Clinical Aesthetic Services

Title: 20% TCA Peel

Policy: All clinical aesthetic staff rendering client care will adhere to this protocol

Purpose: To safely and properly administer peel treatments and solutions by exfoliating with chemical peeling agents on the face, neck, hands, chest, arms, legs and back.

Scope: All licensed aestheticians rendering client care

Definition: Clinical Protocol

Indications: To help minimize fine lines and wrinkles, rejuvenate skin from discoloration and hyperpigmentation due to solar damage, aging, acne and acne prone skin, and large pores.

Contraindications:

Do not peel if client has a sunburn. Cannot treat clients with frequent unprotected sun exposure or tanning bed usage.
Do not peel if client has a Herpes Simplex Virus (HSV) outbreak. If client has a susceptibility to HSV, avoid common outbreak area with solution. Can take prescription Valtrex or Zovirax prior to treatment, or immediately after treatment if beginning signs occur. If client needs a prescription, notify Overseeing Medical Director.
Do not peel if client has significant product irritation or history of cosmetic related irritant/allergic reaction without a test patch.
Do not peel if client is sensitive or allergic to specific chemical peeling agents. If client is allergic to aspirin, do not use Salicylic Acid solution.
Do not peel if client has recurrent contact dermatitis.
DO NOT use on open lesions, rashes, burns, or suspicious lesions.
If client is pregnant, written authorization is required from her medical provider approving chemical peels during pregnancy.
Cannot treat skin if client has been on Accutane (Isotretinoin) within the past 6 months.

10. Use caution on skin that has been treated with Tretinoin (Retin A, Renova) or other photosensitizing oral medications.

Procedure:

All clients treated will have a skin history consultation, signed a chemical peel consent form during which time questions are answered, as well as discussing potential risks, complications, and anticipated results. These completed forms will be present in the chart.
Any drug allergies will be noted on the front cover of the chart.
Photographs may be taken.
Clinician to perform service in latex or non-latex gloves.
Client is placed in treatment chair, supine and in a reclined position.
The client is properly draped, using linens that are laundered after each use.
The skin will be cleansed, with appropriate cleanser and soft gauze, removing all make-up except eye make-up.
Degrease the skin with 70% alcohol.
Apply Vaseline around the eyes, lips and folds of the nose.
The client is given a motorized fan to be placed comfortably on the chest area.
Analyze the skin and determine the appropriate products to use during the treatment.
Set out the Neutralizer, gauze and q-tips for immediate use, if needed.
Apply the 20% TCA Peel solution on a 4 x 4 rough gauze. Hold the skin taunt, and apply gentle, even glide strokes to the skin’s surface ensuring overlap and consistency. Start on the forehead, then proceed to the right side of the face with downward strokes, then to the left side applying slight pressure. Have the client keep their eyes closed during the procedure. DO NOT OVERLAP PASSES.
Wait 5 minutes between layers.
Evaluate the skin for blanching. As soon as an area blanches, STOP applying layers to this area.
After each layer, check to see how “tingley” the skin is between 1 and 10. You should be able to do 2-3 layers.
Working around any blanched (white) areas, apply the second layer of the 20% TCA Peel solution on a 4 x 4 rough gauze. Hold the skin taunt, and apply gentle, even glide strokes to the skin’s surface ensuring overlap and consistency. Start on the forehead, then proceed to the right side of the face with downward strokes, then to the left side applying slight pressure. For any small areas, use a q-tip to apply the peel solution.
Wait 5 minutes.
Neutralize areas that blanch for 15-30 seconds.
If there are any areas unblanched, apply a third layer of the 20% TCA Peel solution WITH A Q-TIP, working between the areas that are white/blanched.
Leave the peel solution on as it self-neutralizes.
The client may experience slight warmth for up to an hour after the treatment is administered.
DO NOT apply moisturizer or SPF. The peel self neutralizes and can be left on the skin for up to 24 hours.
This peel has 7-10 days of down time. It is important to walk them through the post care sheet and make sure they thoroughly understand what they are to do and NOT do.

Post Treatment:

Written post treatment instructions to be given and reviewed with the client after the treatment has been administered.
It is imperative that the area is left to heal and the client does not pick or scratch at it for this could lead to premature healing of the skin and the potential for scarring.
Client is not to apply any irritants, such as Retinols, glycolics, etc. for 2 weeks after this treatment.
Make up can be worn on Day 3 after the peel.
Avoid direct sun and wear sunblock of 30 spf or higher.
Schedule a follow up visit in 2 weeks.