TCA Cross needed before laser resurfacing? (Photo)

Question

I am considering erbium resurfacing with a doctor. I asked to treat my icepick scars with TCA cross before the laser but he said that wouldn’t be necessary. Is this because the boxcars and icepick lie in the same plane? What type of improvement could I expect with an ablative resurfacing alone? Looking for a 2nd opinion, thanks!

Jason Emer, MD · Answer

A combination approach will give the most improvement. These types of scars need a combination of lasers, microneedling/prp, Cosmelan, TCA cross, punch excision and fillers. We often perform these treatments on the same day. It will take a series of treatments and will need life-long treatments to maintain. I recommend getting a formal evaluation with an acne scarring expert. Best, Dr. Emer

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best,
Dr. Karamanoukian 
Realself100 Surgeon

Michael P. Morrissette, DDS, FACS · Answer

A combination approach is best. I prefer a combination of RF microneedling and PRP, TCA peels, CO2 laser skin re-surfacing if you are the right skin type, subcision or surgical excision in some cases. Fillers are helpful as well. In most cases, multiple treatments are required over a period of time.

Richard Ort, MD · Answer

It's hard to tell from just one picture, but for ice pick scars I would generally favor starting with a series of TCA CROSS treatments.  This is less invasive than laser resurfacing with easier recovery and in my hands provides better results for ice pick scars.Regards,Dr. Ort

Davin Lim, MBBS, FACD - Account Suspended · Answer

I suspect you will be left with a few deep ice pick and pick scars after your laser resurfacing treatment. This would depend on your skin type. I personally like to raise everything to the same depth, BEFORE resurfacing. Hence my recommendations- 1 or 2 TCA, re-evaluate, then resurface. Acne scar revision is a sub-specialised field. For the best results, one should target the acne scar type with ideal treatments and not just one device. The web reference below will take you to a resource to help you understand acne scar revision at a specialist level. I embedded all the videos in one page to help. 
For example deep ice pick scars, and narrow box car scars can be treated with TCA CROSS peels, mixed scars, rolling, and atrophic scars treated with fractional devices such as Fraxel, fractional lasers, PRP and INFINI radiofrequency. Atrophic scars (depressions) can be treated with either fat grafts, or with HA dermal fillers. Tethered and anchored scars are best treated with surgical techniques such as subcision. Other surgical techniques that we use include punch elevation, surgical elevation, punch excision and traditional excision of focal scars. 
The majority of patients will have a collection of different scar types, and hence a tailored treatment METHOD will be best. Careful examination, especially under angled lighting with scar mapping will give you an understanding of what are the best options for your scars. In the majority of patients its finding the correct combination that give you best results, and everyone is unique! All the best, 
Dr Davin Lim. Acne scar dermatologist specialist. Brisbane, Australia.

TCA Cross needed before laser resurfacing? (Photo)

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