TCA (Trichloroacetic acid) CROSS (chemical reconstruction of skin scars) helps treat several types of scars (icepicks, some boxcars, linear scars, and pores ). These types of scars can be quite deep going all the way to the bone so typical methods do not work to treat them. The method was developed by a Korean Dr to work on these hard to treat scars. TCA CROSS is used to raise scars to a certain depth, once this depth is achieved other methods are used to work on the scars. By doing this procedure you’re relying on the natural healing process and skill of the person performing it (harder than it looks). This is one modality and scars must be evaluated by a trained specialist as multiple methods must target the patient’s needs. I can evaluate your scars and give you an acne scar plan to address your concerns and individual issues, check out the scar consulting page
Some of the biggest considerations are proper evaluation by a trained professional to make sure your treating the right scar type and you’re a candidate for TCA CROSS. Not all scars are able to be treated with this method universally.
The patient must be considered as well health history, age, outcome and goals. Ethnicity is important as well as some skin types cannot handle this treatment without serious side effects we will cover below. If you need a no-downtime procedure this may not be for you.
So you know you need some tca cross, perhaps you are scheduled to have it done, or you had some complications in the past. It is a relatively safe procedure with a long track record of data and outcomes.
- Medical History
- Underlying Conditions
- Ability to Heal
- Type of scars
- Scar Depth
- Prior Procedures
- Prior Complications
- Are you taking blood thinners, supplements, or foods that do this
- Do you drink wine or spirits
- Are you a smoker
- Do you exercise often or do sports
- Do you have active acne on your skin or other bacterial skin infections
- Was an implant or another filler placed in that area (before)
- What other procedures have you done for your icepicks before
- Scars get worse before better
- Hyperpigmentation and Discoloration
- Larger Scars
- Deeper Scars
- Connecting Scars
- Impatience and Overtreatment
- No Change to Scars
- Unreal expectations
- Poor Dr’s Skill or the tool the Dr used is incorrect (not all CROSS is the same)
** Please DO NOT do this at home, this is where I have seen the most side effects and complications. They see a Dr on Youtube do the procedure. They decide to obtain illegally 100% acid (even though they sell it on Amazon it’s not legal in most countries to obtain this acid and is often car part cleaner or other toxic or harmful chemicals with substances mixed in from China). It is not the same grade as medical materials nor does the patient have the experience and skill to properly do the procedure. They think it looks easy and they cause permanent damage. Or perhaps they do the procedure often with an unethical Dr who causes issues as they have not been able to fully heal (slow process – even if the skin “looks ok”).
Some patients do not know the drugs they are taking (pharmaceuticals) or the side effects as a result. These prescriptions or even over the counter drugs can lead to issues when surgery is done. Tell your provider everything you take including supplements. If you smoke or drink as this can affect your outcome.
The biggest side effect is connecting scars with tca cross if they are nearby and treated at the same time. Rotation can be done to avoid this by treating them at other times.
Impatience is common with this procedure and not trusting the process. Patients don’t see the results they want in a timely manner, are put off by discoloration or long healing or they see the scars get wider which is by design if the floor of the scar is raised. It can take more than one procedure (not a fast thing to do).
When doctors do too many procedures at once often the patient does not notice a change as the body has not had time to heal or their body is overwhelmed. Observe your healing is often best (it is a slow process). Not all doctors produce the same results with tca cross. They may use different acids, techniques, or application methods. So perhaps you failed with one Dr and it was because that was not the desired outcome with a highly skilled provider.
With this procedure, the visual effects as you heal can make it difficult for those who are self-conscious and already feel embarrassed. See my recommendation below about mineral makeup for males and females in the Ethnic section (everyone can wear this).
Fear or Phobia of what occurs during this procedure. Tell your Dr if you have an issue with this they may offer a few solutions
Unreal expectations of perfection after one treatment often occur. It often looks worse before better.
Rare Side Effects
- More Scars
- Bacterial / Viral Infections
- Scar is Deeper
- Chemical Burn
- Tissue loss
- Fat Loss
- Healing for months
- Some other issues are not enough healing time 3 to 6 months
Those with Ethnic skin have a few more challenges. First steps, they NEED to pretreat with a melanin inhibitor prior to treatment, also called a skin lightener to prep their skin. They also must use a retinoid at least a month before to prep. Part of doing this treatment is realizing you will have hyperpigmentation or some redness (PIE/PIH) as healing is slow and occurs, I suggest males and females use a concealer to spot treat their scars and hide the discoloration. Mineral makeup, powder, or makeup made for medical procedures. Do not rub your makeup off or use a strong product to remove it or you will remove the scabs. Males can spot treat or use a tinted moisturizer.
Some countries do not provide this procedure because of the risk of side effects to ethnic patients. They may chose instead to use medical methods or more sensitive treatments in the darkest skin types.
Who is Not Eligible for the Treatment?
The treatment is not recommended for everybody. If you heal poorly I would avoid this treatment. If you are a slow healer be prepared as this can have some downtime or “visual appearance.” Those who get hypertrophic or keloid scars can have the scar types stimulated. It is also not recommended for people who have disorders related to blood clotting or have been exposed to viral infection in recent times.
- Avoid Sun Exposure
- Lay off the skincare actives and harsh procedures, simple skincare
- Do not let the shower go directly on your face instead splash your skin with your hands until the scabs come off
- Some find doing nothing to their scabs beneficial and others provide moisturizer or healing blam which can make the skin heal quicker, know best how your skin heals
- Your skin should have already been prepped with a retinoid and skin lightening agent prior to treatment to avoid hyperpigmentation
- No picking, pulling, or exfoliating (heal naturally)
- Change your pillowcase and use a fresh towel
- You can go back to your normal skincare routine when the scabs have come off
- Raise your head when you sleep
- If your active stop sports at least 24 hours prior to treatment and do not put your face in something that can rub or disturb it
- Discontinue smoking several weeks before until you heal, alcohol can also stop healing
- If you have a break out only spot treat the pimple
Don’t panic if you can SEE a scab INSIDE your scar. We WANT there to be a scab. It’s working. Don’t ever pick or pull or use a scrub brush in an attempt to get it out. The scab (it’s skin-colored) needs to stay attached for as long as possible usually 2 weeks but can be shorter with some people. Ongoing redness after is possible once the scab comes off.
Usually, the areas will look worse before they look better. Do not panic. The goal of performing this IS to damage the scar tissue. It may be red and a bit inflamed for a couple of days. This will go away quickly and the tissue regeneration will be working away even while you are panicking.
This is a procedure that you need to TRUST the process. This has been used for almost 30 years now to treat scarring with excellent results.
I think fear and phobia about the procedure can lead to many not realizing the above are rare and unless more serious side effects occur, many of these are a normal part of treating acne scars. ROI or Risk-benefit – tca cross is definitely worth it for the patient. Finding a skilled provider is probably the hardest thing to do as so many are sloppy with their technique. I find consulting with a patient and alleviating their fear, answering their questions, and education them during our 1-on-1 time leads to a smooth procedure.