atrophic acne scars


Resurface your deep acne scars with a focal specialized chemical technique.

TCA CROSS is a clinically effective way to treat your deep ice pick and boxcar scars by inducing collagen synthesis.

tca cross acne scars treatment for ice pick scars
Ice Pick and Pitted Acne Scars

Table of Contents

What is TCA CROSS Acne Scars treatment?

What is TCA CROSS Acne scars treatment and what does it stand for?

TCA is short for Trichloroacetic acid. TCA is a medium to deep chemical peel that has been used extensively to treat scars, wrinkles and photo aging.

CROSS is an acronym for Chemical Reconstruction of Skin Scars.

The CROSS technique uses high concentration TCA to denature the proteins at the deeper layers of the skin where scar tissue is found. This process stimulates collagen synthesis, skin thickening and a resultant improvement in your acne scar appearance.

For deep scarring, even the most powerful laser resurfacing is rendered ineffective because of the limitation of the laser penetration within the skin.

TCA CROSS acne scars treatment is a specialized focal technique to treat selected deep scars effectively and safely, with minimal downtime. Ice pick acne scars are the most common atrophic acne scars and can extend to the deeper dermal layers and beyond.


TCA CROSS acne scars

TCA CROSS therapy stands as a pioneering solution in the realm of acne scar treatment, offering targeted and transformative results for individuals seeking to address the persistent marks left behind by acne breakouts. Through the precise application of trichloroacetic acid (TCA) at high concentrations to individual acne scars, Dr Ng employ this innovative technique to stimulate collagen production and promote scar remodeling from within.

Is TCA CROSS the best treatment for acne scars?

Different acne scars require specific treatments. TCA CROSS is most effective for:

  • Ice pick scars
  • Deep boxcar scars
  • Deep rolling scars
  • Atrophic and Mixed Acne Scars
  • Enlarged Pores

Ice pick scars are the most common acne scar subtype. Although common, they represent deep scarring within the dermal architecture of the skin. A customised plan for your individual scar type will lead to better outcomes.

histology of skin TCA CROSS
(A) Untreated Scar (B) 65% TCA CROSS (C) 100% TCA CROSS

How is TCA CROSS different from full face chemical peeling?

A wide variety of agents have been shown effective for superficial peeling. This includes alpha hydroxy acids (AHA), beta hydroxy acids (BHA) and Jessner’s solution. All these products work by exfoliating the skin by increasing turnover of the skin cell cycle. These superficial peels are mainly used for full face treatments, to improve skin texture and even out pigmentation.

For deep acne scars, a superficial peel will not be effective. Moreover, it is not only impractical, but also risky to use deep peels to the entire face. TCA CROSS acne scars treatment therefore acts as a bridge of targeting selected deep acne scars for resurfacing, making it an effective and safe procedure.

What Happens After TCA CROSS For Acne Scars?

The TCA CROSS application causes proteins in the cells to denature and coagulate in the epidermal layer. The dermal collagen undergoes a process known as necrosis (cell death). Following this, the skin cells in the epidermal layer renew and regrow. The collagen in the dermal layer undergoes re-organization over months. Moreover, there is thickening of the dermal layer and increase in dermal structural elastin and glycosaminoglycans as well.

A study has documented the changes following TCA CROSS in the skin under histological analysis. Using special staining methods, researchers showed that TCA CROSS activated fibroblasts (cells that produce collagen), increased epidermal thickening and dermal collagen content.

Benefits oF TCA CROSS

TCA CROSS is clinically proven to repair deep scars by stimulating collagen, restoring damaged skin and resurfacing your scars. This leads to an improvement and elevation of your scars over time.

This specialised technique is useful for targeting individual deep scars instead of other treatments that may treat a wider area but with less depth.

Compared to other acne scar treatments, TCA CROSS is associated with faster healing times, typically 5-7 days. TCA CROSS is not a fully face chemical peel but a focal specialised technique.

TCA CROSS has variable concentrations that can be used safely in all skin types.

The wound healing and scar remodelling process is a work in progress over months. Although you will not see immediate improvement, your scars will look better as they heal over time, typically 6-12 months.

TCA CROSS tends to be more cost effective than lasers for example. However, as many patients have mixed atrophic acne scars, Dr Ng will help you customise a treatment that best fits your scar type and skin type.

