How does chemical reconstruction by trichloroacetic acid (TCA) work to reduce the visibility of acne scars? (photo)

Doctor's Answers (2)

Dr Chin Yee Choong

"Dedicated to the ethical practice of Aesthetic Medicine"

For all acne scar treatment, the key principle is to induce controlled damage to the skin to allow healing to occur, forming new collagen and improvement in scar appearance.

There are different ways to induce controlled damage to the skin: surgery, subcision, using energy-based devices such as fractional lasers, fractional microneedle RF and via highly acidic chemicals such as TCA.

In terms of safety and predictability of response, I personally favour the use of energy-based devices to TCA. Treatment with energy-based devices can be precisely calibrated to the severity of scars and patient’s tolerability for downtime, and healing is generally fairly fast with minimal risk of bad complications.

As with all conditions where a variety of treatment options exist and where combination treatments may give better results compared with single modality treatment, it is important for a face to face consultation with your preferred aesthetic doctor and a thorough discussion of the various treatment options he offers and gets good results with.

High concentration TCA acid works by stimulating collagen and by inducing new "scar formation" to fill up the depressed scar.

However, there are different types of acne scar. It could be Icepick, Rolling or Box Scars. Not all treatments are suitable for every type of acne scar. It is important to get an accurate diagnosis and make sure that the treatments you get are individualised for your specific condition.

TCA CROSS might not be the ideal treatment of choice for Rolling and Box Scars. Their effectivity would be quite limited in this instance.

For those type of scars, I would personally recommend a combination of Subcision and Fractional CO2 Laser instead.  That would yield better results and is more effective in improving their appearance. 

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