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TCA Chemical Peel for Acne Scars

Will TCA Chemical peel help improve acne scars? If so, for which types (ice pick, rolling, boxcar) is it most effective?

Doctor Answers (12)

TCA can help with acne scars.

+6

The appearance of rolling, depressed scars can be improved somewhat with full-face TCA peels - moreso with a 20-30% peels than lighter peels. Ice-pick and box-car type scars can respond to higher concentrations of TCA (80-100%) applied to the base of these individual scars. Ice-pick scars also can be treated with other methods such as punch excision followed by resurfacing. I would seek the care of a qualified and experienced practitioner who can walk you through the side effects, potential complications and down-time associated with the various acne scar treatments.


San Diego Dermatologist
5.0 out of 5 stars 4 reviews

TCA peels can be used for full face resurfacing or spot treatments for acne scars

+2

TCA peels can be used for full face resurfacing or spot treatments for acne scars. For Full face chemical peeling, you can improve ice pick scars and box scars. I typically add dermabrasion to medium depth TCA peels for more benefit. Also, I use stronger strength TCA (trichloroacetic acid) peels for ice pick scars to help them raise up. I like to also incorporate fat injections, subcision to elevate depressed scars. I think fat injections are a step up from subcision which adds a layer of tissue under the scars for more benefit, more vascularity to help your scars heal, and to elevate scars, etc. I have many videos for you to watch and pages to read.

Thanks for reading, Dr Young

Philip Young, MD
Bellevue Facial Plastic Surgeon
4.0 out of 5 stars 37 reviews

TCA better for discolored scars, resurfacing better for indented scars

+2

In my opinion, Fraxel restore, Fraxel Repair, Active/Deep FX, and full dermabrasion are the best for most indented scars. TCA peels work less well for altered architecture, but is excellent for shallow scars and discoloration. Ice pick scars respond poorly to all modalities.

Mary Lupo, MD
New Orleans Dermatologist
5.0 out of 5 stars 8 reviews

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Chemical peels for acne scars - Los Angeles

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I would advise most patients to undergo a fractional co2 laser versus deep chemical peels for acne scars.

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Treatment of Acne Scarring

+1

Chemical peels are not very effective for the treatment of deep acne scarring.  TCA is effective as a pre-treatment for ice pick acne scarring.  I usually treat these deep scars first using a toothpick and 90% TCA.  This is then followed a few weeks later with resurfacing with SmartXide with a tight dot spacing and stacking to get deeper penetration.   

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Fraxel For Acne Scars

+1
Thank you for your question. At my practice, I have gotten excellent results for scarring with Fraxel. This treatment eliminates irregular skin discoloration, and stimulates new collagen production, tightening the skin without prolonged recovery. After a series of 2 to 4 Fraxel treatments, the cumulative cosmetic improvement is near more aggressive lasers, but unlike more aggressive lasers, redness and swelling eliminated within 2 to 4 days after each treatment. Fraxel is outstanding for fine wrinkles, mild skin laxity, irregular pigmentation, acne scars, surgical scars, enlarged pores, stretch marks, age spots and Rosacea. It can be used safely on the face, neck, hands, arms, and chest.

Daniel Shapiro, MD
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Great all around treatment

+1

TCA is a great all around treatment that not only improves scarring, but treats hyperpigmentation, wrinkles and builds up collagen and elastic fibers in the dermis.  Certainly one needs to be careful not to start too aggressively so as to avoid side effects as with any treatment.  Another nice side benefit is that it is less risky and can be alot less expensive that laser and dermabrasion treatments.

Victoria W. Serralta, MD
Arlington Dermatologic Surgeon
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TCA chemical peels helpful for scarring

+1

While TCA chemical peels can be helpful for acne scarring, fractional CO2 laser does a better job with significant greater tissue collagen remodeling.

William Ting, MD
Bay Area Dermatologic Surgeon
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TCA peels for skin scars

+1

The answers in this forum give a superb overview of TCA use for facial acne and other scars. Principally for facial scars that cast shadows because of pigment deep in the pits or recesses, TCA can be helpful in reducing that pigmentation. For the most superficial scars, it may soften the shoulders at the edges, in combination with pigment lightening at the depths. At the recommended levels of facial peeling with TCA (10-45%) -- although a few centers still use 50% maximum for selected indications), TCA only penetrates from the upper epidermis down to the upper reticular dermis. It is the deeper lower reticular dermis where the scarring resides. That is also the level where injudicious or overly aggressive peeling, abrasion, and laser can themselves create scarring.

Spot treatments with 100% TCA are used by some in the pits. You can also use spot treatments with phenol B-G formula on broken tip of Q tip and rub them into pits.

Significant acne scarring requires a deeper level of penetration as with coarse Dermabrasion, C02 laser, and deep phenol plus croton oil peels to really make a compelling effect on acne scars. It is never possible to completely erase deep acne scars but to conside the treatment protocol to be a staged repeat effort. Some improvement may be seen over several sessions over a year or more.

The deeper the anticipated penetration and desired effect on wrinkles, blemishes, pigmentation, and scars, the more healing down time, and the potential tradeoff of complexion lightening and even bleaching. A firm understanding of goals, recovery options, depth considerations is important before the procedure.

I prefer chemabrasion, using 30% TCA acid to cover the skin and give a little firming to the scarred areas, then deply a fine diamond tip dermabrasion to the scarred zones by aesthetic facial units where the scars are. This is affective in patients of all skin colors, with respect to proper planning, patient education, skin preparation andpost-care, plus good office or photo follow-up at frequent intervals. With a readiness to use skin fixers and helpers to get the skin back to normal.

Donn Hickman, MD
Los Angeles Plastic Surgeon

TCA Peel depends on how bad your acne scarring is

+1

Hello,

It really depends upon how bad your acne scarring is. TCA peels are good medium depth peels. For thick scarring or scarring involving lots of pits, I would move toward a CO2 laser if the skin type was fair enough. You might want to see a good plastic surgeon about this possibility.

John P. Di Saia, MD
Orange Plastic Surgeon
5.0 out of 5 stars 23 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.