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Acne scars are part of Dr. Michele Green’s expertise in dermatology and she is internationally renowned for her treatment of all types of acne scars and skin discoloration in her NYC boutique office. Whether the scars are atrophic, such as ice pick scars and boxcar scars, rolling, hyperpigmented, hypertrophic or keloid, Dr. Green utilizes the most cutting edge treatments and technologies to help reduce your acne scarring. As one of the many tools in treating acne scars, Dr. Green uses TCA Cross to reduce enlarged pores and elevate deep ice-pick scars.  TCA Cross, trichloroacetic acid chemical reconstruction of skin scars, is a cutting edge treatment that only few dermatologists successfully perform. Dr. Green is a specialist in treating acne scars in patients of all skin types, Asian, Hispanic, Caucasian, and African American skin. Each unique skin type and type of acne scarring requires its own individual acne scar treatment. Dr. Green will customize the best acne scar treatment for you through a combination of chemical peels, TCA Cross, laser treatments, dermal fillers, and skin care products, to rejuvenate your skin and improve your acne scars.

What is TCA Cross?

TCA is an abbreviation for trichloroacetic acid, which is the chemical acid used by Dr. Green for chemical peels and TCA Cross.  “Cross” is an acronym for the chemical reconstruction of skin scars method, using a strong trichloroacetic acid placed directly into atrophic scars. TCA Cross was invented many years ago by a Korean Dermatologist, and is uniquely suitable for treating ice pick acne scars. TCA Cross is used primarily in boxcar scars, rolling acne scars, and ice-pick scars. Minute amounts of TCA, in high concentrations, (70 to 100%), are deposited directly into the surface of the atrophic scar. The goal of TCA Cross is to stimulate the formation of new elastin and collagen production. TCA Cross can be used on most skin types (TCA Cross is not suitable for skin types 3 or darker), with typically 3 to 5 treatments, spaced 6-8 weeks apart for the best cosmetic results. For some patients with atrophic scars, TCA Cross works even better than Fraxel (TM) laser treatments. TCA Cross treatments are safe and  effective, with minimal discomfort.

What are the 3 main types of acne scars?

  • Atrophic scars: which can be further divided into ice-pick scars (60%, narrow and deep), boxcar scars (25% and wide) and rolling (15% ). Ice pick scars can be some of the most difficult acne scars to treat.
  • Hypertrophic scars
  • Keloidal scars

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How does TCA Cross work for ice pick scars?

TCA Cross treats the depression, or area of scarring itself, and not the surrounding skin. The acid is directly deposited with the edge of a syringe or a toothpick/applicator, into the atrophic scar, leaving the entire skin surrounding the scar preserved. TCA Cross can also be used to treat deep open pores, prominent pores, and box car scars. Depending on both the skin type, and the type of acne scar, up to 100% TCA is used to treat these deep ice pick scars. The recovery time is generally less than one week from the procedure. Special emollients and sunscreen are recommended after the procedure, as well as complete sun avoidance to avoid hyperpigmentation. Depending on your skin type, 3 to 4 sessions are needed to best improve the cosmetic appearance of your acne scars.  TCA Cross can also be combined with dermal filler injections, such as Juvederm, Restylane, and Sculptra and various types of laser treatments.

TCA Cross works on the scar by helping to denature the collagen within the scar tissue, at the layer of the dermis, and stimulate new, healthy, collagen production. New collagen production begins as early as 4 weeks after the procedure and continues to form up to 4 months after each TCA Cross treatment. As the new collagen remodels in your acne scars , new tissue is formed which produces noticeable improvement in your scars.

How is TCA Cross technique performed?

  • TCA Cross should not be performed on skin that is sun damaged or which has recently had laser treatments, microneedling, chemical peels or other skin treatments.
  • Discontinue use of all Retinols, Retinoids, Tazorac, alpha hydroxy acids or exfoliants for 3 days before TCA Cross is performed.
  • Patients with darker skin types may need to pre-treat with skin lightening creams for several weeks before the procedure. TCA Cross is not suitable for skin types 3 or darker.
  • Patients should avoid tanning and direct sun exposure for 2 weeks prior to reach treatment.
  • Refrain from wearing makeup or using any other skin care products the day of the procedure.
  • At the start of the procedure, the skin is degreased with alcohol prior to the application of any trichloroacetic acid.
  • Photos are taken of the treatment area to document the progress of the procedure.
  • Each scar is carefully treated with between 50 and 100 % TCA and each area is neutralized with water directly after treatment.
  • After the acid is applied, you will observe frosting of the skin where the treated area initially turns white, and later red in color.
  • Each atrophic scar is treated with the acid on a wooden applicator, toothpick, or insulin syringe.
  • Each lesion then scabs after a few days, creating wounds, which heal to generate new skin.
  • The entire treatment takes between 15 and 30 minutes, depending on the amount of acne scarring.
  • Proper skin care and sunscreen use is reviewed after the procedure and strict sun avoidance is recommended.
  • Downtime is generally 5 to 7 days.
  • Hydroquinone bleaching creams such as those in MGSKINLABS are commonly prescribed for use in darker skin patients.
  • Refrain from makeup after the procedure for several days, until the skin heals and returns to normal. Lycogel may be able to be used post laser.

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Does TCA Cross work for acne scars?

