Lighten hyperpigmentation of box scars after 80% TCA cross peel? (photos)

I had a TCA cross peel performed 2 months ago on my ice pick and box acne scars, the scars did raise significantly, but I'm left with hyperpigmentation particularly visible in the larger box scars. 1. What would you recommend as a treatment for this type of hyperpigmentation? Are there any topicals likely to be effective? E.g. AHA peels. 2. Would you recommend more TCA cross peels to further improve the scars or are there other modalities that are likely more effective, e.g. fraxel laser.

Doctor Answers 3


Thank you for your question Skincaremessiah. Chemical peels such as TCA are used to enhance the face. The TCA CROSS technique is used for acne scars such as icepick scars. With any treatment there is a risk of hyperpigmentation and the risk is higher with darker skin types. For my patients with darker skin types I recommend a regimen including topical brightening products such as hydroquinone, kojic acid, and vitamin C for several weeks before a treatment to minimize the risk for hyperpigmentation. It can be used after a peel to address hyperpigmentation as well. With fractional laser technology TCA CROSS peels are becoming less common. For my patients with acne scars I recommend fractional CO2 laser treatments as a first line treatment. Please consult with a doctor for specific recommendations.  Good luck!

Encino Physician
5.0 out of 5 stars 3 reviews

Hyperpigmentation On Face -- Clear + Brilliant/Viva, Microneelding/PRP, Skin lightening, Aerolase

I find that skin care, peels, more TCA cross with PRP/microneedling all will help.  Clear + brilliant or fraxel, viva, or intensif can help as well.  Please see a scarring expert.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 190 reviews

Try a laser

Thanks for the question and the photos. Have you ever seen anyone about getting a fractionated laser for your acne scars? If you have deep ice pick scars, these will really only significantly improve by having them excised. The more superficial scaring may be improved with a fractionated laser. The fractionated laser will  help with some of the pigment in the scars as well. Look for someone in the Bay Area with experience treating acne scars with a fractionated laser. I would tell you to come see me, but I don't have one! Best of luck.~Dr. Sieber

David A. Sieber, MD
Bay Area General Surgeon
5.0 out of 5 stars 31 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.