Deep acne scars, such as ice-pick and boxcar scars, can be difficult to treat with conventional methods, often leaving the skin uneven despite multiple procedures. If these narrow, sharply bordered scars have been affecting your confidence, TCA CROSS offers a focused and effective way to rebuild the skin from within. This specialised technique delivers high-strength trichloroacetic acid precisely into each scar, stimulating collagen production and helping the scar gradually rise and soften over time.
At Apax Medical, TCA CROSS is performed with careful precision to ensure the right depth, placement, and healing response. It is commonly combined with other acne scar treatments for more complete improvement, especially in patients with mixed scar types.
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From $340
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TCA CROSS is a specialised technique used to treat deep, narrow acne scars, particularly ice-pick and certain boxcar scars that do not respond well to lasers or resurfacing treatments [1]. The term stands for Trichloroacetic Acid Chemical Reconstruction of Skin Scars. In this method, a high-strength TCA solution is applied precisely into each scar, causing controlled protein denaturation within the scar walls. This stimulates collagen production, skin thickening and gradual elevation of the depressed scar over time.
Because deep ice-pick scars extend into the dermis and sometimes even deeper, conventional treatments often cannot penetrate far enough to remodel them effectively. TCA CROSS allows highly targeted penetration into the scar itself, offering meaningful improvement while keeping downtime low. When performed with the correct concentration and technique, it is a safe and effective option for deep, resistant acne scars.
At Apax Medical, TCA CROSS is performed with precision to ensure the right depth, placement, and healing response for each scar. Dr Moses Ng applies high-strength trichloroacetic acid directly into selected scars using a controlled focal technique, encouraging collagen regeneration from within. This tailored approach allows the treatment to address difficult ice-pick and pitted scars safely while preserving the surrounding skin.
Where appropriate, TCA CROSS may be combined with other acne scar treatments such as subcision, lasers or Rejuran to achieve a more complete improvement for patients with mixed scar types. With more than 15 years of clinical experience, Dr Ng customises each treatment plan to match your scar pattern, skin type, and desired outcome.
Different acne scar types respond to different treatments. TCA CROSS is particularly effective for improving [2]:
Ice-pick scars are the most common type of deep acne scar and because they extend into the dermis, they often do not respond to lasers or resurfacing alone. TCA CROSS offers a focused way to rebuild these scars from within and a customised plan based on your individual scar pattern will help achieve the best results.
Superficial chemical peels, such as AHAs, BHAs and Jessner’s solution work by exfoliating the surface layers of the skin [3]. They improve texture, brightness and pigmentation but cannot reach the deeper layers where ice-pick and deep boxcar scars originate.
Deep acne scars require targeted collagen stimulation at the base of each scar, which a full-face peel cannot safely achieve. Using high-strength TCA over the entire face would be both impractical and unsafe due to the risk of over-penetration. TCA CROSS overcomes this by applying a controlled amount of high-strength TCA directly into individual scars, allowing precise remodelling without affecting the surrounding skin [4]. This makes TCA CROSS a safe and effective option for deep, resistant acne scars.
After TCA CROSS is applied, the high-strength acid causes controlled protein denaturation within the scar tissue. This triggers a natural wound-healing response in the epidermis and dermis. Over the next few weeks, the treated area renews as new skin cells form, while deeper layers begin reorganising and producing fresh collagen and elastin. Gradually, this leads to thickening of the dermal layer and a gentle rise in the depth of the scar.
Histological studies have shown that TCA CROSS activates fibroblasts, the cells responsible for producing collagen, and increases both epidermal regeneration and dermal collagen content. These changes occur progressively over several months, contributing to visible improvement in deep, pitted scars.
TCA CROSS offers several advantages for treating deep, resistant acne scars, providing focused improvement with minimal disruption to the surrounding skin.
Different applicators can be used for TCA CROSS, and each offers its own advantages. The syringe technique involves dispensing a controlled amount of TCA through a fine needle, allowing faster application [6]. However, it can be more difficult to regulate the flow on very small scars and carries a slightly higher risk of unintended spreading.
In contrast, the toothpick or wooden applicator method provides excellent control when treating deep, narrow ice-pick scars, making it easier to deliver TCA precisely into the base of each scar. Although this approach may take slightly longer, it offers consistent accuracy and predictable results.
