Fraxel / TCA Treatments for Acne Scarring - Scheduling Question

I'm planning on doing fraxel/TCA combo treatment to improve my acne scars. I have shallow scars on my right side and icepick scars on my left side. My only basis was around my class schedule - TCA #1 was in late July, Fraxel #1 in mid-Sep, TCA #2 in mid-Oct, Fraxel #2 in mid-Nov, TCA #3 in Dec. Will starting fraxel before I'm finished TCA be detrimental, or show less results? Also, do fraxel treatments show less improvement beyond the first 2? They are expensive so I only want to do two.

Doctor Answers 5

TCA Cross for acne scarring

TCA Cross is a very effective method for acne scarring. I have been doing this in my office for 6 years now. I typically use TCA 80% and I do light and darker skin colors. Patients typically need multiple treatment sessions, about one part apart. With each session, there is about 8 to 10% improvement. I typically recommend 4 sessions. 

People typically frost for a few hours, then  it scabs up and then the area is red for several days. I use it for icepick scars and boxcar scars as well. When used in combination with CO2 laser (at separate times), it works really well. 

Santa Monica Dermatologic Surgeon
5.0 out of 5 stars 2 reviews

Acne scar treatments in Los Angeles

Our office specializes in acne scar treatments. We continue to advocate the use of sublative ematrix and fractional laser for acne scars.

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
5.0 out of 5 stars 70 reviews

Fraxel/ TCA Combo

Without seeing a picture of your skin it is difficult to make a recommendation but I would say that if the indentation scars are more prominent and your biggest concern Fraxel would definitely be the way to go to get your skin smoother and more even and then you could follow up with a series of TCA peels to address the icepick scars. However icepick scars can be very difficult to treat and they may not ever go completely away. You can see differences in your skin with up to 5 treatments of Fraxel. After the 5th treatment their may only be a 5 - 10% difference in the skin improvement of your acne scarring.

Paul Vitenas, Jr., MD
Houston Plastic Surgeon
5.0 out of 5 stars 73 reviews

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Not detrimental but there is another option

You might want to look at getting a dermabrasion or fractional CO2 to improve the scars. You would need one to give you the results of all the treatments you are going through because both are more aggressive. It might be worth considering and would likely be less expensive.

Mary P. Lupo, MD
New Orleans Dermatologist
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Acne scarring requires multiple Fraxel Dual Treatments, less if doing Fraxel re:pair

I don't think there is any data on the combo of TCA and Fraxel.  I've done it frrequently, but usually I do several TCA Cross treatments before the Fraxel.  If you are doing the Fraxel re:store or Dual, you will need much more than 2 treatments.  I would look at 4 or 5.  Fraxel re:pair probably 2 is adequate.  One of my biggest issues with patients is that they want to know up front how many treatments are needed.  This is very difficult to say and you have to be very flexible as to how many you will need.  Keep in mind that erasing acne scars is not going to happen.  They are going to look better, but not usually completely gone.

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.5 out of 5 stars 9 reviews

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