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Original Investigation
January 12, 2017

Universal Trichloroacetic Acid Peel Technique for Light and Dark Skin

Author Affiliations
  • 1Division of Facial Plastic, Reconstructive and Esthetic Surgery, Department of Otolaryngology–Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
  • 2Department of Dermatology, McGill University, Montreal, Quebec, Canada
JAMA Facial Plast Surg. Published online January 12, 2017. doi:10.1001/jamafacial.2016.1666
Key Points

Question  Is the trichloroacetic acid peel a safe and efficient treatment modality for light and dark skin types?

Findings  This case series demonstrates that the use of a novel genetico-racial skin classification and a standardized “strip” technique of acid application allows for decreased peel risks and enhanced results.

Meaning  When based on proper guidelines for preoperative evaluation and acid application, trichloroacetic acid peel is a helpful and efficient tool for the enhancement and rejuvenation of light and dark skins.


Importance  Despite their great potential, medium and deep trichloroacetic acid peels are underused in light-skinned patients and are rarely used in darker-skinned patients because of the widespread fear of pigmentary complications and scarring. This concern has led many physicians to opt for the use of lighter types of peels (glycolic acid peel, Jessner peel, etc) and different lasers and intense light technologies. Trichloroacetic acid peels have been described in numerous publications. However, no study to date has described the precise technique and the practical pearls of a successful trichloroacetic acid peel approach in a clear, detailed, and reproducible manner.

Objectives  To clarify a practical approach to a universal trichloroacetic acid peel and to offer novice and experienced facial plastic surgeons an organized, easy, and safe technique for medium and deep trichloroacetic acid peels.

Design, Setting, and Participants  This study was a case series of universal trichloroacetic acid peels in an academic setting. The study dates were January 1, 1996, to November 1, 2015.

Main Outcomes and Methods  This article discusses the preoperative evaluation for a chemical peel, a previously published genetico-racial skin classification, and the trichloroacetic acid peel technique, which aims at standardizing and controlling the application of the acid to improve results and lessen complications. The “strip” technique is described, which increases the physician’s control over the peel depth.

Results  A total of 923 trichloroacetic acid peels in 803 female patients (87.0%) and 120 male patients (13.0%) were reviewed (mean age, 41.59 years). The follow-up period ranged from 6 months to 13 years (mean, 13 months). This case series revealed a low incidence of complications, including 54 patients (5.9%) with persistent hyperpigmentation, 3 patients (0.3%) with mild telangiectasia, 2 patients (0.2%) with acute herpesvirus infection, 2 patients (0.2%) with bacterial Staphylococcus infection, and 1 patient (0.1%) with hypopigmentation.

Conclusions and Relevance  When properly applied, trichloroacetic acid peels are efficient and safe for light and dark skin. The technique can be an easily implementable addition to a physician’s cosmetic practice.

Level of Evidence  4.