TCA Peel to the Lower Eyelids

It is common for me to apply TCA at the end of a transconjunctival lower eyelid blepharoplasty.  I believe it improves the skin quality and treats very fine wrinkles.  It is a relatively weak procedure, and the risk of causing eyelid malposition is low.  It is not as effective as a carbon dioxide laser; however, it is much less expensive.

This is Richard Allen at oculosurg.com.  This video demonstrates a trichloroacetic acid (TCA) peel to the lower eyelids at the conclusion of an upper and lower blepharoplasty.  The concentration of the TCA will be 30%.  The 4-0 silk sutures are retained and ointment is placed into the eyes.  It is important for the TCA to not get into the eyes as this can damage the cornea.  The skin is first cleaned with acetone.  This is performed in the area that the TCA will be applied.  The acetone is applied with a cotton-tip applicator.  The first layer of the TCA is then applied with the cotton-tip applicator.  It is important for the cotton-tip applicator to be damp, but not wet with the TCA.  You do not want pooling or dripping of the TCA.  The same Is then performed on the contralateral side.  The TCA is usually applied to the thin skin of the lower eyelids inside the orbital rim, and then feathered out onto the thicker skin.  Attention is redirected to the first side where a mild frosting has occurred.  Another layer of TCA is applied.  The same is done on the opposite side.  The edges are then feathered.  The frosting appears to be adequate.  The sutures are then removed.  Post-operative instructions for the TCA peel involve allow the skin to peel which takes about one week.  Aquaphor ointment is then applied to the area of the peel as it reepithelializes.  There can sometimes be extended erythema in the area and also sometimes pigmentation which usually improves.