Free radicals are not the cause of scarring and any effect you may see from a vitamin E cream on scarring is either something else in the cream, an effect of the massage you did while you put the cream on, or would have happened anyway. Many creams claim to reduce scarring, such as Mederma, but few have any hard evidence that they work.

Myth #9: Skin pores open and close – When looking in the mirror you may notice lots of black pores, especially on the tip of your nose. Scores of cosmetics and treatments have been devised to reduce the appearance of these pores, many claiming they close the pores. Others claim that steam or hot water opens the pores. The pores are always open, which is necessary to allow us to sweat. The skin oil, or sebum, also comes out of the pores. The pores appear closed or full when the oils get backed up, clogging the opening. Warm water or steam helps melt these oils, cleaning out the pores. The pores, however, have no muscles and do not open or close.

Myth #8: Acne is caused by fatty foods and chocolate – Acne is caused mainly by hormonal changes, which can be affected by stress, genetics and other unknown factors. Diet may affect this to some degree, but their isn’t clear evidence how. A few studies done in the late 1960’s seemed to disprove the relationship between chocolate and acne. Pimples are formed when clogged pores become inflamed and collect both oil and pus. What exactly causes this inflammation to occur is not known.

Myth #7: Anything organic is better for the skin than synthetic products – Natural products rarely exist in a form that is perfectly balanced for you skin’s use. Either they are too potent and can cause irritation or too weak and don’t have much affect at all. Luckily, there are lots of chemists who can balance the beneficial properties of these materials to give you the best effect possible. Organic products only have to contain a small amount of naturally occurring chemicals (as little as 2%) to wear the organic label. (The price will likely be more than 2% greater than the non-organic variety).

Myth #6: Getting a base tan prevents burns later – Tanning in any form, whether at the beach or in a tanning bed is causing permanent damage to your skin. A base tan does nothing to prevent this damage. Face it, if you insist on tanning now, you will pay with extra wrinkles later (but not much later) as well as dramatically increase your chances of skin cancer.

Myth #5: Sunburns are only bad when you are young – Many people believe that any sun damage that will lead to skin cancer or wrinkling occurred when they were a teenager, and is out of their control now. They then proceed to continue tanning thinking skin protection is no longer important. UV damage can lead to skin cancer in only a few years time. I’ve seen several patients with facial skin cancers in their thirties. Sunscreen is always a good idea no matter your age.

Myth #4: Skin creams with collagen can replace collagen – Collagen is a large molecule and isn’t going to pass through your skin and somehow incorporate itself exactly where it was lost. Your body has to synthesize new collagen on its own from basic proteins. Certain vitamins, such as A and C, can help this along.

Myth #3: Vitamin A (retinol) will thin out the skin – Vitamin A enhances the skin’s barrier function, aids in collagen production, regulates oil production, reduces skin dryness, and increases skin oxygenation. Topical steroids will thin the skin when used for prolonged periods.

Myth #2: Dry skin creates wrinkles – Moisturizers may temporarily reduce the appearance of very fine lines by plumping up the skin, but no moisturizer will permanently reduce wrinkles, no matter the cost.

Myth #1: Shaving body or facial hair makes it grow back thicker – The part of the hair you can see above the skin is essentially dead and has no way of signalling back to the body to change its growth pattern when cut. Shaven hair will feel more rough as the cut ends are blunt, but the volume of hair has not and will not change.

Check out our new homepage at