Chemical Peels & Microdermabrasion

Peels and microdermabrasion (MDA) as seen on the web usually mean a light to medium depth skin refresh. This is what is discussed in this article. Deep peels, like phenol or deep TCA, are almost never used now because they leave pigment problems, and lasers have fewer complications at this depth, with an experienced dermatologist. 

What are the different types of chemical peels and MDA?

There are many different types of chemical peels, but MDAs tend to be more standardized.  This means that from one medical clinic or medspa to the next you’ll get a more consistent service usually with an MDA.  There is more variability with peels. 

Chemicals peels are usually alpha or beta hydroxy or TCA (trichloroacetic acid).  Microdermabrasion uses a fine-tipped, tiny vacuum suction device to remove the top layers and clean out clogged pores. 

What are they used for?

Chemical peels and microdermabrasion (MDA) are most commonly used to:

  • Clean out pores and reduce acne
  • To reduce brown spots and age spots
  • To improve the texture of leathery, sun-damaged skin and impart more glow
  • To improve melasma
  • To reduce fine lines

Are there any pros or cons of chemical peels and MDA?

There are very few cons of chemical peels and MDA, but there are some things you should keep in mind when decided what is best for you.

  • These options are generally less expensive
  • Because they are more superficial, less risk of serious complications like infections and scarring
  • Better for skin maintenance, but not as good for the repair of sun damage or scars
  • Better for younger skin than older skin usually because results will be less obvious
  • It can cause pigmentation problems similar to lasers.
  • Often done by inexperienced or poorly trained personnel at medspas so be careful

What are TCA peels?

TCA is a non-toxic chemical (trichloracetic acid), which has been used to perform skin peels for over 20 years. It is a relative of vinegar (acetic acid.) When TCA is applied to the skin, it causes the top layers of cells to dry up and peel off over a period of several days to one week. When the old skin is peeled off, it exposes a new layer of undamaged skin, which has a smoother texture and more even color.

Some dermatologists, in fact, still prefer TCA peels for treating sun damage or melasma, usually in combination with prescription creams. TCA peels are safe in the hands of an experienced dermatologist. TCA peels may be a particularly good option if you have melasma because many lasers are difficult to use when treating melasma.

How do TCA peels differ from alpha or beta hydroxy acid peels?

All peels work by removing a layer of sun-damaged skin. Superficial or “light” peels remove only the top layer, mostly the layer of dead skin called the stratum corneum. Progressing from light to medium peels, the layer of skin removed is greater with each increase in strength of the peel solution. The stronger the peel solution the deeper the peel and the greater the risk of complications like uneven pigment or even scarring.

Lighter chemical peels are usually done in a series of 2 or 3 for best results. This is similar to other light peels that usually involve hydroxy acids such as glycolic, salicylic, or a mixture of other hydroxy acids. Medium depth TCA peels are usually done once or twice a year and do require some downtime – usually about a week – when the peeling is obvious.

What areas can be treated with MDA and chemical peels?

Microdermabrasion is usually used on the face, chest or back. For peels, the most common areas are face, neck, chest, back, arms, and legs. TCA peels may be very cost-effective on the body because larger areas can be done at less cost than a laser. However, the risks of problems may also be greater unless the dermatologist is very experienced with TCA peels on the body.

When considering peels of non-facial areas, it’s important to realize that these areas do not heal as well as the face, and the desired results are not as predictable. It is important to note that you should never peel more than a small percentage of the body at one time in order to avoid any chance of potential toxicity.

What are the pros and cons of TCA peels versus treating the same problem with a laser?

Many dermatologists use lasers now rather than TCA peels because the lasers can be controlled more precisely, limiting complications, and with better results. Peel solutions can be less predictable because the exact strength of the solution, the pre-peel clean (defatting), and the ability of the skin to absorb the peel solution are all variables that can be difficult to precisely control. Still, some dermatologists who are experienced get excellent results.

Another advantage to lasers is that some problems can now be treated with immediate return to normal activities. Medium depth TCA peels usually require some time off to heal.

When will I see results from my chemical peel or MDA?

As soon as you finish peeling you will see results. Your skin should continue to improve for 30-60 days as long as you are protected from the sun.

How much do peels cost and how much time in between?

This really depends on where you live, the depth of peel and the areas you are peeling. Hydroxy acid peels and microdermabrasion range from $100-$300. TCA peels can run from $300 to $1,000 for a full face peel. All of these are often done in a series. A full face, neck, and chest will cost more.  A good interval is 3-6 weeks between treatments.

What does a TCA peel feel like?  Is it painful?

When you arrive, you will be put in a room and be asked to get comfortable on an exam table. Your skin will be cleansed several times with liquid cleanser, alcohol and possibly acetone.  It’s important that all the oil be off the skin so the peel solution will penetrate evenly. Then the peel solution is applied and sometimes this is done in two stages. There is some stinging and a sensation of heat while the peel solution is active. Sometimes a small handheld fan is used for cooling in this stage. Then an ointment is applied to speed healing and post-care instructions are given.

What will I look like right after the treatment, and what will the healing time be?

With microdermabrasion, you may be slightly pink, but usually it’s ok to resume normal activities.  Follow your doctors’ instructions. With lighter peels, the peeling may be microscopic, meaning you can’t see it.  A slightly deeper peel may cause peeling 2-5 days later.

You will usually peel for about one week with a medium peel. The skin will be a light yellow after the procedure for 1-2 hours. This color will gradually fade. The skin will be slightly redder for 2-3 days after the peel and feel tight.

Avoid all sun exposure after MDA or peels, and follow your doctors’ instructions as to how long you need to avoid it. You may be more sensitive to sunlight for 4-8 weeks after so ask your doctor if you have sunny vacations planned.

What are the possible side effects and complications of chemical peels?

You may experience pain. Mild to moderate discomfort during the peel. There is usually no discomfort after the peel, but, in case there is mild discomfort, pain medications can be provided.

A pink or red coloration of the skin may persist for 2-8 weeks after a peel. In rare instances, redness may persist up to six months. This can occur all over or only in certain spots.

In summary:

Light to medium peels or microdermabrasion may be a very cost-effective option, when done carefully and correctly, for melasma, superficial to moderate acne (in addition to medication), mild sun damage, fine lines, and to maintain healthy skin, even if you don’t have problems.