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Effective Acne Scar Treatment with TCA CROSS | Aesthetic Studio Singapore

July 23, 2011

Dr. Jonathan Y. Lee discusses a safe and highly effective treatment method for deep and difficult ‘icepick’ acne scars utilizing TCA for focal chemical scar reconstruction – A method known as TCA CROSS. Many of our acne-scar patients have benefited from the simplicity, comfort and effectiveness of this technique.

Acne scarring is an extremely common complication of acne and can be cosmetically disfiguring and have significant negative psychological impact. There is as yet no single appropriate and effective treatment for acne scarring and combination treatments are often required.

Depending on the type or appearance of the scars, different treatments (modalities) may be proposed by your surgeon. These may include surgical excision, subcision, fillers, laser resurfacing, dermabrasion, fractional laser resurfacing etc.

Icepick Scars
Icepick scars most common type of acne scar. These are very often narrow, sharp and deep. They give the appearance that the skin has been pierced with a sharp instrument or icepick. They may appear as a deep, open pore; and usually extend into the deep dermis layer.

Dermabrasion and laser resurfacing are often ineffective at dealing with this type of scar as these scars are often too deep. They usually develop from a cyst infection or after an inflamed blemish works its way to the skin’s surface. In the process skin tissue becomes destroyed, leaving these column-like scars.

One method that we find particularly effective for the treatment of ‘ice-pick’ scars or ‘pitted’ scars is the method of chemical recon­struction of skin scars (CROSS) or TCA CROSS.


This technique is the precise and focused spot application of TCA (trichloracetic acid) into each ‘pitted’ or ‘icepick’ acne scar, avoiding the non-scar areas of normal skin. The resurfacing response that occurs inside the depression stimulates collagen production increases dermal volume, restructuring the dermal elements within the skin, and this eventually causes the scar to rise up (effacement) and close.

In our hands, this technique has been suc­cessful is treating facial acne scars (especially atrophic ice-pick scars) and damaged or dilated pores. The degree of improvement depends on the number of applications and between 2 to 6 courses of treatment may be required.  Studies demonstrate good improvement after three to six courses in more than 90% of cases.

The technique is safe with few significant complications. Healing is more rapid than conventional full-face medium to deep chemical resurfacing.

It is important to have this procedure performed by a doctor with experience in this technique, as this is very much a procedure that requires expert technique to avoid complications such as burns, prolonged healing, pigmentation etc, that can result from applying too much chemical, or applying it inaccurately. Dr. Jonathan Lee performs this procedure under magnification with specialized instruments.

How is the TCA CROSS procedure performed?

After cleaning and priming the skin, TCA is applied, very precisely into each ‘pitted’ acne scar with a special applicator. This produces a white ‘frost’ on each acne scar, which disappears in 20 to 30 minutes. A mild redness may persist for several hours after the procedure, and an ointment is applied at regular intervals for the first week to aid in healing. Sun avoidance and use of sun protection is advised, during healing.

Are TCA CROSS treatments for Acne Scars painful?

The TCA CROSS procedure is relatively painless. There may be slight discomfort, described as a ‘biting’ sensation’ when the chemical is applied, and this lasts only for a few minutes. During the healing phases, there is no discomfort or pain.

What kinds of Acne Scars are suitable for CROSS treatments?

TCA Cross can be used on all skin types, and is especially useful and effective at treating ‘ice-pick’ or pitted acne scars. TCA CROSS alone can be effective as a single method of treatment for light ice-pick acne scars, or other mild to moderate acne scar types. But more often, it is used in combination with other treatments such as laser resurfacing or selective scar excision or subcision, in the treatment of acne scars and improving overall skin texture.

How many treatments are required?

TCA Cross can take one to several treatments depending on the severity of your acne scar case.  Between 2 to 6 treatments may be required.

An interval of 4 to 6 weeks between the first few treatments is required, to allow the skin to heal, remodel and rejuvenate. You are likely to see continued improvements for several months after a treatment.

For an example of CROSS treatment watch:

TCA CROSS is a safe and highly effective procedure of removing deep acne scars, and patient satisfaction is high. It is virtually painless, has acceptable downtimes, and patients see results very quickly. It may be used alone or in combination with other acne treatments depending on the severity and type of acne scars that you have.

To see if you are suitable for this treatment, and to have an effective treatment plan designed and tailored specifically to your needs; Call us for an appointment at THE AESTHETIC STUDIO, SINGAPORE. (Tel: +65 6440-1200 / +65 67371100)


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