TCA Cross for my shallow acne scars - advice?

Question

I went to speak to a doctor about bellafill and subcision for my acne scars and he was adamant that those are bad options for me. He suggested I try TCA cross instead. I have extremely sensitive skin, and chemical peels make me a bit nervous because of how rash and reaction prone I am. I've tried a ton of micro needling and a few sessions of Fraxel and pixel lasers with mild results. I'm interested in something more advanced now. Should I tr TCA cross or a lower concentration full face TCA peel?

Nelson Lee Novick, MD · Answer

I have been performing subcisions since 1994 for elevating and smoothing all kinds of indented scars, including deeper boxcar and rolling acne scars. And, I have been employing TCA CROSS for improving ice pick scars and dilated pores for well over two decades. Unfortunately, from the one photo provided it is difficult to determine whether either of these simple, relatively inexpensive techniques that have a proven track record for efficacy and safety are appropriate here. What I can say is that TCA CROSS in which concentrations of TCA ranging from 90-100% are applied DOWN the shafts of the ice pick scars and pores (and not across the entire surface of the skin as with TCA peels using concentrations of 10-50%). As any of my regular readers would know, I am hardly surprised by the lack of success of the various laser treatments, as these relatively expensive "bells and whistles" have a whole of lot of marketing hype to support their use, but woeful little hard science. Sorry, but that's the reality check. Microneedling, which I have been professionally performing for over twenty years is best reserved for for the most superficial, surface color and texture irregularites, rather than more pronounced scars. I might also add that the choice of supplementing subcision with a permanent filler carries the potential risk for the subsequent development of nodules and granuloma soon after treatment or even  five, ten or even twenty years+ down the road, adverse reactions that can be disfiguring and are typically very difficult to treat. You would be wise to consult with an experienced board certified cosmetic dermatologist. Best of luck.

Robert T. Buchanan, MD (retired) · Answer

Unfortunately, what is meant by TCA Cross and TCA peels has gotten mixed up because there are home TCA treatments being sold and different doctors do different TCA peels. In a light concentration, TCA can just remove the outer dead cell layer of the epidermis. Ir is also capable of removing the entire epidermis down to about the middle of the dermis. This is called a leveling peel. If you are going to do a peel for acne scars this is what you need as it removes the skin around the acne scars down to the level of the bottom of the scars and then allows the skin to grow back smoothly. It also stimulates the dermis to thicken which improves the skin further. The bad thing about this option is that it has about a 2-3 week down time. However, if you are going to get the results you want from a peel, this is what you have to do. A better option, especially from what I see in your picture, is to begin use of tretinoin (Rain-A) and then do a series of microneedling treatments to thicken the dermis gradually to erase the scars. This takes about a year or so to completely improve the scars but is has no down time except for a little redness that can be covered with makeup.

TCA Cross for my shallow acne scars - advice?

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TCA Cross for my shallow acne scars - advice?

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Everything you need to know about TCA Peel

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