TCA CROSS or chemical reconstruction of skin scars (CROSS) using trichloroacetic acid (TCA) is technique that allows focal treatment of acne scars. Ice pick scars and boxcars are ideal lesions for this procedure. A very high concentration of TCA solution is applied precisely on the scars using a sharp wooden toothpick or a syringe to induce inflammation and collagen production of these deep acne scars. A white frost will develop on the affected areas within 10 to 15 seconds, and burning sensation will be felt by the patient. After a 3 to 5 days, scabs will form. These crusts will fall off in 7 to 10 days revealing a shallower scar. Several treatment sessions may be required depending on the severity of the condition.
In my practice, I combine TCA CROSS with other procedures to hasten improvement. But, compared to other procedures, I only do TCA CROSS every 6 to 8 weeks. I prefer to give the skin time to adequately heal. I find that if I do TCA CROSS within a short interval, the skin will improve depth-wise, but will develop hyperpigmentation. :-O
No, I’m not talking about relationships; rather, I’m talking about one of my favorite treatments for acne scars — SUBCISION.
Before we go into the treatment, let’s talk about why we get acne scars. Acne scarring can be in the form of pigmentation, textural changes or both. Pigmentation is quite easy to remedy. The darkened skin color will eventually lighten to normal skin color by itself or with the help of lightening products. On the other hand, textural changes such as ice pick scars, box scars, rolling scars and atrophic scars stay with you throughout your life. We get depressed scars because when have a pimple the pus in the hair follicle disrupts the skin. So when the skin heals, there is a hallowing in the area where the pus used to be and fibrous adhesions to the upper layer of the skin. This is what we see as depressed scars.
Subcision is a minor surgical procedure that cuts the fibrous adhesions that pull the scars down. After the area is anesthetized, a needle is inserted under the skin to release the fibers. You will hear and feel the a “cruck cruck cruck” sensation as the needle cuts through the fibers. It can be quite bloody and bruising is to be expected after the treatment. In our office, we place the patient under LED light to hasten healing after subcision.
In our Acne Scar Revision Program, I almost always do subcision as a first treatment on patients with box scars and rolling scars. Because the anchoring fibers have been cut to release the skin, the depressions improve faster especially after microneedling or other procedures. 🙂