TCA Chemical Peel for Acne Scars

Will TCA Chemical peel help improve acne scars? If so, for which types (ice pick, rolling, boxcar) is it most effective?

Doctor Answers 14

TCA can help with acne scars.

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The appearance of rolling, depressed scars can be improved somewhat with full-face TCA peels - moreso with a 20-30% peels than lighter peels. Ice-pick and box-car type scars can respond to higher concentrations of TCA (80-100%) applied to the base of these individual scars. Ice-pick scars also can be treated with other methods such as punch excision followed by resurfacing. I would seek the care of a qualified and experienced practitioner who can walk you through the side effects, potential complications and down-time associated with the various acne scar treatments.

San Diego Dermatologist

Great all around treatment

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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.

Victoria W. Serralta, MD
Arlington Dermatologic Surgeon

Chemical peels is not a very effective treatment for significant acne scarring

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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.

Scott Trimas, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 20 reviews

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A clinical examination can answer this question

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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. 

Sameer Bashey, MD
Beverly Hills Dermatologic Surgeon
5.0 out of 5 stars 9 reviews

Absolutely- best for ice pick scars and others- read more....

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Yes, TCA peels can outperform even the most powerful lasers providing it is used correctly. TCA CROSS is a special technique that requires skill and expertise to perform, as the concentration of TCA is very very high- 70-100%.  Box car scars can also respond to TCA CROSS. 
Here are some facts on TCA CROSS

1. Best for ice pick scars and box car acne scars
2. Healing takes 5-8 days depending on concentration
3. Your skin maybe red or dark (if you have dark skin ) for several weeks / months after TCA CROSS
4. You may require 2-3 treatments
5. Darker skin patients can be treated with TCA but the concentration is weaker (50-70%)
6. We often laser patients after TCA has healed, ie. 2-3 months after the last procedure. 
7. See a Specialist who does TCA peels on a regular basis- skill counts. 


Dr Davin S. Lim
Laser and aesthetic dermatologist
Brisbane and Gold Coast

Treatment of Acne Scarring

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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.   

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Fraxel For Acne Scars

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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 chemical peels helpful for scarring

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

William Ting, MD
Bay Area Dermatologic Surgeon
4.5 out of 5 stars 14 reviews

TCA peels for skin scars

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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.

Donn Hickman, MD
Los Angeles Plastic Surgeon

TCA Peel depends on how bad your acne scarring is

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It really depends upon how bad your acne scarring is. TCA peels are good medium depth peels. For thick scarring or scarring involving lots of pits, I would move toward a CO2 laser if the skin type was fair enough. You might want to see a good plastic surgeon about this possibility.

John P. Di Saia, MD
Orange Plastic Surgeon

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.