Active acne breakouts are frustrating enough, but sometimes they can leave scars which are even more annoying. The good news is that these scars can be treated. Having said so, active acne breakouts can lead to new scar formation. It is thus crucial to treat the active breakouts first, before treating the acne scars. Active acne breakouts can be treated with topical creams, oral medications and lasers. Speak to our doctor for an individualized treatment plan for your acne breakouts.
Acne can result in different types of scarring. It can result in:
1. Skin surface issues
a. Atrophic scars – depressed scars
i. Icepick scars
ii. Rolling scars
iii. Boxcar scars
b. Hypertrophic scars – raised scars
2. Pigmentation issues
a. Post inflammatory hyperpigmentation (PIH) – dark spots or marks after acne breakout
b. Post inflammatory erythema (PIE) – residual red/pink/purple spots or marks after acne
It is important to differentiate the different types of scarring that can come as a result of acne breakouts as there are different treatment modalities for the different scars. Pigmentation issues are best treated with lasers. We have a Pico laser for PIH and a Dual Yellow Laser for PIE. Hypertrophic scars may be treated with steroidal injections or ablative laser treatments. There are many treatment options for atrophic acne scars. These include a fractional Pico Laser, Secret RF treatment (microneedling with radiofrequency), chemical peels and subcision with or without the use of Rejuran. Many factors such as the type of acne scars, patient’s choice, downtime etc will affect the choice of treatment.
What are chemical peels?
Chemical peels are topical treatments that are applied to the skin to improve the appearance of the skin. The solution applied will remove dead skin cells and stimulate the body to produce collagen. Chemical peels are used to treat wrinkles, fine lines, hyperpigmentation, sun damaged skin, uneven skin tone and acne scars. There are various types of chemical peels in the market and different chemical peels will have a different strength and result.
What is TCA and what is TCA CROSS?
TCA or Trichloroacetic Acid is a type of chemical peel that treats damaged skin. CROSS, an acronym for chemical reconstruction of skin scars, is a specific way of using TCA to treat acne scars. In this procedure, small amounts of high concentration of TCA are precisely placed directly into atrophic acne scars. This will stimulate the production of elastin and collagen, improving the appearance of the acne scar.
Is there anything I need to do before the procedure?
Ensure that there has not been any recent damage to the skin. There should not be any laser treatments, microneedling or other chemical peels that have been done recently. Stop retinols, retinoids, alpha hydroxy acids or exfoliants for 3 days before the procedure. Avoid tanning for 2 weeks before the procedure.
What is the procedure like?
The treated area is first cleansed and primed. TCA is then precisely placed into each scar using an applicator. The treated scar will “frost” or turn white first before turning red. A patient may feel a warm sensation at this point, but the procedure is well tolerated for most. The process is then repeated to treat each scar individually. An antibiotic ointment will be applied after the procedure.
Is the treatment painful?
There may be some discomfort or a “biting” sensation when the procedure is taking place, but it is well tolerated by most patients.
What do I need to do after the procedure?
Apply the antibiotic ointment for 1 week after the procedure. Application of sunblock is also crucial. Avoid the sun as much as possible for the first 2 weeks after the treatment. Do not apply retinols, retinoids, alpha hydroxy acids or exfoliants after the procedure. Refrain from applying make up for the first few days after the procedure. Do not pick at any scabs should they form.
What is the downtime for the procedure?
Generally, the treated areas will “frost” or turn white initially. It will then turn red followed by brown. The treated areas will then start to peel off after which you will notice new, softer more radiant skin. This will take place over 1-2 weeks.
What are the side effects of TCA CROSS?
TCA CROSS is a safe procedure when done properly. However, all procedures have inherent risks. One of the potential side effects is post inflammatory hyperpigmentation or PIH. This refers to darkening of the treated areas. Darker skin individuals are at slightly higher risk of this. This is usually temporary but, in some cases, may take a few months to resolve. In extremely rare cases, this could be permanent. Hypopigmentation, or an area of lighter coloured skin is also possible. Once again, this tends to resolve but can be permanent in rare cases. An infection is also possible. This is rare should you apply the antibiotic ointment and keep the treated areas clean. Scarring after the procedure is very uncommon but possible.
How many sessions of TCA CROSS do I require?
The number of treatments depend on the severity of scarring as well as response to treatment. Usually, patients will require a few sessions for optimal results.
Can I combine TCA CROSS with other treatments?
Yes, you can. Depending on the type of acne scars you have, you may benefit from a combination of treatment. At TWC, we also offer fractional Pico Laser, Secret RF treatment (microneedling with radiofrequency) and subcision with or without the use of Rejuran. The choice of treatment will be taken based on the type of scars you have, and expectations of treatment after a consultation with our doctor.
Are the results permanent?
Yes, the results are permanent, but it may some time for it to show. This is because TCA CROSS helps to remodel and produce new collagen in the atrophic scars and this process can take some time.
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