Will TCA Chemical peel help improve acne scars? If so, for which types (ice pick, rolling, boxcar) is it most effective?
TCA Chemical Peel for Acne Scars
Doctor Answers 13
TCA can help with acne scars.
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.
Chemical peels is not a very effective treatment for significant acne scarring
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.
Great all around treatment
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.
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TCA peels for skin scars
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.
Treatment of Acne Scarring
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.
Fraxel For Acne Scars
TCA chemical peels helpful for scarring
While TCA chemical peels can be helpful for acne scarring, fractional CO2 laser does a better job with significant greater tissue collagen remodeling.
TCA Peel depends on how bad your acne scarring is
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.
TCA and acne scars
No, it does not work; peels are of uniform depth so they cannot be "sculpted' as can dermabrasion and lasers. They also do not go deep enough, unless they are so strong that they risk depigmentation and scarring.
TCA better for discolored scars, resurfacing better for indented scars
In my opinion, Fraxel restore, Fraxel Repair, Active/Deep FX, and full dermabrasion are the best for most indented scars. TCA peels work less well for altered architecture, but is excellent for shallow scars and discoloration. Ice pick scars respond poorly to all modalities.
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.