TCA Cross Acne Scars At A Glance
- Best Results2-5 treatments
- Treatment Recovery5-7 days
- Procedure Time5-30 min
- Skin SpecialistNurse, dermatologist
- Duration of ResultsPermanent
- AnaestheticNumbing if needed
- Back to Work1-5 days
TCA Cross Acne Scars
TCA CROSS – Paint ranks as one of my most commonly employed methods, along with multi level subcision for the revision of acne scars. This technique is a form of focal deep chemical peeling & is best used for deep or well defined acne scars. TCA is often combined with lasers, RFM, & other modalities depending on your pattern of acne scarring.
FactsFacts On TCA Cross Acne Scars - Paint
- This is one of the best treatments for deep ice pick scars
- TCA can also be used on narrow boxcar scars & undifferentiated scars
- Application can be with a needle or toothpick
- Treatments are well tolerated
- This is a form of deep focal chemical peeling
- Only the affected areas are treated with TCA reducing downtime & side effects
- In my practice I combine this procedure with lasers & other scar directed treatments
- Skin recovery takes 5 -7 days
How does TCA CROSS work?
TCA Cross Acne Scars
TCA CROSS (stands for Trichloroacetic acid chemical reconstruction of skin scars. This procedure uses high-strength acid applied to the scar & not the surrounding skin. This prevents damage to the normal surrounding skin, resulting in much faster recovery & less side effects.
TCA ‘scars the scar’– namely TCA breaks down the scar & denatures collagen, stimulating new collagen to ‘fill in’ the scar. The deeper the scar, the better it works. Collagen stimulation takes at least 3-4 weeks to form, & is maximal at 3-4 months, hence why we advise at least 6-8 weeks between TCA CROSS treatments.
Understanding what type of acne scars respond best to TCA CROSS is important, as this treatment is best for ice pick scars, & narrow boxcar scarring.
How is this treatment performed?
The traditional method of TCA CROSS is to use a toothpick to dip into a jar of TCA. The toothpick is then placed into the scar. My method 12 years ago was to use a one ml syringe to deliver drops via osmosis. This was infinitely faster. In 2019 I started using brushes, a term I call TCA Paint.
I feel that my method of treatment is safer, more controlled, faster & more efficient than the traditional toothpick method.
Here are some points regarding TCA for acne scars-
- Makeup must never be worn prior to treatment. Take it off the night before, if make up is mixed with TCA it evokes an inflammatory response & extends healing times.
- I clean and degrease the skin with alcohol prior to TCA
- I choose an appropriate concentration -50-100% TCA
- Each scar is carefully treated with a tiny droplet of TCA or a brush stroke
- Stinging like an ant bite is experienced for a few minutes
- The skin turns white then red over a period of 20 minutes
- Treatment takes between 5-30 minutes, depending on the extent of scarring
Is the treatment painful?
No. Treatment is more uncomfortable than painful as each droplet ‘feels like a tiny ant bites’. All patients tolerate this procedure well. For cases that require adjunctive laser resurfacing, TCA procedure is painless as numbing cream is used.
What is the difference between TCA CROSS & TCA Chemical Peels?
TCA CROSS only treats the area of scarring, hence the healing up time is only 5-6 days at most. TCA chemical peel uses a much lower concentration of TCA – usually 30-35% & treats the whole face.
TCA peels are great for improving skin texture and skin tone, and will treat age spots, brown discolouration, sun spots, actinic keratosis, and wrinkles. It is not specific for deep scars as the concentration is too low. Healing times from a TCA peel is between 7-10 days.
What types of acne scars can be treated with TCA CROSS?
Deep acne scars respond best to TCA. Scar patterns include-
- Boxcar acne scars (narrow)
- Ice pick acne scars
- Pick & pits
- Large deep isolated pores including Dilated Pore of Winer
- Undifferentiated acne scars
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What types of acne scars can not be treated with TCA CROSS?
Some scar types can not be treated with TCA or they will worsen. These scars include- broad acne scars, rolling, atrophic & hypertrophic acne scars.
During the consultation I will guide you through what is the best course of action for your scars.
Scar grading is extremely important & complex. Most patients try to ‘classify their scars based upon literature, but in reality they are difficult to classify’- even expert dermatologists struggle.
How long does it take to perform TCA to acne scars?
Treatment takes 5 to 30 minutes depending on the extent of your scars. Most patients will have pleomorphic scars, namely other scar types. Procedures such as punch excision, excision, lasers, microneedling & subcision are often performed at the time of TCA.
How many TCA sessions will I require?
2-5 depending on the depth, extent & distribution of your scars. Scar patterns such as icepick scars are more common in smokers. The number of sessions also depend on factors such as your ability to remodel collagen.
The number of sessions also depends on your expectations & goals.
What is the recovery following TCA CROSS - Paint?
5-7 days. During this time you MUST keep the skin moist with an occlusive moisturizer applied 3-5 times a day. For females, special make up called Lycogel can be worn 24 hours after the procedure.
Week 1 – Healing
Weeks 2-4 Red dots may appear in areas where you had the procedure
Weeks 2-8 Skin darkening may ensure. This is universally seen in darker skin types including Sri Lankan & Indian patients. This is temporary & will fade with time. Sun Protection is a must to speed up resolution. In some patients the use of HQ or pigment faders may be required.
