TCA Cross Acne Scars

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
  • Cost$-$$$

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.

Ice-pick scars treated with TCA Paint & conservative fractional CO2 laser.

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.


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.

tca cross acne scars
TCA Paint-drip or CROSS
is useful for acne scars.

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

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.

box car scars
TCA or phenol is a low downtime, cost effective method to treat multiple scar types.

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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