6 Tips for an efficient TCA cross

The TCA cross is simple and effective, and what you want is to optimize results.

Here are 6 tips to help you:

• For many, it is hard to localize the treatment to the scar. What you can do is dip the toothpick in the TCA solution for at least 30 seconds for the toothpick to soak up enough solution and press firmly on the center of the scar. You can also sharpen the end of the toothpick for a flatter point. Other manufacturers of TCA peel give their own customized applicator along with the kit.

• Do not get frustrated, and more importantly, do not be lazy. Avoid getting a whole drop of TCA at the end of the toothpick so you can put that drop into the indented surface. It will cover a greater area than intended. Instead, wait patiently for the TCA to be soaked up into the end of the toothpick, which is just enough for the size and diameter of acne scars.

• Some scars are wide. Cover the whole indent but remember to move the toothpick to untouched areas only.

The plant C. asiatica

• Consider using products that stimulate collagen production such as vitamin c and EGF (epidermal growth factor)/copper peptides or the herb Centella asiatica as a topical treatment after the TCA cross.

I've learned about C. asiatica from a girl I've met online. We were discussing TCA cross, as I've done them previously and she planned to also do it DIY style. The herb is easily available in her province, and she swears by it. She has performed just a few sessions of TCA cross and is happy with the results. Granted, hers is a mild case.

• Aftercare is very important. Avoid sun exposure before and after performing the TCA cross method and always use sunblock. 

• Do as much research as you can before doing this treatment. You can learn a lot by reading people's experiences and problems when performing this technique. Also, consider consulting a professional for an evaluation.
   

Must-read reminders before doing a TCA cross

 Here are a few reminders if you plan to do a TCA cross:

• If you want to try this, I suggest that you start at a lower concentration (15-25%) and leave the 100% TCA to professionals.

Even if the TCA cross method is simple, remember that TCA is still an acid and can do further damage to your skin when used improperly or when accidentally applied to healthy skin. You want to be on the safe side and do safer applications.

• Make sure to buy from a trusted seller. Are you getting the right percentage you ordered? Where do the supplies of TCA come from? Is the manufacturer reliable and follows standards and local regulation? These are very important questions. Buy only from trusted sellers.

• When expired, the TCA's concentration strengthens. Ask your seller for the expiration date of the solution. Otherwise, you might be using one with a higher concentration than the one you opt for and not know it.

•  TCA cross is not for removing raised or keloidal scars. It is also more effective on scars that are deep and narrow rather than shallow.

• Consult your dermatologist first if you are taking any medication or antibiotics. Some medications can affect skin sensitivity, which may cause bad reaction, or thin the blood, thus spoiling proper coagulation of the blood.

• As with other treatments, there are potential complications for the TCA cross method, such as hypo/hyperpigmentation and formation of keloids, although these are unlikely to occur. Skin types are important in determining the risk for potential pigmentation.

• The TCA cross method is not recommended if you have active acne on the area to be treated, as well as cold sores, dermatitis, or psoriasis, and if you are prone to keloid scarring. Smokers should also be cautioned, as smoking affects the body's ability to produce new collagen. 

•  As far as I know, the TCA cross method still requires much research in the part of the medical community, meaning, it is still in the experimental stage. Also, from what I've read, doctors have different views in certain areas of this procedure (e.g., to use vaseline/moisturize, effectivity of collagen-inducing creams or products after the cross, pressing firmly with the toothpick or pressing repeatedly, etc.). Further studies are needed, so do this at your own risk.

One last thing: please read everything, every material you can find before doing this treatment including the scientific basis and explanations and precautions because the worst thing that you can do is to start without a clear view of how this process works.

Performing the TCA cross method

The TCA cross method is simple but should be done with extreme precaution. I cannot emphasize this further. Like all other procedures, you might achieve negative results, i.e., further damage to your skin, widened pitted scar, when done improperly. So read everything first and be patient.

A sample of TCA peel solution

Thus saying, if you feel like you cannot carry this out, then seek out a professional to do this for you.


