TCA CROSS
Chemical Reconstruction of Skin Scars
Ice pick scars are one of the most challenging types of acne scar to treat. These are small epithelial tracts within the skin. Techniques for treating these scars often involve physical removal of the ice pick scars
Chemical Peels
This proven technique in the treatment of acne scars. A chemical agent such Trichloroacetic Acid (TCA) is applied to the skin and causes the outer layers of skin to be removed by a process of controlled chemical burn. This helps acne scarring in two ways. There is an element of surface remodelling through regrowth of a new superficial dermal and epidermal layer. The inflammatory process causes an increase in the production of new collagen as part of the healing process. By the nature of chemical peels, this remodelling and collagen formation is limited to the upper layers of the skin.
We use 40% TCA on mainly darker and Asian skin and up to 100 % on white skin.
The downside is that recovery time is in the region of 7-9 days.
What types of acne scars respond best to TCA CROSS peels?
-Ice pick scars
-Box Car acne scars
-Enlarged pores the effects o
TCA CROSS technique:
The CROSS technique is used for ice-pick and narrow boxcar scars. A high-strength trichloroacetic acid (TCA) solution is placed in the base of these scars to ablate the epithelial wall and to promote dermal remodelling.
How long does TCA cross take to heal?
The recovery time tends to differ from patient to patient but, generally speaking, it will take between three and eight days to fully recover. After this time, you should be able to see the results of the treatment.
Can you have other treatments combined with TCA?
Once healed Dr Sagoo may carry out C02 or erbium Yag laser to resurface the whole area of scarring addressed by TCA to give the best results.
How often can I do TCA cross?
TCA cross can be administered to patients with varying skin types, including those with ethnic and Asian skin. However, due to the nature of the treatment, it is recommended to space TCA cross treatments four to six weeks apart in order to achieve the most optimal outcome.
Are the results from TCA cross permanent?
Once we have confirmed that you are a good candidate for TCA cross treatment, the procedure involved should leave you with long-lasting results. So, in other words, yes – the results will be permanent.
Are there any side effects of TCA cross treatment?
Following the procedure, some patients have been seen to develop Post Inflammatory Hyperpigmentation but this is rarely anything to worry about. This simply means that the treated areas have become darkened, leading to a prolonged period of redness (typically up to three months). However, over time, this should resolve on its own, as cases of permanent pigmentation are exceptionally rare.
What to expect after a TCA Cross treatment?
Following the procedure the patient may develop crusts which will persist for about one week. The patient should not wash the face for at least 24 hours after treatment. Make-up should only be applied a week after treatment. Redness will be persistent around treated areas for several weeks. Patients should expect to have redness around the treated areas for the duration of all treatment cycles. This will eventually settle on completion of treatment.
Can I perform TCA cross at home?
No, you should only ever have TCA cross performed by a medical expert with the training required to do so. Otherwise, there is a strong likelihood you will end up causing severe permanent scarring to yourself.
The following are some of the frequently asked questions regarding the chemical peel treatment:
How long will I take to recover from TCA cross chemical peels?
Immediately following TCA cross, the treated skin turn white. Over a few hours, the area becomes much redder than the surrounding skin. Pin-point areas surrounding the treated area may peel over the next 3-4 days. The skin slowly returns to its normal colour over 8-21 days. In darker skin patients, pigmentation changes may be more prolonged. It is essential that sun exposure is avoided in all patient for at least 2 weeks following TCA Cross.
The recovery time of TCA Cross is 3 to 8 days, and differs from patient to patient. The results can be observed after the recovery time has passed. The patient can proceed the daily routine tasks; however, some precautions are required.
Recovery is also dependent on the strength of the TCA CROSS chemical peel- a higher concentration means a longer recovery time.
Does the TCA Cross treatment hurt or burn the skin?
The most common perception of people is that this chemical peel hurts or burns the skin. The TCA Cross procedure is very tolerable for the patient. How many treatments will I need?
As with many other acne scar treatments, multiple sessions are advised for the best results. As a guide we encourage patients to complete 3-6 sessions, over a period of 3-6 months spaced 4- weeks apart. Very deep scars can be treated with subscision during the time of TCA Cross or as a separate procedure.
How much will my acne scars improve with TCA cross?
As a guide we should aim for at least 50-80% improvement of deep ice pick scars after a series of 2-3 TCA cross chemical peels. Scar specialists do not recommend fractional laser resurfacing for deep ice pick scars, as TCA peels or punch surgical excision out performs lasers in this setting. Once deep acne scars are raised up to form a shallow scar, we then use microneedling to complete the scar revision process.
Are there any side effects chemical peel?
There are no major side effects of Chemical peels, if performed by a specialist. The minor effects include redness, hyperpigmentation, scarring or a burning sensation for a while.
Can microneedling be combined with TCA cross?
Yes. To provide patients with the best outcomes, specialists frequently combine a variety of approaches. Microneedling, TCA cross, and subcision can all be combined. A mix of therapies will be required because the majority of patients will have multiple types of scars.
TCA cross for acne scars can form an integral part of our Program for acne scar revision. The concept is to map and treat each scar individually, using the best method available for the scar type.
Is TCA cross chemical peel safe in dark skin types?
All skin types can benefit from TCA cross treatment for acne scars. Patients with a darker colour may have 1-2 mm portions of the treated skin becoming somewhat darker, but this goes away in a few weeks. Darkening may occasionally persist for several months after therapy. It’s crucial to apply sunscreen following this surgery.
Darker skin types may find it more difficult to treat acne scars because of the possibility of skin discolouration after treatment. Generally speaking, a lower concentration of TCA is used in patients with darker skin, thus it can be advised to undertake an additional one or two sessions. Because bleaching agents help lighten dark scars, we frequently recommend them both before and after the TCA Chemical peel operation.
What precautions are required after chemical peel?
Direct sun light must be avoided for a couple of days, the patient must wear sunblock with high SPF when going into the day light.
Home-exfoliators must not be used for a certain amount of days after the chemical peel treatment.
