Help. Will TCA Cross and subcision treat my acne scars?

I'm not at all surprised that microneedling and superficial peels were not particularly successful for your acne scars. A hammer is a great tool if you wish to drive in or pull out a nail. But, you would never choose a hammer to screw in a screw. Relying on superficial chemical peels (which may be helpful for active acne and surface color and texture problems) or microneedling (also for surface tone and textural irregularities) is like asking a hammer to do the job of a screwdriver. Unfortunately, closer HD photos would have been more helpful. But in general, subcision is appropriate for elevating and smoothing indented (depressed, atrophic) boxcar and rolling scars and TCA CROSS is most appropriate for improving ice pick scars or very, very narrow based boxcar scars. Make sure to consult a board certified aesthetic physician. Best of luck to you. 

Acne scars are usually characterized within the subtypes of atrophic, hypertrophic, pigmented, or inflammatory. These subtypes of acne scars can be visually discerning in ambient light and can cause significant cosmetic concerns. Indented and atrophic scars require a combination approach to stimulate collagen and elastin, thereby smoothing contour and uneven skin. These are usually combined with lasers and depigmentation protocols to reduce inflammatory hyperpigmentation (Melarase AM and Melarase PM). Our Hidef protocols for acne scars include fillers such as Sculptra, Juvederm, Radiesse, and Restylane to improve deep acne scars; Vascular lasers to reduce inflammation and post-inflammatory redness and erythema; Fractional lasers to smooth contour and collagen; and Fractional RF to stimulate production of collagen within atrophic scars. Textural improvement and superficial scarring can be improved with Cosmelan peels, TCA Cross for ice-pick scars, deep chemical peels, and fractional CO2. We offer a personalized approach to your combination of scars and a formal evaluation with consultation is recommended to help you achieve your final results. Our plastic surgery office offers subcision and combination TCA Cross to help reduce deeply pitted scars. In terms of pigmentation and skin resonance, we recommend daily use of Melarase AM and Melarase PM coupled with Retinoid creams to achieve brilliant skin.

Best,
Dr. Raffy Karamanoukian
Realself100 Surgeon

Results are dependent on both the METHOD and the person behind it. TCA CROSS can be beneficial. Your scars, especially forehead scars are hard to treat. You will need 3-5 sessions. I manually subcise and micro needle in the same session. Your temples- subcision and HA fillers, you will need 2-4 sessions. Your cheeks, TCA CROSS, subcision and angled Co2 lasers. 3-5 sessions. In Europe see Prof. Tony Chu, United Kingdom. He has the skill sets to improve your scars. Acne scar revision comprises of many specialised procedures. For the best results, one should target the acne scar type with appropriate treatments METHODS. Using one or two devices is not optimal. As everyone has a unique pattern of acne scarring, the best solution is a tailored one. Remember, scar revision is a medical procedure that is technical to perform. It is not dependent on the clinic, branch, machine, or laser but by the skill of your dermatologist of plastic surgeon. 


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.