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

Question

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.

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

Jason Emer, MD · Answer

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.

Alex Eshaghian, MD, PhD · Answer

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!

David A. Sieber, MD, FACS · Answer

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

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

Answers (4)

Answer: Try a laser

Answer: Try a laser

Recommended reading

Everything you need to know about TCA Peel

Our mission is to create a world where every investment in modern beauty is Worth It.

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

Answers (4)

Answer: Try a laser

Answer: Try a laser

Browse related questions

Recommended reading

Everything you need to know about TCA Peel

Our mission is to create a world where every investment in modern beauty is Worth It.