What you need: TCA, anti-bacterial ointment, a steady hand








Steps:

1. Prep you skin by washing with soap or gentle cleanser. Cleanse with alcohol and air dry. 
2. Dip a toothpick in the TCA solution and pressed firmly (not too hard or too soft) on the depressed area until frosting appears. This will only take, literally, a few seconds. There will be mild and temporary stinging, but this is tolerable. No local anesthetic is required, and TCA is self-neutralizing. Remember to treat only the depressed part; you do not want to affect the normal skin surrounding it.

   

   Photo credit to Bhardwaj and Khunger, on their study on the efficacy and safety of TCA cross

3. After treatment, use an ointment-based antibiotic until scabs form. You can go to any generic drugstore and ask for a triple anti-bacterial ointment. Others suggest Vaseline petroleum jelly for the same moisturizing effect.
4.  Scabs will form a few days after. This will naturally fall off, so be careful not to prematurely detached the scabs. You can also use emollient ointments (such as Vaseline) until the scabs fall off.
5. Use a facial sunscreen daily thereafter. This is an important after care to avoid damage caused by sun exposure.
6. After the scabs have fallen off, you may wash your face with a gentle cleanser and resume your daily routine for skin care as well as use make-up.

Wait for at least a month to allow skin reconstruction. Production of collagen is slow and on-going. Multiple sessions of the TCA cross method are required before you can see significant improvement.


As long as you follow the protocol and take precautions, you should be fine.

Also, don't forget to read a few reminders before doing this.

Effective way to improve your pitted scars: TCA cross method

I wrote this series of articles because (i) I have pitted scars myself and know how depressing this can be, (ii) I think this approach to improving pitted scars is effective and provides hope, and, (iii) to my knowledge, this is not widely known in the Philippines.

The TCA cross method is a hope for people wanting to improve pitted scars. The good thing about TCA cross is that, unlike other products or treatments, it completely focuses on the pitted scar and offers as much as 70% improvement (according to the original study which I will briefly discuss below). This, of course, still depends on your skin condition and the treatment itself.

I broke down this topic into several parts to make it simple and readable. There is a study and scientific explanations about the TCA cross method, and I will try to talk about them in layman's term. Okay, read on.

Dr. Jung Lee and the original study

A before-and-after TCA Cross treatment photo from acne.org

The TCA cross (chemical reconstruction of skin scars) method allows pitted scars to be filled in through new collagen production. The best result that you can achieve is for the scars to be barely noticeable unless you look closely or viewed in a certain angle or light.

The TCA cross method was discovered by a Korean doctor (surprise), Dr. Jung Bock Lee, and this study was published in 2001. All in all, 64 patients that have acne scarring were studied, and all of them showed significant improvement. The observed results were better when using a higher concentration of TCA (65% versus 100%).

Read the abstract of the study in Cosmetic Skin and Surgery Center. There's also a follow-up study regarding the efficacy and safety of using 100% TCA in NCBI.

TCA cross

Basically, the TCA cross method uses a high concentration of trichloroacetic acid (TCA), which is applied locally on pitted scars. Reported complications are rare because of the localized and focus treatment; unlike other kinds of treatment, only the pitted scars are treated and not the whole face, which means that you spare the healthy skin tissues.

The TCA cross method reconstructs acne scars by inducing new collagen production and dermal thickening. The scar is treated with TCA, a scab forms and will eventually fall off, and the weeks of collagen regeneration begins.

The TCA cross methods works best on ice pick scars. According to the study, the TCA Cross method can also normalize deep rolling and boxcar scars. However, I have yet to see a testimonial on its effectiveness on the latter scars mentioned.

How does it work?

The TCA causes cell death to several years of the skin cells. These layers will then slough off and new tissues will form. Dermal collagen remodeling then follows and will continue for several months. The TCA cross method results in cumulative effect; since the skin is filled in gradually in each treatment, result improves with the number of treatments.

This procedure is conducted by professionals but can also be done at home. This is because the steps are quite basic and simple.

Ready? Read the basic steps here.



PS: Once formed, pitted scars will be hard to remove; in fact, with the current technology that we have now on skin care, I think that it would be downright impossible to bring back the old smooth skin. But you’re thinking, “I saw this testimonial, this advertisement, this comment on a forum…” well, that's just marketing folks. You can, however, improve the scars and make them less noticeable to the point that it's only visible in certain angles and lighting condition.