A medium-depth peel involves complete destruction of the epidermis with penetration into and
destruction of the upper layers of the dermis. Medium depth peels require sequential use of either
Jessner solution, or frozen CO2 followed by 20% to 35% trichloroacetic acid (TCA). This type of
chemical peeling is designed to improve acne scarring, uneven skin texture, and discoloration by
stimulating controlled skin renewal and collagen remodeling.
What types of acne scars improve?
This peel is most effective for shallow to moderate rolling scars, shallow boxcar scars, and post-
acne discoloration. Deep ice-pick scars require alternative treatments such as TCA CROSS or
punch excision.
Can medium depth peels be combined with TCA CROSS in the same session?
Yes. This is a very effective “one-two punch” to address all acne scar types in the same session.
How is a medium depth peel applied to the skin?
Jessner solution or CO2 primes and prepares the skin for the deeper wounding agent. TCA is then
applied to create a controlled deeper injury, into the upper layers of the dermis.
What sort of preparation is necessary?
Strict sun avoidance for 1 month before and 1 month after, use of proper skin care routine including
tretinoin and/or glycolic acid. Initiation of Valtrex 1 day prior and for 1 week afterwards. Avoidance
of smoking is also necessary.
What to expect during treatment
You will experience burning or stinging during application. The stinging typically lasts 3 minutes but
can be quite intense. The entire procedure typically lasts 30 minutes. Visible frosting and peeling
for 1 week are expected.
Recovery and downtime
Expect 7–10 days of visible peeling and healing, followed by several weeks of pinkness. Strict sun
avoidance and post-care instructions are critical. Most people stay inside for 1 week afterwards.
Risks
Risks include prolonged redness, pigment changes, infection, delayed healing, and scarring (rare).
These risks increase if aftercare instructions are not followed.
Summary
This is a deeper medical-grade peel, not a superficial peel offered by med spas and aestheticians.
Advanced training and experience are necessary to perform these chemical peels. Proper patient
selection, downtime, and aftercare are essential for safe and effective results.
