- Primary effects on papillary dermis
- Combination peels safer than higher concentration TCA
- Prepeel rejuvenation program mandatory, especially in darker skin types
Medium-depth peels by definition are chemical peeling agents used to exert a controlled injury extending to the papillary dermis [47]. The prototypical medium-depth peeling agent, 50% TCA, has fallen into relative disuse because of its high risk of complications. Scarring and postpeel dyschromias are possible sequelae of higher concentrations of TCA due to an unpredictable pattern of absorption and resultant “hot spots”. Many clinicians have abandoned the higher level TCA peels for combination peels using 35% TCA with Jessner’s solution, 70% glycolic acid, or solid CO
2 [47]. Although comparative data is not yet available, pyruvic acid is a new addition to the medium-depth chemical peel armamentarium showing many of the same clinical benefits as the traditional medium-depth peeling agents [48]. The combination peels can achieve the same depth of penetration as the solitary 50% TCA but without the associated risks.