Although the procedure appears simple from videos, it should only be performed by an experienced doctor who performs this procedure regularly for safety and to minimise side effects. Never attempt to carry out the treatment on your own as you lack depth perception and the necessary experience.

Once your acne scars have resurfaced, they are likely to stay that way for a long time save for the effects of the intrinsic ageing process. Maintenance treatment with other modalities may be carried out to restore and rejuvenate your skin depending on your skin and acne scar type.

What is the TCA CROSS Acne Scars Procedure like?

After an initial assessment is made to ensure you are safe to proceed with the TCA CROSS acne scars procedure in Singapore, your face is cleansed to remove any impurities and to facilitate absorption of the chemical peel. The concentration of the TCA CROSS chosen depends on the individual skin type and scar depth. Studies have shown that TCA concentration up to 100% to be safe and effective.

An applicator is used to apply the TCA within the base of the selected scar tissue. The treated area will turn white (frost), which signals that the proteins in the skin are being denatured. You many feel a warm heating sensation, but the procedure is well tolerated for most individuals. This process is repeated to treat each scars individually. An antibiotic ointment is applied after the procedure to allow healing and to reduce the risk of infection.

White spots after application of TCA to ice pick scars

toothpick vs syringe for TCA CROSS
TCA CROSS methods: Toothpick vs. Syringe

Toothpick or Syringe Technique?

The chemical reconstruction of skin scars (CROSS) by the syringe technique is another method of treating ice pick scars. In this study, the syringe technique involves filling a 1ml syringe with TCA and delivery via a fine gauge needle. Bending the needle allows the flow rate of the TCA to be regulated. However, the main advantage of the syringe technique is only faster treatment time. In contrast, the disadvantages are difficulty manipulating the flow of TCA on small scars and an increased risk of squirting onto the treatment area. 

In our experience, the toothpick method gives better control although treatment time may be longer. There is no advantage over the clinical outcome when using one method over the other. Your safety is always a priority when it comes to any medical treatment.

What do i need to know after the procedure

The frosting (white areas) will remain for up to 12 hours, and the surrounding skin will appear red and swollen for up to 24-48 hours.  A scab will develop in a few days, which typically falls off within 3-7 days. It is important not to pick at the scab to allow healing and prevent further scarring.

An antibiotic ointment is applied regularly until healing is complete, and strict sun avoidance is necessary to prevent pigmentation around the treated area.

How many treatments will I need?

The number of treatments you may need will depend on the severity of your scarring and your healing response to the treatment. On average four to eight  TCA CROSS acne scars treatments may be required over a 3-6 month period for better results. Interval between TCA CROSS treatment is about 6 weeks to allow optimal healing.

What is the Post Procedure Recovery like?

While TCA CROSS is considered safe and effective for all skin types, and is generally a well tolerated procedure, some individuals may experience:

  • Temporary skin redness/swelling
  • Skin colour changes (Hyperpigmentation or Hypopigmentation which is rare)
  • Poor response to the treatment (This may be due to delayed or inadequate collagen synthesis)
  • Infection (rare)

For Asian type skin, it is important to avoid the sun and use a sunscreen regularly to avoid hyperpigmentation (darkening at the treatment areas).

Combination approach to acne scars

TCA CROSS is often combined with other acne scar treatments to give better results. For example, subcision to release the deep bands of the acne scars may be performed at the same session.

For mixed acne scarring, the Acne Scar Removal Program offers a comprehensive treatment option to manage the wide variety of acne scar types. Different scars require different approaches, and a synergistic effect is seen with combined treatment. Generally, we treat the deep scars at the initial stages of acne scar revision before we perform fractional resurfacing of the skin. 

Releases deep tethered scars within the skin. A variety of approaches is used but a blunt cannula method allows minimal tissue trauma and therefore shorter downtime.

Fractional lasers or energy-based devices such as Pico fractional laser, INFINI and Genius helps to induce collagen synthesis through a natural wound healing process. The newer microneedling RF treatments such as the Genius is able to deliver precise energy within the skin while sparing the epidermis, making treatments safer and healing times faster.

Injectable filler treatments such as Hyaluronic acid, Profhilo and Rejuran S elevate scars by restoring volume loss and stimulation of wound healing.