At Apax Medical, patient safety and precision always take priority. Both methods can be effective, and the choice of technique depends on scar type, treatment goals, and clinical judgement.
| Type of Tip | Advantages | Disadvantages |
| Wooden Applicator | Offers precise control over TCA flow and placement | Slightly longer treatment time |
| Syringe with Needle | Faster application for multiple scars | Harder to regulate TCA flow; higher chance of unintended spread |
Frosting at the treated spots may remain visible for up to 12 hours, followed by redness and mild swelling for 24–48 hours. A small scab will form within a few days and typically sheds naturally within 3–7 days. It is important not to pick the scab, as doing so may lead to delayed healing or scarring.
Apply the prescribed antibiotic ointment until healing is complete, and avoid sun exposure to minimise the risk of pigmentation around the treated areas.
The number of sessions depends on the severity and depth of your scars, as well as your individual healing response. Most patients require 4–8 TCA CROSS sessions over a period of 3–6 months to see meaningful improvement. Treatments are usually spaced about 6 weeks apart to allow proper healing and collagen remodelling.
TCA CROSS is generally safe and well-tolerated. Some individuals may experience temporary redness or swelling, mild colour changes (hyperpigmentation or, rarely, hypopigmentation), or slower-than-expected improvement if collagen stimulation is limited. Infection is uncommon.
For Asian skin types, strict sun protection is especially important to reduce the risk of temporary darkening at the treated sites.
TCA CROSS is frequently combined with other acne scar treatments to achieve more complete and balanced results. Deep scars often require different methods of correction and a multimodal approach helps address the full range of scar types more effectively. For mixed acne scarring, the Acne Scar Removal Program at Apax Medical provides a structured treatment plan that sequences procedures appropriately. Typically, deeper scars are treated first, followed by fractional resurfacing to refine overall texture.
| TREATMENT | PRICE |
| TCA CROSS | from $340 |
| Cannula Subcision | from $480 |
| Fractional Pico Laser | from $599 |
| Fractional CO₂ Laser | from $499 |
| Rejuran S | from $500 |
| Injection Steroids | from $200 |
These prices serve as a general guide. During your consultation, Dr Ng will assess your scar type and recommend a personalised treatment plan based on the severity and combination of procedures required.
TCA CROSS is a focused and effective method for treating deep ice-pick and pitted acne scars that do not respond well to other procedures. By delivering controlled high-strength TCA directly into each scar, the treatment stimulates collagen production and helps the scar gradually lift over time. With careful technique and a personalised treatment plan, TCA CROSS can offer meaningful improvement, especially when combined with complementary therapies for mixed scar types.
If you are looking for a precise and reliable approach to improve the appearance of deep acne scars, schedule a consultation with Dr Moses Ng to explore the most suitable TCA CROSS treatment plan for your skin.
Yes, it can be safely performed on darker skin when applied precisely to individual scars. Strict sun protection is important to reduce the risk of temporary pigmentation.
Those with active acne, very sensitive skin, unrealistic expectations or a history of keloids may not be suitable. A consultation helps determine appropriateness.
TCA CROSS starts from $340 per session. The total cost depends on the number of scars, severity and whether it is combined with other treatments.
Most patients require 4–8 sessions spaced about six weeks apart, depending on scar depth and individual healing response.
Temporary redness, mild swelling and scabbing are expected. Transient hyperpigmentation may occur, especially in darker skin, but usually resolves with proper care.
Redness and swelling settle within 1–2 days, followed by scabbing that naturally sheds within a week. Normal activities can be resumed quickly with sun protection.
Improvement becomes noticeable over several weeks as collagen forms, with continued progress for three to six months after each session.
Results vary, but most patients see a visible softening and lifting of deep ice-pick or pitted scars. Combining TCA CROSS with other treatments often enhances overall outcomes.
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.
Dr. Moses Ng
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.
Dr. Moses Ng is a distinguished professional in the field of aesthetic medicine, renowned for his expertise in advanced cosmetic procedures. With over 15 years of experience, extensive training and a keen eye for detail, Dr. Ng specializes in a wide range of treatments, including injectables, laser therapies, and acne scar management.
Dr. Moses Ng’s commitment to excellence and patient-centric approach have earned him a reputation as a trusted clinician in aesthetic medicine. His continuous pursuit of the latest advancements in the field ensures that his patients receive the highest standard of care and the most effective treatments available.