Yes. In many cases, TCA Cross treatment works better for certain atrophic acne scars than laser treatments. Darker skin types may need to use a 50% TCA solution to treat their scars, as opposed to 100% TCA in lighter skin patients. Due to the weaker strength acid in darker skin tones, an increased number of TCA Cross treatments may be needed to reduce the unwanted acne scars. The TCA concentrations differ and the correct strength is based on both the type of scar and the skin type of the patient. Meticulous treatment must be performed using TCA Cross to prevent pigmentation changes or worsening of acne scarring. Hydroquinones are commonly prescribed by Dr. Green in darker skinned patients to be used before your treatment and for several weeks after TCA cross to prevent and treat resulting hyperpigmentation.

What is the difference between a TCA peel and TCA cross?

The main difference between TCA Cross and a TCA chemical peel is that TCA Cross treats the individual acne scars, with a very high concentration (50 to 100%)of trichloroacetic acid. A TCA chemical peel, is generally at much lower concentrations, from 10 to 30%, and is used to treat the entire face, chest, back, arms, or buttock.

TCA chemical peels are used to treat discoloration, sun damage, actinic keratoses, hyperpigmentation, brown spots, sun spots, fine lines, wrinkles and acne breakouts. Chemical peels are very effective to treat a variety of skin conditions, and generally require a series of peels to effect the most change. TCA peels improve the skin texture, tone, and overall complexion.

How many treatments of TCA Cross are needed?

In general, three to four TCA Cross treatments are needed to have the best cosmetic results. Patients with deep acne scars may need more treatments. TCA Cross treatments should be performed six to eight weeks apart, or longer. Patients with darker skin tones, or deep scars may require more than four treatments.

How often can I do TCA Cross for acne scars?

It is best to wait 6 to 8 weeks after TCA Cross before having the next treatment session. This time period allows the skin to heal, any discoloration to be treated, and new collagen and elastin to start remodeling.

Are the results of TCA Cross permanent?

The positive results that you experience from the treatment of acne scars with TCA Cross are permanent. TCA Cross will help remodel and produce new collagen in your atrophic acne scars and will be a step forward in combining other modalities and treatment options to improve the cosmetic appearance of your acne scars.

Does TCA Cross hurt?

TCA Cross is not painful at all. Each tiny amount of TCA that is used in each individual acne scar feels like a tiny sting. There is no need for any topical numbing cream with this procedure.

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What is the downtime for TCA Cross?

Most patients have between 5 and 7 days of downtime after the procedure. Strict skin care and sun avoidance needs to be maintained after TCA Cross. Some patients can experience redness or hyperpigmentation for several weeks after treatment.

What should I do post-op after TCA Cross?

Use of SPF 50 or higher every day, hats, and direct sun avoidance are all essential to have the best cosmetic results. Emollients are used several times a day to allow the skin to heal properly after the procedure. Avoid being overheated, excessive exercise, avoid hot tubs, saunas, and steam rooms or excessively hot showers, in the first 3 days after treatment. Regular home skin care products can be resumed once your skin returns to normal. Avoid picking, scrubbing, or exfoliating the skin after the procedure, to prevent acne scarring. Avoid electrolysis, waxing, or any hair removal for the area for at least 2 weeks after your treatment.

Can I do TCA Cross at home?

No. TCA Cross uses a very high medical grade acid that only physicians, like Dr. Green, are licensed  to use, and requires expert skill and knowledge to used effectively and safely.

What are the side effects of TCA Cross?

  • One of the main potential side effects, especially in darker skin types, is post inflammatory hyperpigmentation or PIH. Darker skin types are more susceptible to skin discoloration, especially when utilizing these higher strength trichloroacetic acid solutions. This darkening of the skin can last for several months and will fade over time. Many patients will use a bleaching cream with hydroquinone or Cosmelan for several months, a week after TCA cross, to treat this PIH. Strict sun avoidance is always necessary to lessen the side effect of facial discoloration and pigmentation.
  • Hypopigmentation is a possible side effect and may be permanent.
  • Erythema and local irritation from the procedure
  • Increased acne scarring
  • Infections
  • Scarring
  • Blisters
  • Allergic reactions
  • Peeling
  • Acne breakout
  • Activation of viral infections such as herpes simplex

Which procedures can be done with TCA Cross?

Treating acne scars usually requires a combination of treatments. Although TCA Cross can be used alone to treat some patients with atrophic scars, many patients require a combination of treatments to have the best cosmetic results including:

Is TCA Cross the best treatment for all acne scars?

Acne scars are unique to each individual and a customized treatment plan need to be created for each patient. Dr. Green will create a tailored treatment plan for you, since each pattern of acne scarring needs to be based on your individual needs. Whether it be combining TCA Cross with punch excision or dermal fillers, laser treatment, Dr. Green will create the best treatment plan for you.

Am I a good candidate for TCA Cross?

The best way to determine if you are the best candidate for TCA Cross is to schedule an in-person consultation with an acne scar specialist and board certified dermatologist like Dr. Michele Green. She will examine your pattern of acne scars and identity the best treatment methods to help you address these scars.  A unique treatment plan will be designed based on your unique needs and cosmetic goals. Please note that TCA Cross is not suitable for skin types 3 or darker.

How do I begin the process with Dr. Green?

The best way to begin the process of treating your acne scars is to call the office of Dr. Michele Green at 212-535-3088 and schedule a consultation to discuss your concerns, you can also contact us online

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