Are these scars ideal for TCA Cross 100%? (Photos)

Question

Or would it be safer to go with a less potent solution multiple times or try derma stamping? I'm particularly bothered by the latest ones nearest the nose on the front right side of my face. They're a few weeks old, feels a bit raised underneath, and was the result of a giant cystic pimple which depressingly left 4 ice pick scars relatively close together. I'm concerned if it's too large for TCA Cross? Is there a general rule about the size and depression + strength of TCA to use? Ethnicity: Asian

Jason Emer, MD · Answer

Thank you for your question, 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 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.  Best, Dr. Emer.

Sachit Shah, MD · Answer

You could do TCA cross. However, you would need preparation first to stop hyperpigmentation. Even then you will require multiple sessions. You may be able to combine this with an ablative laser treatment as well. You would require fairly close post treatment post treatment follow up.

Davin Lim, MBBS, FACD - Account Suspended · Answer

CROSS or preferably paint is my choice in the context of your scars. Diluted TCA due the broader base, together with conservative Co2 to the walls of the scars. 3-4 sessions followed by ablative laser and lastly picosecond lasers will improve things by 80-95%. Time line of 8 months with your skin type. Acne scar revision comprises of many specialised procedures that are dependent on the skill sets of your Plastic Surgeon or Surgical Dermatologist. For the best results, one should target the acne scar type with an appropriate treatments METHOD. Using one or two devices is not optimal. Everyone has a unique pattern of acne scars- hence the best solution is a tailored one. Remember, scar revision is a medical procedure- much like the revision of inflammatory, traumatic and burn scars. It is not dependent on the clinic, branch, machine, or laser but by the skill and reputation of the surgeon. The surgeon MUST be skilled to deliver all forms of dermal fillers, and or autologous collagen- tissue matrix. The use of fillers, both on label and off label via needle and cannula techniques will usually give better results, and less downtime compared to lasers and energy devices. Scientific papers have recently confirmed the change in paradigm for acne scar revision.

Take for example deep ice pick scars, and narrow box car scars. These are best treated with TCA CROSS and focused angled CO2 fractional laser in low density. Deep narrow scars respond better to this treatment than even the most expensive lasers. On the flip side, rolling, and atrophic acne scars can improve with fractional devices such as Fraxel, fractional lasers, ProFractional erbium lasers, Infiini –Intensif –Intracel radiofrequency microneedling. Atrophic scars (depressions) can be treated with either fat graft, PRP or dermal fillers. Tethered and anchored scars are best treated with surgical techniques such as subcision. Other surgical techniques that I use include punch elevation, surgical elevation, punch excision and traditional excision for focal scars. Early and very mild acne scars respond well to eMatrix and non-energy microneedling, as well as vascular lasers. Skin colour changes such as PIH or dark marks respond best to sun protection, creams, and Q switch lasers in the nano and pico pulse durations.

In the vast majority of patients, different patterns of acne scars will be present. Monomorphic acne scarring (scars of the safe subtype) are extremely rare. Careful examination, especially under angled lighting with scar mapping will give you an understanding of what are the best options for your scars. Additionally tactile examination namely touch will give me an understanding of the amount of subdermal fibrosis, as special equipment is needed for this sub-set of acne scars.  In the majority of patients its finding the correct combinations that yields the best results. It is never about the device, it is about the specialist behind the equipment that will deliver the best outcomes.

Global leaders in acne scar revision will always use manual methods to revise scars, and employ lasers and energy devices as instruments to assist. All the best, Dr Davin Lim. Acne scar dermatologist specialist. Brisbane, Australia.

Are these scars ideal for TCA Cross 100%? (Photos)

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Are these scars ideal for TCA Cross 100%? (Photos)

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