TCA stands for trichloroacetic acid. It is a type of deep chemical peel that has been traditionally used for non-invasive skin rejuvenation procedures to treat fine wrinkles, skin discoloration, and scarring. Only until more recently has TCA been touted as an effective medium for acne scar removal, having been extensively studied in numerous clinical trials.
CROSS stands for Chemical Reconstruction of Skin Scarring. It is a special technique in which miniscule amounts of TCA are focally applied to scar tissue only while sparing the surrounding healthy skin. This mode of application is thus highly effective for acne scar patients, whose scar tissue is interspersed across healthy skin. Common tools that are used for applying TCA to acne scars, which are often less than 2 mm in diameter, include tooth picks, paint brushes, and syringe needles. Regardless of what applicator tool is used, TCA CROSS is a highly operator-dependent procedure. The method of application and number of passes, among other technical factors, can heavily influence your treatment outcomes.
Interestingly, while TCA CROSS has become increasingly popular, it has also become equally met with criticism in numerous scientific papers. A paper by Dalpizzol et al in 2016, pointed out that widening of scars was observed when using 100% TCA CROSS. In the same paper, it also pointed out that another chemical, called phenol, produced equally effective results WITHOUT widening scars. This stirred a lot of debate within the field of acne scarring, as phenol too had already been widely recognized as a skin rejuvenation medium and is becoming increasingly more popular for acne scar removal.
It is hard to say because every patient is so different. Both chemicals are known to produce post-inflammatory hyperpigmentation, which is why it is wise to test these chemicals on only a few acne scars to determine not only how much benefit you derive from them but also whether or not it is safe to apply to your skin. Also, the variety of concentrations and cocktail formulations for deep chemical peels are endless and thus have a broad range of depth penetration.
At the Scar Healing Institute, the best acne scar treatment center in California, we have our own proprietary CROSS treatments that we spent years developing in-house with our team of expert chemists and dermatologists. This CROSS treatment can be used for acne scar removal as well as for body acne scar treatment. We are very meticulous when it comes to testing these treatments on you, as we always abide by a high standard of safety. To see if you are a good candidate for acne scar removal via CROSS treatment, contact our team to set up a consultation TODAY!
Dalpizzol M, Weber MB, Mattiazzi APF, Manzoni APD. Comparative study of the use of trichloroacetic acid and phenolic acid in the treatment of atrophic-type acne scars. Dermatol Surg. 2016;42(3):377–383. doi: 10.1097/DSS.0000000000000606