What could cause a lack of improvement after TCA CROSS treatment? (photo)

Doctor's Answers 2

Hi,

TCA Cross is a deep chemical peel for acne scars such as deep box-car scars and ice-pick acne scars. Several sessions of TCA Cross might be needed for satisfactory results.

How to Get Good Results from TCA Cross for Acne Scars?

1. Optimise your Recovery

TCA Cross, like Fractional Resurfacing Lasers (Fractional CO2, Erbium, Pico lasers), improve acne scars by "damaging" your scarred skin in a controlled manner to stimulate healing, thereby improving the appearance of the scars.

Your recovery phase is a critical time period. Based on your photos, you are still in the recovery phase. It is important that you apply generous amounts of sunblock and moisturiser during this time to ensure that you get the best healing and minimal side-effects.

2. Combination of Acne Scar Treatments

Your scars appear to need more than TCA Cross.

Deep scars tend to be tethered down by fibrous bands - this requires subcision treatments.

Also, there might be skin atrophy/ localised volume loss which will require filler/rejuran treatments.

TCA Cross is a good treatment but it will not address these aspects of your scars.

It is best to consult your doctor regarding other synergistic acne scar treatments. Scars are best assessed by your doctor face-to-face under different lightings, manual palpation (by feel) and also animation (smiling/talking).

3. Sufficient number of treatment sessions

Collagen production and scar remodelling takes time and multiple treatment sessions - usually 3-5 sessions.

Each TCA Cross/Acne Scar treatment session will progressively improve your scar appearance.

Hope this helps!

Warmest Regards,

Dr Justin Boey

10 days after TCA CROSS treatment is definitely too short a time to see significant improvement and you are right that you would need 4-8 weeks to appreciate the full effects as it takes time for the fibrosis and collagen stimulation to occur.

Also, depending on the depth and type of your acne scars, it may take a few sessions before you can see significant improvement. Also, you may need other adjunct treatments like subcision to improve the deep and tethered scars, and fillers for the very atrophic ones.

Other factors that can influence how an individual responds to a particular treatment will be:

1. Skin texture - dry skin may have a different healing/regeneration time compared to oily skin

2. Skin tone and quality - With increasing age, there is lesser collagen and elastin in the skin and the skin regeneration time is longer

3. Genetics

4. Sun exposure - UV rays increase skin collagen breakdown and induce the accumlation of abnormal elastin

5. Smoking - The multitude of toxins and chemicals present in cigarettes cause damage to skin collagen and elastin and hence can affect the rate of skin regeneration

6. Diet - A high sugar diet results in high blood sugar levels, resulting in formation of Advanced Glycation End products(AGEs) which damage proteins like collagen.

These factors basically affect the amount and quality of collagen in the skin, as well as the regenerative capacity of the skin. Hope that it answers your query!

Similar Questions

Is the Venus Viva or Acnexel machine more effective for acne scar treatment?

Hi, As pointed out, individual scars may require different treatments, so it is really wrong to say that TCA cross is the best treatment for acne scars. TCA Cross is really effective for ice pick scars but may not be worth the risk for rolling type scars. Both the Venus Viva and Acnexel treatments use good technology for acne scar treatments, and are able to get some of the best results without the downtime of ablative fractional lasers like the CO2. I still use both fractional CO2 and RF/heat in my practice, but interchangeably depending on my patients' needs and demands.

How effective is 30% versus 100% TCA CROSS for acne scars? (photo)

Thank you for your question. TCA CROSS (trichloroacetic acid chemical reconstruction of skin scars) is a good technique for atrophic acne scars, especially of the ice pick morphology, but there is some variation in technique among doctors as each doctor has their own preferred way of performing it. How effective is 30% TCA CROSS versus 100% TCA CROSS for acne scars? 100% TCA CROSS has been shown to be effective in multiple published studies. Excellent results (>70% improvement) are seen in the large majority (>70%) of patients.

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Answered By

Dr Wan Chee Kwang

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