Can TCA cross be used for these deep, atrophic, linear scars? (Photos)

Question

I have two deep, atrophic, linear burn scars. Can TCA cross be used on these? If not, I there anything that may be helpful.

Nelson Lee Novick, MD · Answer

From the photos, the scars appear fairly superficial and narrow. Subcision with a very fine needle can be used to elevate them, and once elevated and smoother with the surrounding surface, then microneedling may be used to help to blend, in both color and superficial texture, the treated region with the surrounding normal skin. Typically two to four treatment sessions will be required with each modality to achieve optimal improvement. Make sure that you consult with a board certified aesthetic physician with experience and expertise in both of these time tested, relatively inexpensive approaches. Be very cautious when confronted with the marketing hype for all kinds of bells and whistles devices, like fraxel lasers, radiofrequency and ultrasound machines, as these to date have little hard science (but plenty of device manufacturer) support for their benefits. The same may be said of PRP. So, do your due diligence before agreeing to go ahead with any proposed treatments. Best of luck.

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for acne scars depending on the depth of atrophy or hypertrophy. Acne scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of acne scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic acne scars and indented acne scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve  the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture.  Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your acne scarring.
 
Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Jason Emer, MD · Answer

these types of fine lines need a combination of mesotherapy/skin booster type fillers, needling and lasers.  regular halo or Fraxel with micro needling PRP and cosmelan peels will make your skin look fantastic. TCA cross is not good for this.
Acne scar treatment needs a combination approach for improvement.  For the best results, one should target the acne scar type.  As everyone has a unique pattern of acne scarring, the best solution is a tailored one.  Typically you need fillers like bellafill and sculptra for atrophic indented type scars with or without subcision.  Subcision for depressed tethered scars.  Vascular lasers like yellow laser, aerolase, excel V or IPL for redness or thick scars. And lasers such as fraxel, erbium, co2 or fractional radiofrequency like venus viva, skinfinity, intensif or fractora microneedling RF for textural issues and superficial scarring.  Deep ice pick scars and narrow box car scars are best treated with TCA CROSS and punch excision.  All lasers are combined with microneedling and PRP to get even better results and improve healing times.   The majority of patients will have a collection of different scar types, and hence a tailored treatment plan is needed by an expert physician.  It is never about the laser or product that gives the results, its about the expert behind the equipment that gets you the outcome.  Scars cannot be cured and will need life-long treatments to maintain and build on the results.  For those at high risk for hyperpigmentation (darker skin types or asian or hispanic or mixed ethnicities) we alreayd pre-treat the skin with cosmelan or enlighten lightening peels to prevent complications from energy-based or chemical-based treatments.  Best, Dr. Emer.

Can TCA cross be used for these deep, atrophic, linear scars? (Photos)

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Can TCA cross be used for these deep, atrophic, linear scars? (Photos)

Answers (3)

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