TCA Chemical Peel for Acne Scars

Chemical peels is not a very effective treatment for significant acne scarring. Chemical peels in general are placed on the surface and penetration is similar in all areas of the scar so their major improvement relies upon improving skin texture. With acne scarring whether it is raised or depressed, the goal is to make the skin as close to one level as possible. For example, it is like driving over hills and valleys. The deeper the valleys, the more visible the scars. The higher the hills, the deeper the adjacent valleys appear. In my opinion, either a laser abrasion typically a CO2 laser or dermabrasion are effective treatments for any significant degree of acne scarring since they take the hills down or stretch the valleys so that the skin is smoother. Chemical peels are not effective in producing this type of an effect or improvement.

Our office performs both deep chemical peels, laser resurfacing, and sublative treatments for acne scars. All of these treatments provide benefits for different types of acne scars. Best, Dr. Karamanoukian

While TCA chemical peels can be helpful for acne scarring, fractional CO2 laser does a better job with significant greater tissue collagen remodeling.

Thank you for your message! Generally, a combination of treatments provide the best result for diminishing the appearance of acne scarring, of all types. Chemical peels, such as a TCA based peel is an option, though we often recommend incorporating microneedling and laser resurfacing. Multiple treatments of each are typically needed and sometimes, depending on the tone of your skin, a pre/post treatment may be needed. I would recommend a consultation with a provider in your area for further assessment! 

Your scars have to be examined. A peel can help some scars and won't help others. Only an examination can determine if you would benefit from peeling for scars. 

Chemical peels are not very effective for the treatment of deep acne scarring.  TCA is effective as a pre-treatment for ice pick acne scarring.  I usually treat these deep scars first using a toothpick and 90% TCA.  This is then followed a few weeks later with resurfacing with SmartXide with a tight dot spacing and stacking to get deeper penetration.   

Thank you for your question. At my practice, I have gotten excellent results for scarring with Fraxel. This treatment eliminates irregular skin discoloration, and stimulates new collagen production, tightening the skin without prolonged recovery. After a series of 2 to 4 Fraxel treatments, the cumulative cosmetic improvement is near more aggressive lasers, but unlike more aggressive lasers, redness and swelling eliminated within 2 to 4 days after each treatment. Fraxel is outstanding for fine wrinkles, mild skin laxity, irregular pigmentation, acne scars, surgical scars, enlarged pores, stretch marks, age spots and Rosacea. It can be used safely on the face, neck, hands, arms, and chest.

TCA peels can be used for full face resurfacing or spot treatments for acne scars. For Full face chemical peeling, you can improve ice pick scars and box scars. I typically add dermabrasion to medium depth TCA peels for more benefit. Also, I use stronger strength TCA (trichloroacetic acid) peels for ice pick scars to help them raise up. I like to also incorporate fat injections, subcision to elevate depressed scars. I think fat injections are a step up from subcision which adds a layer of tissue under the scars for more benefit, more vascularity to help your scars heal, and to elevate scars, etc. 

Thanks for reading, Dr Young

TCA is a great all around treatment that not only improves scarring, but treats hyperpigmentation, wrinkles and builds up collagen and elastic fibers in the dermis.  Certainly one needs to be careful not to start too aggressively so as to avoid side effects as with any treatment.  Another nice side benefit is that it is less risky and can be alot less expensive that laser and dermabrasion treatments.

The answers in this forum give a superb overview of TCA use for facial acne and other scars. Principally for facial scars that cast shadows because of pigment deep in the pits or recesses, TCA can be helpful in reducing that pigmentation. For the most superficial scars, it may soften the shoulders at the edges, in combination with pigment lightening at the depths. At the recommended levels of facial peeling with TCA (10-45%) -- although a few centers still use 50% maximum for selected indications), TCA only penetrates from the upper epidermis down to the upper reticular dermis. It is the deeper lower reticular dermis where the scarring resides. That is also the level where injudicious or overly aggressive peeling, abrasion, and laser can themselves create scarring.
Spot treatments with 100% TCA are used by some in the pits. You can also use spot treatments with phenol B-G formula on broken tip of Q tip and rub them into pits.
Significant acne scarring requires a deeper level of penetration as with coarse Dermabrasion, C02 laser, and deep phenol plus croton oil peels to really make a compelling effect on acne scars. It is never possible to completely erase deep acne scars but to conside the treatment protocol to be a staged repeat effort. Some improvement may be seen over several sessions over a year or more.
The deeper the anticipated penetration and desired effect on wrinkles, blemishes, pigmentation, and scars, the more healing down time, and the potential tradeoff of complexion lightening and even bleaching. A firm understanding of goals, recovery options, depth considerations is important before the procedure.
I prefer chemabrasion, using 30% TCA acid to cover the skin and give a little firming to the scarred areas, then deply a fine diamond tip dermabrasion to the scarred zones by aesthetic facial units where the scars are. This is affective in patients of all skin colors, with respect to proper planning, patient education, skin preparation andpost-care, plus good office or photo follow-up at frequent intervals. With a readiness to use skin fixers and helpers to get the skin back to normal.