TCA CROSS for Acne Scars

TCA CROSS for Acne Scars

TCA CROSS is defined as TriChloroacetic Acid Chemical Reconstruction of Skin Scars.  By utilizing TCA it is the perfect procedure to treat atrophic (ice-pick, rolling or boxcar) acne scars.  The technique used is to place a small amount of high concentration TCA within in the affected acne scar.  This results in a chemical reaction causing localised inflammation.  This inflammatory process leads to new collagen fibres to be stimulated causing a change in the appearance of the acne scar.   TCA CROSS is usually coupled with other treatment modalities to improve facial skin texture and tone.

The procedure is performed by a specialist Dermatologist.  The treatment time itself is relatively quick.  During the initial consultation the treating Dermatologist will explain which scars are best suited with TCA.  TCA is administered into the base of the scar with a fine instrument.  Once frosting has been achieved the instrument is removed and that particular acne scar has been treated, it is then repeated for all remaining scars.  On completion of the procedure a topical emollient is applied.

Frosting of the acne scar caused by TCA application can remain for up to 12 hours following the procedure.  The skin will have localised redness for up to one week. The skin can be cleansed with a gentle cleanser and kept moist with an emollient.  Sunprotection is encouraged to protect the skin from sunlight and the risk of hyperpigmentation.  TCA CROSS is generally well tolerated, complications are rare.  If further TCA CROSS treatments are required it will be repeated at 4-6 week intervals.

On average 2-3 subsequent TCA CROSS treatments are required.  Each treatment of TCA CROSS causes subtle raising of the level of acne scars from ‘deep’ to ‘shallow’. Once the scars are deemed to be shallow enough by the treating Dermatologist.  A laser is then used to level out the ‘shallow’ scars resulting in global facial rejuvenation. Consider TCA CROSS as the first stepping-stone in removing deep scars and open pores.

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  • TCA peels can also be used as a safe way of addressing sun damage, wrinkles and pigmentation.
  • This type of peel can be performed on the face, neck and chest areas.
  • TCA peels are prescribed by a specialist dermatologist.
  • Recovery and results are dependent on the concentration of TCA used and area of treatment. 

Deep acne scars and enlarge pores lie below the safety zone of lasers. Lasers including CO2, Erbium and Fraxel can all deliver the necessary power to reach scars, however this will be pushing the safety margin for deeper acne scars, such as ice pick scars.

TCA CROSS overcomes this problem by placing a known concentration of acid. Sounds weird doesn’t it? The acid actually ‘scars’ the scar, stimulating collagen and raising the level of the scar. After just one treatment, you will notice a difference, however most ice-pick scars will require 2-3 treatments before they reach the ‘safe to laser’ mark.

Specialists will choose a concentration of TCA ranging from 35% to 100%- this depends on your skin colour, and depth of your acne scars.

A through examination and map of your skin is made by a Specialist prior to any scar revision. Scars sites are assessed, and photographed.  Your Dermatologist will then discuss various options for each type of scarring. Assessment, planning and a comprehensive discussion of procedures is the initial step.

The TCA cross procedure is performed by a Specialist Dermatologist trained in this technique. Using an applicator, TCA is injected into the base of the deep acne scar. The procedure is very well tolerated, with minimal discomfort and takes between 5-15 minutes to perform. A special healing balm and face wash will be prescribed after the procedure.

We generally recommend 2-3 treatments, spaced 8 weeks apart.

‘Shallow scars and rolling scars are best treated with Fractionated lasers/ Fraxel, deeper scars such as ‘ice-pick’ acne scars are best treated with TCA cross or punch excision.’ Dr Davin S. Lim

No. The truth is the procedure is slightly uncomfortable but not painful. To date we have done over 1500 cases of TCA CROSS at the Acne Specialist Clinic, and local anaesthetic is not needed. The procedure can be likened to a sensation of ‘nettle stings’ or small ant bites and is over within minutes.

For DEEP ice pick scars, this is the BEST treatment – hands down. Our Specialists will choose to perform TCA CROSS over any laser, any day to treat ice pick and deep acne scars. This is because laser treatment cannot safely reach the bottom of the ice pick scar, but TCA can.

Remember, TCA CROSS is a stepping-stone before any laser treatment. The time-tested philosophy is to raise deep scars before lasering.

Recovery from TCA cross is quick, and painless. The treated areas are initially white for several hours, there after turning red for several days. Each treated area (1-2mm) will remain red for 3-4 days, then shed or peel. Full recovery is expected within 5-7 days, however the residual redness may take a week or two to fully recover. Sun protection is essential during this recovery period.

Yes. All skin types can be safely treated with TCA cross, however in darker skin types, such as Asian, Middle Eastern or Latino skin the risk of post treatment darkening will increase. This means, treated areas maybe darker than the surrounding skin for weeks to months. The use of sunscreen and a bleaching cream can reduce this incidence. Your Specialist will discuss this with you after examining your skin type.

Treating darker skin types requires a modified method of TCA CROSS, to reduce the chances of side effect, the flip side is that darker skin patients will require an extra one or two more treatments to achieve optimal results.

Yes. In some cases pore size can be reduced by TCA CROSS, however most patients will need 2-3 treatments for a 30-50% reduction in pore size.

The larger the size of the pore, the greater the improvement.

Please contact us for pricing.

(Small areas) – (multiple large areas)

2-4 treatments are recommended for optimal results.

This procedure is often combined with specialist surgical scar revision- Medicare rebate may apply in these cases.

Trusting a physician to revise scars can be daunting form many patients as acne scars can be a complex mixture of scar types.  Laser trained and procedural dermatologist are best equipped with expertise and the latest technology to give optimal results to our patients.

At Westside Laser Dermatology, all TCA treatments are performed by our highly qualified Dermatologists, so you can be sure that you are in experienced hands.

Call us directly on 07 3871 3437 to make an appointment, or to discuss issues regarding the referral process. For unbiased opinions on acne and acne scar revision, ask your GP whom they would recommend.

This is our favourite treatment for acne scar revision. Why? Because it works well, and it is predictable in the results it delivers. The deeper the scar, the better it works. Patients can see results with just one treatment, however, most patients will benefit from 2-3 treatments before laser resurfacing. The procedure is also relaxing, and well tolerated. In Specialist’s hands-it just works!

Matching a concentration to the scar depth, scar type and skin type is the challenge.

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Dr Davin S. Lim
Laser Dermatologist
Westside Laser Dermatology

TCA Cross is a simple, effective and safe method that is ideally suited for deep acne scars. Even with the event of complex lasers such as Fraxel and Fractional lasers, TCA still plays an important role for the revision of ‘ice pick scarring.’ Acne patients often have several types of scars including rolling scars, ice-pick scarring, box scars, and bound scars. Optimal treatment involves combing treatments such as lasers, subscision, TCA chemical peels and punch excision for the best results.

This is my favourite procedure, as it is relaxing for both doctor and patient- it’s well tolerated, the results are very predictable, and it can be used on all skin types- including Asian and very dark skin types.

Patients should view this treatment as the very first step in the treatment of deep acne scars and enlarged pores. Once the scars are raised up to a safe level, I then use either a CO2 laser or Erbium laser to finish the job. In some cases, up to 80% scar improvement can be seen after the program.