I perform this procedure for the treatment of enlarged pores, and deep ice-pick acne scars. TCA CROSS can also treat other forms of scarring including linear scars as well as shallow box-car scars. This treatment can be used on all skin types including ethnic and Asian skin. 2-4 treatments spaced 6-8 weeks apart are needed for optimal outcomes. TCA CROSS is superior to even the most advanced Fractional lasers for the treatment of ice pick and deep scarring, as well as pore size reduction. Treatments are quick, safe with minimal discomfort.
- This stands for TriChloroacetic acid Chemical reconstitution of Skin Scars
- This procedure was invented by a Korean Dermatologist over a decade ago and remains the Gold Standard for the treatment of deep ice pick acne scars in all skin types
- TCA CROSS only treats the area of scarring and not the surrounding skin
- This procedure can also treat deep open pores, shallow prominent pores as well as narrow box car acne scarring
- I vary the concentration depending on the scar type and skin type
- Up to 100% TCA is used for deep ice pick acne scars
- Recovery following TCA is between 5-6 days
- A special healing balm/antibiotic balm applied 5 times a day for 5 days speeds up recovery
- Following treatment, the treated acne scars will be red for several weeks
- Depending on your skin type, 2-4 sessions are needed for optimal outcomes
- TCA CROSS can be combined with lasers and fillers in the same session
TCA CROSS is unique because TCA is only applied to the scar and not the surrounding skin. TCA ‘scars the scar’- namely TCA breaks down the scar and denatures collagen, stimulating new collagen to ‘fill in’ the scar. The deep the scar the better it works. Collagen stimulation takes at least 3-4 weeks to form, and is maximal at 3-4 months, hence why we advise at least 6-8 weeks between TCA CROSS treatments.
Understanding what type of acne scars respond best to TCA CROSS is important, as this treatment is best for ice pick scars, and narrow box car scarring. The video below shows you how to assess and understand acne scars and the revision processes.
The traditional method of TCA CROSS is to use a toothpick to dip into a jar of TCA, this toothpick is then placed into the scar. My method that I wrote up in a recent journal article breaks this traditional method and uses a 1 ml syringe. I feel that my method of treatment is safer, more controlled, faster and more efficient than the traditional toothpick method.
Here are some points on treatment-
- Make up must never be worn prior to treatment. Take it off the night before, if make up is mixed with TCA it evoke an inflammatory response and extend healing times.
- I clean and degrease the skin with alcohol prior to TCA
- I choose an appropriate concentration -50-100% TCA
- I use a syringe osmosis technique to draw a tiny drop of TCA to the scar
- Each scar is carefully treated with a tiny droplet
- Stinging like an ant bite is experienced for a few minutes
- The skin turns white then red
- Treatment takes between 5-15 minutes, depending on the extent of scarring
- A healing balm and antibiotics completes the procedure
- You can use a special make up called Lycogel (post laser make up) to help speed up the healing process
No. Treatment is more uncomfortable than painful as each droplet ‘feels like a tiny ant bites’. All patients tolerate this procedure very well with out the need for any local numbing cream.
TCA CROSS only treats the area of scarring, hence the healing up time is only 5-6 days at most. TCA chemical peel uses a lower concentration of TCA – usually 30-35% and treats the whole face.
TCA peels are great for improving skin texture and skin tone, and will treat age spots, brown discolouration, sun spots, actinic keratosis, and wrinkles. It is not specific for deep scars as the concentration is too low. Healing times from a TCA peel is between 7-10 days. I still perform 5-6 full face TCA peels per year, but this procedure has been superseded by high density Fraxel Laser. TCA low concentration (8% to 10%) is excellent for treating skin pigmentation and fine wrinkles.
More on Fraxel Laser
- Deep acne scars such as ICE PICK scars respond best to TCA CROSS
- Box car scars
- All Skin Types including Asian and ethnic skin can be treated with TCA CROSS
- Open and prominent pores on the nose, cheeks and upper lip also respond to TCA peels
More on treating pores
2-15 minutes, depending on the extent of treatment.
Some patients will only have a few deep pores to treat, others will have extensive areas of deep ice pick scarring with more than 200 lesions to address. I use either the traditional toothpick method, for very fine shallow pores, or the “drop osmosis method’ that I invented in 2007.
Skin immediately after TCA CROSS. The skin completely heals in 5-6 days.
2-4 TCA peels treatments needed for best results. The deeper the scar the greater the number of sessions needed.
Treatment should be spaced 6-8 weeks apart, however intervals can be longer- not shorter. Darker skin patents will require an additional 1-2 treatments as the TCA concentration I use is weaker.
5-6 days. Downtime means the time it takes your skin to heal. During this time you are not allowed to wear normal make up or sunscreen. You can use a special healing makeup called Lycogel to conceal the redness during this period.
