How to treat ice pick acne scars

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TCA peels for acne scarring
TCA chemical peels can be an excellent method to treat very deep acne scars including ice-pick, and open deep skin pores. Deep acne scars, called ice-pick scarring do not respond to Fraxel/ Fractionated laser treatments, but can be effectively treated with chemical peels. TCA cross stands for ‘Trichloroacetic Acid Chemical Reconstruction of Skin Scars’. Chemical peels work by stimulating collagen, lifting deep and indented acne scars.

How do I perform TCA for acne scars?
First of alI, I examine your scar types, taking notes and photographing acne scars under angled lighting. Depending on your skin type and depth of your acne scar, I select a concentration of TCA between 70- 100%. Most doctors use a toothpick technique to deliver the TCA chemical peel to the acne scar, however I invented my syringe delivery system- this is much more accurate, and much faster than older techniques.

I often combine several types of treatments for acne scarring in the one sitting. Shallow scars and rolling scars are best treated with Fractionated lasers/ Fraxel, deeper scars such as ‘ice-pick’ acne scars are best treated with TCA cross or punch excision. I also perform subcision to lift up tethered scars. Most patients will have different scar types, hence the importance to use the best method for acne scar removal.

How long does it take to recover from TCA CROSS chemical peels?
Recovery from TCA chemical peels are quick, and painless. This is because only the acne scar is treated, and not the surrounding skin. Scared areas are white for several hours, before turning red for several days. Each treated area (1-2mm) will remain red for one week before peeling. Full recovery is expected in 5-6 days, however redness may take a week or two to fully recover. Sun protection is essential during this period.

Can darker skin types be treated with the TCA cross technique?
Yes, even deep ice pick acne scars caused from zits, acne, and cysts can be treated with TCA chemical peels in darker skin types, however darker pigmentation is always seen after the peel, and can persist for a few months. The use of Picosure laser and sunscreen and a bleaching cream can reduce this incidence.

TCA CROSS chemical peel is an effective and safe method that is ideally suited for deep acne scars. Even with the event of lasers such as Fraxel and ProFractional lasers, TCA still plays an important role for the revision of ‘ice pick scarring.’ Acne patients often have several types of scars including rolling scars, ice-pick scarring, box scars, and bound scars. Always remember it is the method, not the machine that gives acne scar patients the very best results. Chemical peels, along with microneedling, skin needling, radiofrequency, fractional co2, Profractional, subcision, and dermal fillers give my patients the very best results for their acne scars.

Thanks for watching, and remember to subscribe to Lasers and Lifts by Dr Dr Davin Lim Lim for more up coming videos on acne scar revision and cosmetic dermatology.

Dr Davin Lim
Laser, surgical and aesthetic dermatologist
Brisbane, Australia

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