TCA CROSS is the chemical reconstruction of skin scars using high concentrations of trichloroacetic acid focally within each scar. TCA CROSS is uniquely preferential when treating ice pick, some boxcar scars and enlarged pores. Other therapies such as lasers cannot reach the depth of these types of scars to make a significantly visible difference.

The goal of TCA CROSS treatments is to decrease the depth of scars as much as possible, if not completely. This procedure induces the formation of new collagen, elastin and tissue to raise scar depth. If further improvement  is desired, lasers, subcision, dermal fillers, Secret RF and/or SkinPen may be recommended in conjunction with or post  TCA CROSS. For some with highly responsive skin, some scars close or raise completely using TCA CROSS alone.

Pre-Treatment Protocol

  • If you have a history of cold sores, you must take an anti-viral medication (Valtrex, Valacyclovir) before treatment. We can prescribe one for you.
  • Darker skin types should be pre-treated with retinoids and pigment suppressing products for a few weeks to a month before treatments.
  • Retinoids must be stopped 48-72 hours before TCA CROSS.
  • Patients must not have tanned or self-tanned skin.
  • Patients on isotretinoin (Accutane) or patients with active acne are not candidates for TCA CROSS until acne is controlled and isotretinoin has been stopped for at least 4 months.
  • Patients with a propensity to keloid are not candidates for TCA CROSS.

The Treatment

  • Skin is thoroughly cleansed with a degreasing agent.
  • Skin may be marked to separate areas to be treated and areas to not be treated.
  • TCA (70% – 100%) is dropped into the base of each scar using a toothpick or syringe. Scars may be stretched as the TCA is applied to avoid this acid to spill over the sides of the scars.
  • Each treated scar will frost, appearing white, then may turn red the same or next day.
  • Each frosted area will then crust or scab over, sometimes appearing black and freckle-like.

IMPORTANT: DO NOT ATTEMPT TO PICK, SCRUB OR PHYSICALLY REMOVE THE SCABS. If you do, you risk making the scars deeper or broader. Allow your skin to heal at its own pace. These crusts or scabs will fall off on their own, usually within the week.

Post-Treatment Protocol

  • You will need to purchase products for skin recovery and to prevent infection. We will review those products with you at your appointment.
  • You must protect skin from sun exposure – sunscreen, hats, masks, etc.
  • Try to refrain from wearing makeup for the first few days.
  • Resume retinoids and pigment suppressants after a week.

Tips and Observations

Immediately after the scabs or crusting falls, the treated scars may look reddish and worse than before treatment.

Don’t panic. The erythema is part of the healing process.

Be patient. Collagenization continues up to four months after each treatment. (Translation: Scars continue to improve/fill for up to four months post-treatment.)

Generally, 3-4 sessions of TCA CROSS is recommended, scheduled at monthly intervals.

TCA CROSS combined with Pixel Laser, SkinPen, Secret RF or subcision may be recommended to enhance results if needed.

Watch how TCA CROSS works here.