With each treatment expect a 20-30% improvement in the scar. Namely the scar should be shallower and less noticeable, especially in the light and shadows. Scar improvement will continue for several months following the procedure. Realistically after 3 treatments, expect between 50-80% improvement in deep ice pick scars and prominent pores. Before and after photos will reveal the improvements
Enlarged pores like these are ideally treated with TCA CROSS followed by lasers. Most patients will require 2-3 TCA CROSS treatments and 1-3 laser sessions for a good to excellent permanent reduction in pore sizing.
Side effects are very rare following TCA CROSS as only the individual scars are treated and not the surrounding skin. Side effects include-
- Infection – this is rare providing you follow the antibiotic balm instructions. In some cases I may give you a prescription for antibiotics, depending on the areas I treat.
- Skin colour changes are very rare in patients with fair skin types (Caucasian skin), redness is NOT a side effect, it is a predictable event that WILL occur in everyone. This takes 4-8 weeks to subside. In Asian and ethnic skin, skin colour changes (darkening of skin) WILL occur in 100% of cases. This is not permanent and will fade over 2-3 months with the use of bleaching creams. Bleaching creams can be used 7-10 days after the procedure. Gentle lasers such as QSL can also improve pigmentation changes following TCA peels.
Yes, in some cases I perform surgery or subscision with TCA CROSS, in other cases I perform HA or dermal fillers. If you have rolling and atrophic scars, I can combine Fractional CO2 lasers with TCA CROSS in the one session- it depends on your type of acne scars.
Think of TCA CROSS as a procedure that raises deep scars to the same level. Once all the scars are at the same plane, laser can remove the vast majority of acne scarring. This principle also applies to deep pores. This video shows how I use TCA to raise deep acne scar, followed by laser resurfacing to treat the more superficial scars 2-3 months later. I then finished this treatment with PICOSURE FOCUS to help decrease pigmentation and help further scar remodelling.
Yes, all Ethnic skin types including darker skin patients can be treated with TCA CROSS. With ethinic skin types all patients will develop PIH or post inflammatory hyperpigmentation. This means that you will develop temporary darkening of the skin that will last for a few months. All cases will fade with time. To help speed up the process of healing I advise patients to –
1.Use SPF50+ twice a day 2 weeks before the procedure, and restart at day 7 for the next 3 months
2. Use a fading cream such as HQ or Lytera, starting 7 days after the procedure
3. Wear hats and stay out of the sun.
4. I can use QSL lasers such as Picosure to quicken recovery, improve scarring, and shift residual pigmentation.
Skin darkening will occur in everyone with darker skin types- it HAS to happen, but the flip side is that your scars will be shallower.
In darker skin types, and extra one or two TCA CROSS treatments are needed, as the concentration of TCA is less to reduce the chances of prolonged PIH.
TCA CROSS for acne scars / open pores cost between $990-$1390 per session out of pocket.
All TCA treatments are performed by Dr Davin Lim, a World Leading Specialist in this field and inventor of the TCA CROSS drop technique. Technique, skill and safety is paramount for this procedure. Rebates only apply for Grade 4 Acne Scars.
By Dr Davin Lim
TCA CROSS is one of my most frequently performed medical and cosmetic procedures. Sometimes simple solutions provide the best outcome. TCA CROSS easily outperforms lasers such as Fraxel, CO2 CORE, Erbium Sciton, PEARL, eMatrix and even Deep Fx in the treatment of deep ice pick scars. Unlike lasers, treatment is in a quite environment- no eye shields, no humming of laser machines, no particle extractors and nurses checking on pre-op and post-op protocols.
This treatment is relaxing for both patient and myself. I’m in my zone when performing TCA CROSS. I find every scar that can be treated with this procedure, prime the delivery system and treat. I can treat up to 200 pores/ scars every 10 minutes. Treatment is well tolerated and feels like tiny little ant bites. Healing takes place over 5 to 6 days. Most patients require 2-4 treatments, depending on the depth of scars and their skin type.
TCA CROSS can be a stand-alone procedure, namely 2-4 treatments to treat open pores, or it can be a stepping stone towards laser resurfacing. With the later, TCA CROSS is used to raise scars to a certain depth, once this depth is achieved, laser will take care of the rest. Remember the best way to treat acne scars is to find the correct METHOD. The video below will guide you as to newer ways to incorporate TCA CROSS into your acne scar management program. This will give the highest cure rate for acne scars.
‘ I two laser treatments performed at another center. The doctor wasn’t a Specialist and I had very little improvement. Two sessions of TCA peels with Dr Lim and I can’t believe the improvement’
Adam T, Gold Coast
‘I couldn’t believe the outcome of the TCA peel for my deep scars- and the procedure was totally painless.’
Laura H, Brisbane