ABSTRACT
A trichloroacetic acid (TCA) peel, even if it reaches the papillary dermis, is not always enough to correct the patient’s cosmetic problem, and experienced doctors are often led to combining several techniques to achieve the results they want. Peels can be combined to work together or with other surgical or non-surgical techniques. Using another technique or another peel before a TCA peel is often intended to remove part of the epidermis to enhance penetration of a lower-concentration TCA. The first technique provides the equivalent of a superficial peel that will enhance the action of the TCA applied afterwards. Some authors maintain that using a combination of peels lowers the frequency of complications compared with using more concentrated TCA, in aqueous solution. Not all combinations are safe, however, and a combination of different peels on the same surface often tends to make the symptoms more complex and increase the risk of complications compared with the safer formulations of today.
