TCA CROSS is the chemical reconstruction of skin scars (CROSS) using trichloroacetic acid (TCA). It is used to to treat atrophic acne scars such as ice pick scars, rolling scars, and boxcar scars. It works by stimulating collagen production in the scar. It is very effective but may need to be repeated multiple times, typically 3 times.  Patients can experience significant improvement with this treatment. It is safe in all skin colors however one must be careful in darker skin individuals. 

Frequently Asked Questions

The following are some of the frequently asked questions regarding the chemical peel treatment:
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How long will I take to recover from TCA cross chemical peels?

Immediately following TCA cross, the treated skin turn white. Over a few hours, the area becomes much redder than the surrounding skin. Pinpoint areas surrounding the treated area may peel over the next 3-4 days. The skin slowly returns to its normal color over 8-21 days. In darker skin patients, pigmentation changes may be more prolonged. It is essential that sun exposure is avoided in all patient for at least 2 weeks following TCA Cross.

The recovery time of TCA Cross is 3 to 8 days, and differs from patient to patient.  The results can be observed after the recovery time has passed. The patient can proceed the daily routine tasks; however, some precautions are required.

Recovery is also dependent on the strength of the TCA CROSS chemical peel- a higher concentration means a longer recovery time.

Does the TCA Cross treatment hurt or burn the skin?

The most common perception of people is that this chemical peel hurts or burns the skin. The TCA Cross procedure is very tolerable for the patient. 

How many treatments will I need?

As with many other acne scar treatments, multiple sessions are advised for the best results. As a guide we encourage patients to complete 2-3 sessions, over a period of 3-4 months. Very deep scars can be treated with subcision during the time of TCA Cross or as a separate procedure.  Microneedling treatments in between treatments will provide best results.  Individualized treatments will give the best results. 

How much will my acne scars improve with TCA cross?

As a guide we should aim for at least 50-80% improvement of deep ice pick scars after a series of 2-3 TCA cross chemical peels. Scar specialists do not recommend fractional laser resurfacing for deep ice pick scars, as TCA peels or punch surgical excision out performs lasers in this setting. Once deep acne scars are raised up to form a shallow scar, we then use microneedling to complete the scar revision process.

What types of acne scars respond best to TCA CROSS peels?

-Ice pick scars
-Boxcar acne scars
-Enlarged pores​

What are the side effects of chemical peel?

There are no major side effects of Chemical peels, if performed by a specialist. The minor effects include redness, hyperpigmentation, scarring or a burning sensation for a while.

What are some things I should do before getting chemical peels?

This is a good question. What to do before getting a chemical peel is important because it can help the doctor or provider know your current skin condition. Tell them what you’re allergic to, if you have any history of scarring or cold sores, and any medications you may be taking. Most of the time, the doctor will work with you and ask these questions.

Can microneedling be combined with TCA cross?
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Yes. Specialist often combine a number of techniques to give the best possible results to patients. We can combine subcision, microneedling and TCA cross. Remember, most patients will have a number of different types of scars, and hence a combination of treatments will be needed.

TCA cross for acne scars can form an integral part of our Program for acne scar revision. The concept is to map and treat each scar individually, using the best method available for the scar type. 

Is home-exfoliation of skin same as chemical peel?

The home-exfoliation is not same as the professional chemical peel. Though the home exfoliators are useful and beneficial, they cannot be compared to the chemical peel treatment.

The treatment includes application of an acidic solution with supervision of a qualified provider.

Is TCA cross chemical peel safe in dark skin types?

TCA cross can be used to treat acne scars in all skin types. Darker skin patients may develop slight darkening of the treated skin (1-2 mm areas), but this fades over a period of weeks. Occasionally post treatment darkening may last a few months. The use of sunscreen after this procedure is very important.

Treating acne scars in darker skin types can be more challenging as post -treatment darkening of the skin can be encountered. As a guide, it may be recommend that an extra one or two treatments be performed, as a lower concentration of TCA is used in darker skin patients. Often we will prescribe a bleaching agent before and after the TCA Chemical peel procedure, as this can fade darkened scars.

​What precautions are required after chemical peel?

The provider will explain all the precautions that need to be taken after the chemical peel treatment. Direct sunlight must be avoided for a couple of days, the patient must wear sunblock with high SPF when going into the daylight.
Home-exfoliators must not be used for a certain amount of days after the chemical peel treatment.​

Our providers have extensive training in the treatment of acne scars in darker skin patients, including Asian, Hispanic, Middle Eastern, as well as African skin types.

Ananya Aesthetics LLC, DBA Ananya Aesthetics is the MSO for ZKN Medical Corporation.  Medical director Luani Lee, M.D.