title: Universal Trichloroacetic Acid Peel Technique for Light and Dark Skin.
abstract: OBJECTIVE
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  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
  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.
  
  
  METHODS
  4.
authors.affiliation: Division of Facial Plastic, Reconstructive and Esthetic Surgery, Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.
authors.forename: Nabil
authors.initials: N
authors.lastname: Fanous
authors.affiliation: Department of Dermatology, McGill University, Montreal, Quebec, Canada.
authors.forename: Shadi
authors.initials: S
authors.lastname: Zari
mesh_terms: D000328:Adult; D002615:Chemexfoliation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D012871:Skin Diseases / Q000188:drug therapy* / Q000208:ethnology / Q000209:etiology; D012880:Skin Pigmentation; D016896:Treatment Outcome; D014238:Trichloroacetic Acid / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D014238:Trichloroacetic Acid