How Soon After Having Tca Cross Done on Acne Scars Can I Get a Deep Chemical Peel?

Question

Raffy Karamanoukian, MD, FACS · Answer

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Nelson Lee Novick, MD · Answer

I have been using the CROSS technique for several years for the improvement of pit scores and widely dilated pores with good result after one or more treatment sessions. And while, a deep chemical peel may be performed about six or eight weeks later, this would not my approach. Deep peels, like the Baker's Peel, are not without their risks complication and entail substantial downtime. The same may be said of ablative laser therapy. Instead, I prefer a combination approach that tailors treatments to the particular kinds of scars present.

	Most people with acne scarring significant enough to warrant treatment possess a variety of different types of acne scars (e.g. box scars, atrophic scars, craters, etc.). For this reason, I have found that a comprehensive approach involving volumization, subcision, medical microneedling and, if necessary, a particularly helpful fractionated peel, The Punctuated Phenol Peel, to yield quite gratifying overall improvements.

	Not uncommonly, especially with chronological aging and loss of facial volume, acne scarring may actually appear worse as the cheeks sink somewhat from the volume loss of time. A very quick and easy way to restore volume and to re-inflate and smooth the skin is to volumize the cheeks immediately under the scarred area with an injectable volumizing agent, such as Radiesse or Radiesse combined with Juvederm UltraPlus XC, which is what I routinely use in my Upper East NY office. (In my Israel practice, where many more regulatory agency products are approved, I typically use Stylage XXL for this purpose).

	Next, I address craters with rounded edges via subcision. Subcision is a simple procedure that uses a needle-like cutting device that is slipped under the scar (under local anesthetic) and moved from side to side in order to break up the fibrous bands of scar tissue. This allows for the surface of the scar to float to the surface and also to promote new, more normal collagen synthesis to fill the potential space created. The result--a much more shallow scar and often significant visual improvement. A decided benefit to this approach is that the results are permanent, since the technique, as was pointed out, is predicated upon the person's own ability to produce new collagen in response to treatment.

	When there is an unsightly surface texture to the scar, a series of medical microneedling treatments can be initiated. For relatively small scars, the DermaStamp can be used. This is a small instrument with a series of sterilized needles attached, which may be used, under local anesthesia, to disrupt the surface of the scar, allowing it to reform in a more uniform texture and sometimes color.

	Alternatively, the Punctuated Phenol Peel technique may be used. With this technique, also performed as a series of treatments, microdroplets of full strength phenol are placed along the scar--leaving intervening untreated spaces (a fractionated approach) from which healing may take more rapidly and with less risk for actually causing a scar. 

	In my experience, this tailored and individualized plan for treating acne scars is most likely to produce satisfactory improvement and is preferable to the one-size fits all approach.

David A. F. Ellis, MD · Answer

Chemical peels cannot alter the scarred collagen in your skin. Chemical peels make your skin less oily and brighter. You need an ablative laser on your skin, or if you have dark skin, laser Genesis would help the scarrs look more level. Injectable fillers can also be very useful!!!

How Soon After Having Tca Cross Done on Acne Scars Can I Get a Deep Chemical Peel?

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How Soon After Having Tca Cross Done on Acne Scars Can I Get a Deep Chemical Peel?

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