Vascular lasers improve redness and inflammation on the skin. It is useful for post-inflammatory erythema, rosacea, active acne and facial veins. 

An alternative to TCA CROSS for deeper ice pick scars is punch excision. A specialised circular blade is used to surgically remove the deep scars and the wound is sutured together. After 5-7 days, the sutures are removed, and the deep scar is converted to a liner scar which can then be lasered to improve its appearance. 

Keloid scars may result from untreated acne. Keloids are commonly found on the jawline, shoulders and chest. When they cause pain, itch or discomfort, injection steroids help to relieve these symptoms and improve the appearance of your keloids.

Acne scars are a common consequence of acne that has been not treated early and effectively. Your acne scar type, scar grade and skin type and important factors we consider at APAX Medical & Aesthetics Clinic. During consultation, Dr Moses, who has more than 15 years of clinical experience and having treated thousands of patients will determine the best TCA CROSS acne scars treatment for you.

Frequently Asked Questions

Yes, there is good safety profile for individuals with darker skin phototypes. A lower concentration of TCA is usually recommended during your first treatment.

Individuals with active skin infection, inflammation and known allergies to trichloroacetic acid. We do not recommend TCA CROSS to pregnant and breastfeeding women.

TCA CROSS is from $320/session. 

The number of TCA cross treatments needed depends on the severity of the acne scars and the individual’s response to treatment. Most people require multiple sessions spaced several weeks apart to achieve optimal results.

Common side effects of TCA cross may include temporary redness, swelling, crusting, and mild skin irritation at the treatment sites. In rare cases, complications such as infection, scarring, or pigment changes may occur.

The downtime after TCA cross is typically minimal, although the treated areas may appear red, swollen, or crusty for several days following the procedure. It’s important to follow post-treatment care instructions provided by the dermatologist to promote proper healing.

Results from TCA cross are not immediate and may take several weeks to months to become noticeable. Improvement in the appearance of acne scars is gradual as collagen production and tissue remodeling occur. Multiple treatments may be needed to achieve the desired outcome.

Individuals that respond best to TCA CROSS are the ones with severe deep scarring. On average, most individuals should see an improvement in their acne scarring over a 9 to 12 month period. Over time, the process of collagen synthesis and remodelling will lead to your acne scars resurfacing.

Schedule a consultation for TCA CROSS acne scar treatment in singapore

TCA CROSS is a specialised technique that demands experience, skill and precision. Contact us today to schedule a consultation, so that Dr. Ng can develop a personalized treatment approach for resolving your skin concerns and helping you to achieve long-term improvements in the health and appearance of your skin.

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Get in touch with us with any questions, pricing, or bookings.

Or give us a call at +65 6769 6007 | WhatsApp us +65 9855 3022

Dr Moses Ng dermatologist

TCA Cross

Renowned for its efficacy in treating icepick and boxcar acne scars, TCA CROSS therapy presents a versatile solution for individuals with varying scar types and severities. With its minimal downtime and low risk of adverse effects, TCA Cross therapy offers a safe and well-tolerated option for individuals seeking significant and lasting improvement in their acne scar appearance. Through personalized consultation and expert guidance, we collaborate with patients to develop tailored treatment plans that align with their unique skin concerns and aesthetic goals.

Related Information:
1. Lee, J.B., Chung, W.G., Kwahck, H. and Lee, K.H. (2002), Focal Treatment of Acne Scars With Trichloroacetic Acid: Chemical Reconstruction of Skin Scars Method. Dermatologic Surgery, 28: 1017-1021. 
2.Yug A, Lane JE, Howard MS, Kent DE. Histologic study of depressed acne scars treated with serial high-concentration (95%) trichloroacetic acid. Dermatol Surg. 2006;32:985–90.
3. Agrawal N, Gupta LK, Khare AK, Kuldeep CM, Mittal A. Therapeutic response of 70% trichloroacetic acid CROSS in atrophic acne scars. Dermatol Surg. 2015;41:597–604.
4. 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;10:51–7.
5.Rullan, P. P., Olson, R., & Lee, K. C. (2020). A Combination Approach to Treating Acne Scars in All Skin Types: Carbolic Chemical Reconstruction of Skin Scars, Blunt Bi-level Cannula Subcision, and Microneedling-A Case Series. The Journal of clinical and aesthetic dermatology13(5), 19–23.