TCA for Ice pick scars | Dr Davin Lim

How does TCA CROSS work?
TCA Cross Acne Scars
TCA CROSS (stands for Trichloroacetic acid chemical reconstruction of skin scars. This procedure uses high-strength acid applied to the scar & not the surrounding skin. This prevents damage to the normal surrounding skin, resulting in much faster recovery & less side effects.

Ice-pick scars treated with TCA Paint & conservative fractional CO2 laser.
TCA ‘scars the scar’– namely TCA breaks down the scar & denatures collagen, stimulating new collagen to ‘fill in’ the scar. The deeper the scar, the better it works. Collagen stimulation takes at least 3-4 weeks to form, & is maximal at 3-4 months, hence why we advise at least 6-8 weeks between TCA CROSS treatments.



How is this treatment performed?
The traditional method of TCA CROSS is to use a toothpick to dip into a jar of TCA. The toothpick is then placed into the scar. My method 12 years ago was to use a one ml syringe to deliver drops via osmosis. This was infinitely faster. In 2019 I started using brushes, a term I call TCA Paint.

I feel that my method of treatment is safer, more controlled, faster & more efficient than the traditional toothpick method.

Here are some points regarding TCA for acne scars-

Makeup must never be worn prior to treatment. Take it off the night before, if make up is mixed with TCA it evokes an inflammatory response & extends healing times.
I clean and degrease the skin with alcohol prior to TCA
I choose an appropriate concentration -50-100% TCA
Each scar is carefully treated with a tiny droplet of TCA or a brush stroke
Stinging like an ant bite is experienced for a few minutes
The skin turns white then red over a period of 20 minutes
Treatment takes between 5-30 minutes, depending on the extent of scarring
Is the treatment painful?
No. Treatment is more uncomfortable than painful as each droplet ‘feels like a tiny ant bites’. All patients tolerate this procedure well. For cases that require adjunctive laser resurfacing, TCA procedure is painless as numbing cream is used.

TCA Paint-drip or CROSS
is useful for acne scars.
What is the difference between TCA CROSS & TCA Chemical Peels?
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 much lower concentration of TCA – usually 30-35% & 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.