Combination peels

Combinations peels salicylic acid + trichloracetic acid... 

Ethanol formulations of salicylic acid (20 and 30%) are used for combination peeling (see salicylic acid section). Trichloroacetic acid is prepared as an aqueous solution, since ethanol solutions do not penetrate the skin. It is prepared by mixing the appropriate concentration of crystals with up to 100 cc of distilled water. Ten and fifteen percent TCA is prepared by mixing 10 or 15 g of crystals in up to 100 cc of total volume, respectively. Aqueous solutions of TCA remain stable for up to 6 months unless contaminated. Other methods have been used to formulate TCA peeling solutions however, the weight/volume methods appear to be the most reliable formulation [5]. Premixed TCA solutions are available from a variety of medical... 

Fig. 11.18. Acne scarring treated with combined peel...

There is minimal published data on the use of combination peeling protocols in deeply pigmented skin (Fitzpatrick skin types IV-Vl). The author has reported the efficacy of combination peeling with salicylic acid 20 and 30% in combination with 10% TCA for recalcitrant melasma patients. This peeling regimen was well tolerated with minimal side effects in darker racial ethnic groups (see Salicylic acid/TCA peel section). 

Fig. 14.7a, b. Malar melasma before and after combined peeling with 25% salicylic acid and 10% TCA gel... 

Distillation of citrus juices yields two volatile fractions, namely, aqueous essences and essence oils that are separated from each other by condensation of the distillate (7). Aqueous essence, the bottom layer of the condensate is comprised of organic acids, alcohols, aldehydes, esters, hydrocarbons, ketones, hydrogen sulfide, and oxides (10). Considering many components found in both cold-pressed peel oil and aqueous essence, essence oil has a flavor similar to that of the combined peel oil and aqueous essence (10). However, essence oil usually contains a larger amount of... 

First session combined peels application of Lip 8c Eyelid formula (occlusive protocol) on the upper lip, immediately followed by an application of Only Touch peel on the lentigines. Next, Easy TCA is applied to the whole face, except for the area treated with phenol. 

Combined peels usually reach the dermis. We have just seen that the papillary dermis is easily reached, but it is also possible to reach the reticular dermis using more aggressive combinations locally. This type of peel cannot be repeated until the skin has completely recovered, and not before 3 months. Any persistent erythema, a sign of even the slightest inflammation, rules out another peel. 

Combinations peels Salicylic acid+trichloroacetic acid... 

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