From the Guidelines
For improving pink and wrinkly top surgery scars that aren't very hypertrophic, superficial chemical peels like glycolic acid (20-30%), salicylic acid (20-30%), or lactic acid (20-40%) peels can be effective, as supported by the guidelines of care for the management of acne vulgaris 1. These peels should be applied every 2-4 weeks for a series of 4-6 treatments.
Key Considerations
- TCA (trichloroacetic acid) at lower concentrations (10-15%) may also help improve scar appearance without excessive downtime.
- Before starting any peel regimen, ensure the scars are fully healed (at least 6-12 months post-surgery) and consult with a dermatologist or plastic surgeon experienced with transgender healthcare.
- Begin with a patch test to assess skin sensitivity, and always use sun protection (SPF 30+) daily as peels increase photosensitivity.
Mechanism of Action
These acids work by accelerating cell turnover, removing damaged surface skin, stimulating collagen production, and evening out pigmentation.
Maintenance and Professional Care
Between professional treatments, gentle at-home products containing lower concentrations (5-10%) of these acids can help maintain results, but should not replace professional care for optimal outcomes. While other treatments like autologous platelet concentrates and laser therapy have shown promise in managing acne scarring 1, chemical peels remain a viable and effective option for improving the appearance of pink and wrinkly top surgery scars.
From the Research
Chemical Peels for Top Surgery Scars
To improve top surgery scars that are somewhat pink and wrinkly but not very hypertrophic, several chemical peels can be considered. The choice of peel depends on the individual's skin type, the depth of the scar, and the desired outcome.
- Alpha-hydroxy acids: Glycolic acid, a type of alpha-hydroxy acid, can be used to improve skin texture and reduce the appearance of fine wrinkles 2.
- Beta-hydroxy acids: Salicylic acid, a type of beta-hydroxy acid, is commonly used to treat acne and acne scars, and can also be used to improve the appearance of pink and wrinkly scars 2, 3.
- Trichloroacetic acid (TCA): TCA peels can be used to treat deeper scars, including atrophic acne scars, and can be combined with other treatments such as subcision and fractional CO2 laser resurfacing for improved results 4, 5.
- Glycolic acid peels: Microneedling with 70% glycolic acid peels has been shown to be effective in treating atrophic acne scars, and can also be used to improve skin texture 6.
- Combination peels: Combining different peeling agents can minimize side effects and achieve better clinical results 2, 3.
Considerations
When choosing a chemical peel for top surgery scars, it's essential to consider the individual's skin type, the depth of the scar, and the desired outcome. A series of chemical peels can lead to significant improvement over a short period, and combination peels can be used to achieve better clinical results 3.