This section of the forum is dedicated to discussions on managing, treating, and correcting acne scarring. (Of note, Dr. Lam is focused principally on acne scarring rather than on managing the ongoing condition of acne, which a dermatologist would be better equipped to address.)
Dear doctor, good day! I just saw another of your video logs, the one on CROSS used for some types of scars. Very very interesting. Wow, those concentrations of TCA are no joke! Thank God I am not a doctor, for my hands are not too steady, me, with those high concentrations of TCA would maybe burn the skin of someone! aghhhh. Glad that there are experts for that like you!!
Just a question on TCA strenghts (and no, I would never use those acids myself ).
I thought (maybe because I never had one of those peels) that TCA was a super strong peel, even with the much lower concentrations that docs usually offer (don't remember which specific concentration, though) for "entire face" peels with it. Maybe because I saw pics of the "crusting" from TCA, but it looked scary at lower concentrations .
Since it has or at least *looks like* it has such a strong impact in how the skin looks for some days, I wonder why TCA is needed in even higher concentrations for TCA CROSS? To be honest I would not trust almost any doc but you, who already have such an experience with it, with using such strenghts on my face I mean, I really wonder if any of the docs I know would have a steady hand and not make a hole in my face with it!
Are the super high concentrations needed because at lower concentrations TCA does not cause enough collagen buildup/formation? Does the skin need a real bad burn/wound for the scar to fill up a bit? or do serial applications of the peels offered by derms - I don't know, at 20% say??- over one same spot get eventually the same result than one 50 or 100% TCA? (taking longer, of course) Or does the skin need strong TCA to have the sort of reaction one is looking for?
If not truly effective for, say, scars, why are lower strenght TCA peels used anyway and called "medium" to strong peels? Do they have any effect, as in "better" than lighter peels with glycolic, mandelic, lactic acid? Do they fill in anything over time or only the CROSS method can get that result?
Just curious, I do not plan using any acid myself nor ask any doc I know to use it!!! I will better wait, in case I ever had it, to have YOU do it. It sounds like stuff that can be good or horrible, depending on whose hands apply it.
Since someone else might have asked this and me not noticed it, do you think it would be a good idea to create a FAQ section, so less of us would post questions already asked?
Here are the answers. There are two things that affect the depth of TCA: strength and the number of applications. In the past before I started plasma resurfacing, I used Jessner's as a pre-peel followed by 3 to 5 layer so 35% TCA. The depth of the peel was contingent upon both the strength (percentage) and number of applications. Most aestheticians only use 10 to 20% TCA because it is much safer and only the OUTER epidermis peels not the main part of the epidermis nor dermis. When I did it, the epidermis and part of the dermis peeled for a medium-depth peel. The 50% TCA has been also used for peeling the skin but has a higher risk of scarring so most people do not prefer to use that percentage.
Now 100% TCA is a whole different animal. Anything above 50% is INTENDED to create scar and not to do a peel. There was a study that compared the effectiveness between 60% and 100% TCA for scarring up the acne scars and the 100% was much better. If I applied 100% over your whole face you would be left with burn scars that would be horrendous. I use it only as a microspot treatment with the tip of a toothpick, at times modified but that is about it. I am trying to create scar tissue in atrophic tissues to bring them up. DO NOT TRY THIS AT HOME!
thanks for the question. sorry it took me a day to respond. i had started half of it here yesterday at work and did not want to have to rewrite it at home last night. best, sml