Chemical Peels For Acne Scars/TCA CROSS Q&A

  • TCA Cross technique is the deposition of TCA 100% into ice pick or boxcar scars, which stimulates collagen production within the scar. The appearance of scars is improved by the increase in collagen and the reduction in the dark shadow cast by skin depressions. It is safe in all skin types, however, care must be exercised in darker skin types.

  • Number of treatments will vary based on skin type and severity of acne scars. The average patient will require at least 2-3 treatments spaced 4-8 weeks apart with a goal of 50-80% improvement over 3-4 months. Although patients will see an improvement in the appearances of acne scars with TCA Cross alone, we highly recommend combining TCA Cross with other acne scar treatments concurrently to enhance results. These treatments include surgical techniques (punch excision, subcision) for individual deep scars, microneedling, Genius microneedling with radiofrequency and fractional laser resurfacing. For example, once deep ice pick acne scars are raised up to form a shallow scar, we can then use fractional laser resurfacing to complete the scar revision process.

  • The procedure can take anywhere from a few minutes to about 20 minutes, depending on the number of scars. Patients can expect to have their face cleaned with an alcohol solution using gauze. Then, a fine blunt instrument like a toothpick will be used to deposit the TCA to the base of the atrophic scar(s) until a white frost is seen.

  • Patients should expect the white frost to last on the surface for up to 12 hours, followed by some redness and soreness for the next 24-48 hours. Subsequently, a small scab will develop within 2-3 days and the scab should fall off after 3-7 days. Post-procedure pigmentation can take up to 3 weeks to fade and this may be prolonged in darker skin types. Patients are instructed to avoid rubbing or scrubbing skin, applying any potentially irritating topicals like benzoyl peroxide, glycolic acid, or retinol/retinoids, or picking off the scab, etc. And minimizing sun exposure and applying sunscreen is imperative for up to 2 weeks to decrease the chance of pigmentation, especially in darker skin types.

  • TCA CROSS is well tolerated by the average patient. Patients may or may not experience temporary redness and local irritation. There is also a risk of treatable post-inflammatory hyperpigmentation that can persist for a few weeks or even months. To reduce this risk, your provider may recommend pre- and post-treatment with a skin lightening topical like hydroquinone.