Dr. Sam Lam Plastic Surgery Forum

I am a 30 year old caucasian woman and recently received TCA CROSS treatment for one deep icepick scar and a few barely noticable scars in Korea. The Doctor recommended 10 treatments for a near 100% improvement, unfortunately I could only get 5 treatments and then I was transferred to Germany. I've been delighted with the results. The Korean Doctor told me that he had changed the one bad icepick scar into more of a rolling scar and I'm now a good candidate for laser treatment. I have seen your 'youtube' videos and I know you do not recommend laser treatment as a good solution to scarring. My question is should I continue with the TCA CROSS treatment in Germany? Or do you think that the mild scarring I have now (it's only a small area on one cheek) would benefit from laser?

in general, i am not a big fan of laser for acne scarring as you have correctly read. if you are happy i would leave it because CROSS is very technique dependent. i would only go to someone experienced doing it. those are my thoughts. you can make it worse if you don't know what you are doing. if you find someone who is good, then have that person make the appropriate recommendations. hope that helps a little.
best,
sml

Hi Dr Lam,

A few clarifications re: TCA cross.
1. does it really form a scab? or is it better that there is no scab? how to prevent the forming of the scab?
2. i read in some forums that there is usually a scab and once it falls off, the treated pit is redder and looks worse. is this the rule or the exception?
3. how long is the usual downtime?
4. does sun exposure inhibit collagen formation or is only more on the risk of hyperpigmentation?
5. what is the best topical to be used post-crossing and when should it be applied?

thank you

1. does it really form a scab? or is it better that there is no scab? how to prevent the forming of the scab?
THE SCAB IN MY OPINION IS NOT CRITICAL. IT TYPICALLY ONLY OCCURS WHEN A LARGER AREA IS TREATED. PINPOINT AREAS KEPT MOIST TYPICALLY DO NOT SCAB BUT STILL MAY. THE SCAB SHOULD NOT BE READ AS A NEGATIVE OR A POSITIVE.
2. i read in some forums that there is usually a scab and once it falls off, the treated pit is redder and looks worse. is this the rule or the exception? AGAIN, THE SIZE OF THE AREA AND HOW LONG THE PRODUCT WAS LEFT ON WILL MATTER. IT IS NEITHER THE EXCEPTION NOR THE RULE. YES, IT WILL LOOK REDDER WITH OR WITHOUT SCAB FORMATION BUT MUCH MORE COMMONLY WITH SCABBING.
3. how long is the usual downtime?
WITHOUT SCABBING AND REDNESS OR LATER HYPERPIGMENTATION, IT CAN BE LESS THAN A WEEK. IF THERE IS SCABBING IT CAN BE A COUPLE OF WEEKS. IF REDNESS OR PIGMENTATION PERSISTS, IT CAN BE SEVERAL MONTHS. IN DARKER SKIN PATIENTS, BLEACHING PRODUCTS MAY BE NEEDED WHICH I TYPICALLY USE ONLY AFTER THE LAST ROUND IF I AM SEQUENCING SOMEONE MORE RAPIDLY THROUGH A FEW ROUNDS LIKE ONCE A MONTH.
4. does sun exposure inhibit collagen formation or is only more on the risk of hyperpigmentation?
HYPERPIGMENTATION IN MY OPINION.
5. what is the best topical to be used post-crossing and when should it be applied?
DOES NOT MATTER. I LIKE AQUAPHOR OR VASELINE. IF SOMEONE HAS A REACTION, THEN CRISCO IS EVEN MORE HYPOALLERGENIC BUT IT IS A BIT NASTY TO USE.
hope that helps.
best,
sml

Thank you for the prompt response, Dr Lam.

Btw, a few more queries:

1) Is TCA cross really the best treatment for ice pick scarring?
2) Can it be performed more than 6 times because the Korean study only had 6 sessions max?
3) Does the TCA cross itself help build the collagen or is it also better to use collagen-building serum like EGF or Centella Asiatica (Gotu Kola)?
4) Does it work on chicken pox scarring?

Thank you!!

1) Is TCA cross really the best treatment for ice pick scarring?
for small little picks, in my opinion absolutely the best.

2) Can it be performed more than 6 times because the Korean study only had 6 sessions max?
i am sure that it can. in my opinion if i cannot get it done in 5, i stop because i think a technology only has so much to give in terms of collagen growth. i think there is probably a risk of scarring if you push it too many times. obviously, that is a case by case basis.
3) Does the TCA cross itself help build the collagen or is it also better to use collagen-building serum like EGF or Centella Asiatica (Gotu Kola)?
i do not believe that any serum will help acne scarring. even a light chemical peel is a joke. you need 100% CROSS done by a trained professional with tons of experience. anyone else or anything else either will fail or carry undue risk.
4) Does it work on chicken pox scarring?
yes, most types but i would have to see it. i have used it successfully on these types of scars.

Thanks Dr Lam! Very informative indeed. But how small are "small little picks"? is it possible that it works also on small boxscars? Will the result of the cross result to complete disappearance of some scars? What do you think of CIT or needling as a scar treatment?

Many thanks!

small is all relative. 1-2 mm. yes, it can work on boxscars. there is never such thing as complete disappearance when discussing acne scars. as soon as you get that out of your head, then they can be treated. acne scar corrections are always disappointing if the end point is "disappearance". improvement is the watchword. i think CIT may help but i have found it frustrating. possibly only as a small adjunct.

Thank you for your honest answers. I do believe you are one of the most honest doctors around. I also don't believe people when they say 100% disappearance of the scars because it is almost impossible. maybe 80-90% is more feasible. I hope to have a consult with you when I have the free time. Thank you.

by the way, dr lam, you said in some of the threads on cross that it is best to wait for 2-3 months in between crossing minor scars. does collagen still grow within that period? when the cross is done, how far does it go below the skin when pressing hard? thanks!

yes, when it is minor i wait because collagen takes 90 to 120 days to grow so i do not want to overtreat it. i have no idea how deep it goes but the trick is that the dermal layer builds up not the subcutaneous fat since fat is not where the collagen is. when there is a dip in the fat, like a big hole in the face, then i use silicone since silicone replaces the lost fat.

Hi dr lam! So even if the treated areas aren't pink anymore, but instead look normal already, the collagen still continues to grow? Thanks.

typically yes. collagen grows over 2 to 4 months period of time.