TCA CROSS Peel

Treats Certain Atrophic Acne Scars

What is TCA CROSS Peel?

TCA CROSS Peel stands for TriChloroacetic Acid Chemical Reconstruction Of Skin Scars.
TCA CROSS peels are used to treat certain types of atrophic ("ice-pick" and "boxcar") acne scars. The technique involves placing a small amount of high concentration TCA (85% to 100%) to the desired area. The acid causes destruction of the epidermis and dermis within the scar. New skin regenerates from adjacent hair follicles with production of dermal collagen and glycosaminoglycans over the next several weeks. The stimulation of new collagen helps elevate and improve the appearance of ice pick and box car type of acne scars. TCA CROSS peels are usually combined with other modalities in the treatment of acne scars.

How is the TCA cross peel performed?

The procedure is always performed by a physician.

After the patient’s face has been thoroughly cleansed and prepared, the areas to  be treated are mapped out.

High concentration TCA is applied using the point of a sterilized toothpick or wooden  applicator to approximate the shape of the acne scar. The applicator is placed into the  base of the scar until a white frost develops. A topical antibiotic ointment is then applied  to all treated sites. Aftercare instructions are provided. 

How many treatments are needed to see results?

Most patients usually require anywhere from 3 to 4 treatments spaced 4 to 6 weeks apart.

How long does the procedure take?

The procedure takes between 10 to 20 minutes to perform depending upon the extent of  scarring.

Frequently Asked Questions (FAQ)

There is some mild discomfort but no significant pain. A slight burning/stinging  sensation lasts for minutes. No anesthesia is needed. 

Recovery from TCA cross peel is relatively quick with minimal discomfort. The treated  areas frost white for several hours, thereafter turning red for one week. A crust or scab  typically forms on day #2 but will fall off spontaneously in a week on average. Full  recovery is expected within 7-10 days; however, residual redness may take weeks to  resolve. Sun protection is essential during this recovery period. Do not schedule a  TCA peel within 2 weeks of a social event. 

Yes. All skin types can be safely treated with TCA cross peels; however, darker skin  types, such as Latino, Middle Eastern or African-American, have a greater risk of  hyperpigmentation. This means that treated areas may be darker than the surrounding  skin for months. The use of sunscreen and bleaching creams are essential.

Significant complications are rare. Most scientific studies demonstrate a high level of  safety with this procedure. The following complications are possible but rare:

  1. Persistent redness
  2. Persistent hyperpigmentation
  3. Persistent hypopigmentation
  4. Flare of herpes simplex virus
  5. Additional scarring
  6. Keloid formation
  7. Bacterial infection 

Priming the skin for several weeks beforehand with a topical retinoid (i.e Retin-A,  tretinoin, tazorac, adapalene, etc.) is advisable. However, you must stop the retinoid 5  days prior to the peel. Patients with darker skin types should also use a bleaching cream for 2 weeks prior to the peel. Oral Valtrex (to prevent herpes infection) is started  one day prior to the peel and should be taken one week afterwards. Direct sun  exposure should be avoided 7 days before the peel and 2 weeks afterwards.