Trichloroacetic Acid (TCA peels) is listed on the SUSMP as an S4 Prescription Only Medicine. Scheduling is a national classification system that controls how medicines and poisons are made available to the public. Medicines and poisons are classified into Schedules according to the level of regulatory control over the availability of the medicine or poison, required to protect public health and safety.
The following advice is for health professionals and cosmetic/beauty clinics who advertise cosmetic services that involve therapeutic goods containing Schedule 4 (prescription-only) substances.
Advertising of prescription medicine to consumers is illegal. Generally, it is an offence under section 42DL(1)(f) of the Therapeutic Goods Act 1989 (the Act) for a person to publish or broadcast an advertisement about therapeutic goods that contains a statement referring to goods, or substances or preparations containing goods, included in Schedules 3, 4 or 8 of the Standard for the Uniform Scheduling of Medicines and Poisons (SUSMP) (the Poisons Standard). This offence attracts a maximum penalty of $10,200 for an individual and $51,000 for a body corporate.
The Act broadly defines an advertisement concerning therapeutic goods as including any statement, pictorial representation or design, however made, intended, whether directly or indirectly, to promote the use or supply of the goods.
So what exactly is a TCA peel?
TCA is a non-toxic chemical known as Trichloroacetic Acid which is a regulated substance used by medical professionals such as dermatologists to perform skin peels during facial rejuvenation treatments. TCA is a derivative of vinegar which is known as acetic acid.
How does TCA affect the skin?
All skin undergoes a complex process known as keratinisation. Keratinisation normally takes about four weeks however; it can take as long as seventy-five days, depending on age and the condition of the skin.
Younger skin is far more efficient at desquamation or shedding. As we age, the glue-like intercellular cement holding the cells together becomes denser, causing a build-up in the layers of cells.
For my cosmetic tattooing colleagues this is why our older clients’ skin is sometimes tough to tattoo.
As we age, cell sloughing becomes more difficult, resulting in skin that appears dull, thicker, pigmented and less toned. This may be exacerbated by environmental factors such as exposure to sunlight, hormonal influences such as androgens, estrogens and epidermal growth factors and deficiencies in various vitamins such as vitamin A & D.
With all of these influences affecting the desquamation process you can see why skin peels and manual exfoliation methods are so important to the skin. Removing this build-up of dead, damaged cells stimulates the regeneration of new cells, improving the skin’s appearance, feel and texture that may accelerate the skin ageing process. So removing the build up of skin cells through the use of a TCA peel will help accelerate our skin renewal process.
When a TCA peel is applied to our skin, it causes the top layers of our epithelial cells to dry up and peel off. The drying and peeling process may take several days to a week. Although once your skin has finished peeling the new skin is exposed and should be smoother, less pigmented and display a more even texture.
What is the benefit of a TCA peel?
Often TCA peels and laser therapies are complimentary treatments. However a facial peel is a great way to experience the benefits of facial rejuvenation and provides you the opportunity to evaluate if laser resurfacing is right for you.
When you’re unsure if you’re ready to undergo full facial rejuvenation with the use of lasers there is always an option of a fruit acid peel or a TCA peel.
As we advance in years our skin cells form like cement and renewal slows down. Our skin will begin to display fine lines, wrinkles and irregular pigmentation. Our genetics, gravity, sun exposure, lifestyle factors, including smoking and alcohol consumption, air conditioning, pollution, diet and exercise all influence our skin health. TCA peels are an ideal way to manually exfoliate and rejuvenate your skin.
Having a peel may assist in lighten pigmentation, sun spots, liver spots, freckles, and blemishes due to sun damage. Mild acne scarring & certain types of acne can also be treated. Peels are used to rejuvenate the skin, soften fine lines, increase circulation and improve the appearance and texture of the skin. Ideally your skin should be prepped well in advance before undergoing a facial peel.
A home skin preparation will need to be applied each day for at least 4 weeks. Adherence to your pre-treatment regime will allow for greater absorption of the preparation by gently encouraging the regeneration process of skin cells and shedding of the thickened, outer layers of the skin.
The depth of the peel can be adjusted depending on your needs, skin type and skin damage.
What’s involved in a facial peel?
Before your procedure your skin will be cleaned thoroughly with a special skin preparation to remove any oil and makeup residue. The peel will be painted on your skin with cotton swabs. A white “frosting” usually occurs on the surface of the skin during the first 5 minutes. The white colour or frosting will decrease as the preparation is absorbed by your skin and your face will feel tight and become red like you’ve been sunburnt. Mild TCA’s can be repeated monthly.
You should not drive after your procedure, so arrange for someone to collect you from your appointment.
What do you feel during the procedure?
Most patients report a warm to somewhat hot sensation, which lasts 5-10 minutes, followed by a stinging sensation. You should be aware that deeper peels may call for pain relief during the procedure.
What to anticipate after treatment?
The peel solution causes separation and eventual peeling of upper layers of epidermis, enabling new regenerated skin to appear. Individual reactions depend on the depth of the peel used. A response like a mild to severe sunburn occurs following a facial peel. Superficial shedding usually involves slight inflammation and redness, followed by flaking and peeling that ends within 3-5 days.
The new skin will be fragile and more susceptible to injury during the healing phase so sun avoidance is mandatory for 3 months post procedure and it is crucial to wear sun protection at all times while outdoors.
What are the limitations of facial peels?
TCA facial peels cannot eliminate sagging of excess skin and are not a substitute for an eye, brow or facelift, as they cannot correct the gravitational forces that produce loose skin. Facial peeling will not remove deep scars; laser resurfacing or dermal fillers can be more effective for these.
Facial peels cannot change pore size, or remove broken capillaries, however, facial peels may improve the appearance of these conditions.
What about laser?
Many professionals use lasers now rather than TCA peels because the lasers can be controlled more precisely, limiting complications. Peel solutions can be less predictable because the exact strength of the solution, adherence to the pre-peel skin regimen and the ability of the skin to absorb the peel solution are all variables that can be difficult to precisely control. Also, many patients with sun-damaged skin have some redness or dilated blood vessels that need to be treated as well. The IPL laser systems can treat both the redness and the sun spots at the same time. Sometimes peels and lasers may be used in combination for optimism results.
Another advantage to lasers is that many problems can now be treated with immediate return to normal activities. Medium depth TCA peels usually require some time off to heal.
TCA peels, because of the risk of uneven absorption, blistering, and possible scarring, should only be performed by a dermatologist or medical professional.