title: Comparison of a series of superficial chemical peels with a single midlevel chemical peel for the correction of facial actinic damage.
abstract: BACKGROUND
  Chemical facial peels are common cosmetic procedures that have gained in popularity over the last decade.
  
  
  OBJECTIVE
  The aim of this study was to compare the efficacy and morbidity of a series of superficial glycolic acid (GA) peels with those of a midlevel trichloroacetic acid (TCA) peel.
  
  
  METHODS
  We conducted a split-face study of 7 female patients, comparing the benefits of a single 35% TCA peel with those of a series of 5 30% GA peels performed at monthly intervals. Throughout the study, we performed noninvasive biophysical measurements, optical imaging, and expert and naïve image evaluations and conducted subject-group discussions so that we might objectively quantify and compare the treatments over time. An additional objective of the research was to use quantitative objective measurements of skin condition and actinic damage to establish these techniques as biologically based standards for treatment evaluation.
  
  
  RESULTS
  Skin elasticity and hydration increased during the course of the study but were not significantly different between the 2 treatment modes. Overall improvement with both treatments was relatively small as judged by expert evaluations of digital images taken at baseline and 3 months after treatment. No important differences were perceived when naïve judges were asked to evaluate the images. Digital-image analysis of wrinkles in the cheek region revealed significantly greater improvement in wrinkles with the TCA peel. In patient-group discussions, TCA peels were associated with greater improvement but also with more discomfort; GA peels were associated with a high degree of satisfaction, although their effect on quantitative technical measures of actinic damage was not dramatic.
  
  
  CONCLUSIONS
  Although a single TCA peel produced more improvement than a series of superficial peels, the differences were small, and the TCA peel was associated with significantly greater discomfort.
authors.affiliation: Division of Plastic, Reconstructive and Hand Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA.
authors.forename: W John
authors.initials: WJ
authors.lastname: Kitzmiller
authors.forename: Marty O
authors.initials: MO
authors.lastname: Visscher
authors.forename: Susan
authors.initials: S
authors.lastname: Maclennan
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Butterfield
authors.forename: Ellen
authors.initials: E
authors.lastname: Fuhrman
authors.forename: Darrell
authors.initials: D
authors.lastname: Doughty
authors.forename: Nancy
authors.initials: N
authors.lastname: Dawes