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document
Histopathologic changes of the eyelid skin following trichloroacetic acid chemical peel . The use of trichloroacetic acid ( TCA ) as a periorbital and eyelid peel for skin rejuvenation is gaining significant acceptance among oculoplastic surgeons , dermatologists , and other surgery groups . In spite of the current enthusiasm , there remain potentially serious complications resulting from any periorbital peel . Cases of cicatricial ectropion have been reported in phenol-peeled patients , and lower eyelid ectropion has reportedly occurred in patients undergoing deep eyelid peel in conjunction with a blepharoplasty ( 1,2 ) . To avoid this complication , it is necessary to better understand the depth of the wound produced by different strengths and combinations of peeling agents applied to living eyelid tissue and , more important , to determine the concentrations of TCA that are likely to lead to cicatricial ectropion when applied in a consistent fashion . We chose upper-eyelid skin because it is easier to obtain for histopathologic study than lower-eyelid skin and , in our experience , is more sensitive to hypertrophic changes after chemical peeling or carbon dioxide laser resurfacing . We applied TCA to the preseptal skin of 10 patients 48 h before standard upper-eyelid blepharoplasty . The acid was applied to produce a " frost , " using varying concentrations of acid , ranging from 20 to 50 % . The treated skin removed at the time of blepharoplasty was reviewed in a masked fashion by a dermatopathologist to determine the depth of necrosis . We found that superficial peels with necrosis involving 30 % of the epidermis were produced by the lowest-concentration combination of TCA applied ( 20 % followed by 0 % ) . As the strength increased , so did the depth of peel . The combination of 50 % followed by a second application of 50 % produced the deepest peel , with necrosis into the papillary dermis . This finding would indicate that the chance of developing cicatricial ectropion with any of the tested combinations of TCA should be very remote .
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Intervention_Physical
trichloroacetic acid chemical peel
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Intervention_Pharmacological
trichloroacetic acid ( TCA )
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Intervention_Surgical
blepharoplasty
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Intervention_Pharmacological
TCA
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Intervention_Pharmacological
TCA
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Intervention_Pharmacological
TCA
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Intervention_Pharmacological
TCA
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Outcome_Physical
Histopathologic changes of the eyelid skin
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Outcome_Physical
superficial peels with necrosis
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Outcome_Other
applied
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Outcome_Other
strength increased
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Outcome_Physical
deepest peel
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Participant_Condition
eyelid skin
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Participant_Condition
phenol-peeled
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Participant_Condition
deep eyelid peel
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Participant_Sample-size
10