How successful is TCA in the treatment of acne scars?
TCA treatments are predictable. With each treatment expect a 20-30% improvement in the scar. Namely the scar should be shallower & less noticeable, especially in the light & shadows. Scar improvement will continue for several months following the procedure. Realistically after 3 treatments, expect between 50-80% improvement in deep ice pick scars & prominent pores. Before and after photos will reveal the improvements.
Can scars get worse with TCA?
Spread scars are extremely uncommon, occurring less than 0.1% of cases. Scars however are frequently pigmented after the procedure. This may perceivably worsen the look of scars (as pigment is most within the scar itself). A way to gauge progress is to visualise the scar with low lighting & angles. This removes the aberration of pigment.
How does Phenol Croton oil peels compare?
I use both Phenol Croton Oil & TCA in my clinical work. In the majority of cases, TCA gives better results than the former. Though there are clinical papers suggesting that TCA has a higher incidence of hypo (white) pigmentation, I have not found this to be true.
Can I do TCA at home?
Not a good idea. TCA in the context of skin scars is an easy procedure to learn, but an extremely difficult procedure to apply clinically. Only some scar types can be treated with TCA. Treat the incorrect scar, & the scar WILL worsen.
Procedures such as sensible microneedling or derma stamping are relatively safe to perform at home (especially if needle length is conservative).
What are the side effects of TCA peels?
Side effects are rare following TCA CROSS as only the individual scars are treated and not the surrounding skin. Side effects include-
- Infection – this is rare. In some cases I may give you a prescription for antibiotics, depending on the areas I treat.
- Skin colour changes are very rare in patients with fair skin types (Caucasian skin), redness is NOT a side effect, it is a predictable event that WILL occur in everyone. This takes 4-8 weeks to subside. In Asian and ethnic skin, skin colour changes (darkening of the skin) WILL occur in 100% of cases. This is not permanent and will fade over 2-3 months with the use of bleaching creams. Bleaching creams can be used 7-10 days after the procedure.
- Scar spread can occur (about 0.1%). This is more common in areas like the midline nose. If spread scars occur they can be treated with fractional lasers.
What procedures are often performed with TCA CROSS?
In most cases other scar directed procedures are performed concurrently with TCA. These include fractional lasers, microneedling, RFM, subcision & skin surgery. The ideal combination depends on your scar pattern.
Think of TCA CROSS as a procedure that raises deep scars to the same level. Once all the scars are on the same plane, fully ablative lasers can remove the vast majority of acne scarring. This principle also applies to deep pores.
Can all skin types - colours be treated with TCA CROSS?
Yes, all Ethnic skin types including darker skin patients can be safely treated with TCA CROSS as I vary the concentration depending on skin colour.
With ethinic skin types, patients will develop temporary PIH or post inflammatory hyperpigmentation. This means that you will develop temporary darkening of the skin that will last for a few months. All cases will fade with time. To help speed up the process of healing I advise patients to –
- Use SPF50+ twice a day 2 weeks before the procedure, and restart at day 7 for the next 3 months
- Use a fading cream such as HQ starting 7 days after the procedure
- Wear hats & stay out of the sun.
- I can use QSL lasers such as Picosure- Pico lasers to quicken recovery, improve scarring, and shift residual pigmentation.
Where do I start?
Book an appointment with either myself or one of my nursing staff. I deal with moderate to severe acne scars or complex – resistant scarring. My wait times vary depending on the time of year & cancellations.
A sensible option is to book an appointment with my senior nurses – Katie or Alison. They have been extensively trained in this procedure & have treated well over 10,000 scars with this procedure. Complex cases are referred to me.
What is the cost of treatment?
Treatment cost will vary depending on scar severity & associated procedures. My work focuses on objectively severe acne scars. Adjunctive surgical procedures such as subcision may carry a Medicare rebate.
TCA performed by my clinical nursing team ranges from $490 for localised scars. In many non-surgical cases the outcome will be very similar if I perform the procedure, hence booking with my senior nurses will be a cost saving.
Davin’s Viewpoint on TCA CROSS & Paint
TCA CROSS is one of my most frequently performed medical procedures. Sometimes simple solutions provide the best outcome. TCA CROSS easily outperforms lasers such as Fraxel, CO2 CORE, Erbium Sciton, PEARL, eMatrix and even Deep Fx in the treatment of deep ice pick scars. The advantage of focal TCA is it’s precision application. This procedure spares the surrounding skin.
TCA treatment is relaxing for both patients & myself. I’m in my zone when performing TCA CROSS. We can treat up to 200 pores/ scars every 10 minutes. Treatment is well tolerated by all. Healing takes place over 5 to 6 days. Most patients require 2-4 treatments, depending on the depth of scars and their skin type.
TCA CROSS can be a stand-alone procedure or it can be a stepping stone towards laser resurfacing. With the later, TCA CROSS is used to raise acne scars to a certain depth, once this depth is achieved, the laser will take care of the rest. Remember the best way to treat acne scars is to find the correct METHOD.
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