TCA Cross is a technique that treats ice pick scars, sometimes referred to as “open pores” or “enlarged pores”, through chemical reconstruction of skin scars (CROSS) using trichloroacetic acid (TCA). This strength of TCA is much stronger than what’s available over-the-counter, but it is safe when used by trained physicians, as is always the case at Reflections Center.


The TCA Cross Treatment Process

Step 1: Free Consultation with a Doctor Acne scars are difficult to remove – and they often require more than 1 type of treatment, because most patients have more than 1 type of acne scar. TCA Cross works the best for ice pick acne scarring, sometimes also referred to as enlarged or open pores. TCA Cross can often be performed at the same appointment as the consultation.

Step 2: Application of the TCA Chemical Peel Our physicians can use a variety of tools to apply the trichloroacetic acid (TCA) into the scars – and the tool being used isn’t actually important to end results, since it’s just being used to lightly rub the acid into scars, so long as we’re able to selectively “paint” the TCA into the right depths and areas. TCA creates a white frost when it’s applied correctly, showing that it’s creating a change in the skin.

Step 3: Recovery from TCA Cross There’s very little “downtime” from TCA Cross. You can expect the treated spots to become much redder than surrounding skin for a few days after treatment (3-8), before calming down. You may notice flaking and peeling in those spots as well (or it may occur without your notice, as the areas are so small). Patients with darker skin tones may notice the area appears darker. This is transient in nature – but we encourage you to discuss any concerns with your cosmetic physician. It is imperative that you avoid sun exposure(either with sunscreen, sun protective clothing, staying in the shade, etc.) during this time, as the sun can negatively impact these treated areas, turning them permanently darker and encouraging the body to create new scar tissue in that area (the opposite effect of what you want).

Step 4: Schedule & Treat for Your Recommended Series of TCA Treatments Like most acne scar removal treatments, TCA Cross must be done in a series of treatments to see the kind of improvements that will make most patients happy. In studies, a single TCA Cross treatment offered an improvement of 10-26% in depth of scarring.1,2,3 Studies followed various treatment protocols between 4 to 8 treatments, spaced 2-6 weeks apart, with the strength of the TCA being used ranging between 50-100%. Our physician team has found that you do need to treat certain patients, especially those who are more prone to pigmentation changes in the skin, a bit gentler, with more treatments done over time, to achieve the same end point, safely. Going in with 100% TCA on every patient, just because it’s the very strongest, is not going to yield great results, because you’re going to create new problems for many patients with such strong TCA. This is why it’s important to see a physician who is experienced and understands how to use clinical study, along with industry experience, to create the best and safest outcomes for a variety of patients.

Frequently Asked Questions About TCA Cross for Acne Scars Treatment

Sources Cited

  1. Deepali Bhardwaj and Niti Khunger; An Assessment of the Efficacy and Safety of CROSS Technique with 100% TCA in the Management of Ice Pick Acne Scars; Journal of Cutaneous and Aesthetic Surgery, 2010 May-Aug; 3(2): 93–96. doi: 10.4103/0974-2077.69020
  2. Horovitz T, Salameh F, Shehadeh W, Koren A, Artzi O. Painting CROSS TCA technique: Modification of the CROSS method for the treatment of atrophic acne scars-Case series. J Cosmet Dermatol. 2021 Nov 13. doi: 10.1111/jocd.14611. Epub ahead of print. PMID: 34773721.
  3. Khunger N, Bhardwaj D, Khunger M. Evaluation of CROSS technique with 100% TCA in the management of ice pick acne scars in darker skin types. J Cosmet Dermatol. 2011 Mar;10(1):51-7. doi: 10.1111/j.1473-2165.2010.00526.x. PMID: 21332915.
Medical Director at Reflections Center

Dr. Mitchell Chasin founded Reflections Center for skin & body as a place where physicians specializing in cosmetic medicine could focus on helping empower patients to feel their most beautiful. Dr. Chasin believes strongly that the best cosmetic physicians are those who are dedicated to mastering their craft through continuing education and collaboration with the industry’s top doctors.