What it is
TCA CROSS (Chemical Reconstruction of Skin Scars) is a specialized chemical peel technique used to treat deep, narrow acne scars, particularly ice-pick scars. The treatment involves the focal application of high-concentration trichloroacetic acid (TCA) directly into the scar using a fine applicator, such as a toothpick or micro-needle tip.
Unlike traditional chemical peels, which cover larger areas of skin, TCA CROSS targets only the scar itself, stimulating new collagen production and causing the scar tissue to gradually fill in and smooth out.
Types of scars best treated with TCA CROSS include:
- → Ice-pick scars: deep, narrow, V-shaped scars
- → Boxcar scars (deep and small): sharp-edged depressions
- → Resistant scars that do not respond to laser or microneedling
Korean dermatologists are known for their expert precision in TCA CROSS, often combining it with other treatments such as subcision, microneedling, or lasers for comprehensive results.
Why it’s Done
TCA CROSS is widely chosen for its effectiveness on deep scars that most other treatments struggle to improve.
➤ Medical Reasons
- • To stimulate collagen remodeling in scarred areas
- • To create a controlled wound that triggers natural healing
- • To reduce the depth and sharpness of acne scars
➤ Cosmetic Reasons
- • Significantly improves the appearance of deep ice-pick scars
- • Restores smoother, more even skin texture
- • Helps achieve the K-beauty ideal of clear, flawless skin
- • Can be combined with other treatments for a multi-dimensional approach
➤ Psychological Benefits
- • Boosts self-esteem by reducing visible scars
- • Encourages a more youthful and confident appearance
- • Reduces anxiety or self-consciousness linked to acne scarring
👉 In Korea, patients choose TCA CROSS because it’s a targeted, effective, and affordable solution for stubborn acne scars.
Alternatives
While TCA CROSS is excellent for deep scars, there are alternatives depending on the scar type and patient preference.
➤ Topical Alternatives
- • Retinoids → promote skin renewal and superficial scar improvement
- • Vitamin C and niacinamide → reduce pigmentation but have minimal effect on deep scars
- • Scar creams with silicone or onion extract → best for surface-level scars
➤ Procedural Alternatives
- • Laser resurfacing (CO₂, Fraxel, Er:YAG) → improves overall texture but less effective on very deep scars
- • Subcision → releases fibrotic bands under rolling or boxcar scars
- • Microneedling or RF microneedling → stimulates collagen remodeling for shallow scars
- • Dermal fillers → temporarily fill depressed scars
- • Punch excision/grafting → surgically removes or replaces deep scars
⚠️ For deep ice-pick scars, TCA CROSS is often considered the gold standard treatment.
Preparation
Proper preparation helps ensure safety and effectiveness.
➤ General Preparation
- • Consultation with a dermatologist to confirm scar type and treatment suitability
- • Discontinue retinoids, exfoliants, or harsh skincare at least 5–7 days before
- • Avoid tanning, sun exposure, or recent chemical peels
- • Keep skin well-hydrated
- • Avoid blood-thinning medications if combined with subcision or fillers
➤ Specific Preparation in Korea
- • Patch test or sensitivity assessment may be done
- • Some clinics recommend starting with pre-treatment creams (like hydroquinone) to minimize post-inflammatory pigmentation risk
- • Application of numbing cream before the procedure, though many patients tolerate TCA CROSS without anesthesia
How it’s Done
TCA CROSS is a quick in-clinic procedure, usually lasting 15–30 minutes, depending on the number of scars.
Step-by-step process:
- → Skin cleansing: The area is cleaned and disinfected.
- → Targeted application: High-concentration TCA (50–100%) is applied directly into the scar pit using a toothpick or fine applicator.
- → Controlled frosting: The scar area turns white (“frosting”), indicating protein coagulation.
- → Healing phase: The treated scar undergoes controlled injury, stimulating collagen production.
- → Repetition: Multiple sessions (typically 3–6 sessions, spaced 4–6 weeks apart) are required for significant improvement.
Combination treatments in Korea:
- • TCA CROSS + Subcision → releases tethered scars and rebuilds from the bottom up
- • TCA CROSS + Laser Resurfacing → improves both depth and surface texture
- • TCA CROSS + PRP or Rejuran Healer → accelerates healing and reduces downtime
Recovery
Recovery is usually straightforward but requires careful skin management.
➤ Immediate Recovery (1–3 Days)
- • Redness and swelling around treated scars
- • White frosting turns into scabbing or crusting
- • Mild stinging or tightness may be felt
➤ Short-Term Recovery (1–2 Weeks)
- • Crusts naturally fall off in 5–10 days
- • Treated area may look darker temporarily
- • Gradual improvement as new collagen forms
➤ Long-Term Care
- • Strict sun protection (SPF 30–50) is essential
- • Use gentle cleansers and fragrance-free moisturizers
- • Avoid picking or scratching scabs to prevent hyperpigmentation
- • Results continue to improve over 3–6 months as collagen remodeling progresses
👉 Most patients can return to normal activities immediately, though downtime for redness and scabbing should be expected.
Complications
TCA CROSS is safe when performed by experts, but side effects can occur.
➤ Common Side Effects
- • Temporary redness, stinging, or swelling
- • Formation of scabs and crusting
- • Mild hyperpigmentation (darkening) in treated areas
➤ Moderate Risks
- • Prolonged pigmentation changes, especially in darker skin types
- • Uneven skin tone if aftercare is not followed
- • Small chance of scar worsening if applied incorrectly
➤ Rare Complications
- • Infection from improper hygiene
- • Hypopigmentation (light spots) in sensitive patients
- • Persistent redness or texture irregularity
👉 In Korea, dermatologists minimize risks by using precise application techniques, strict sterilization, and post-treatment pigmentation control protocols.
Treatment Options in Korea
Korea is a top destination for acne scar treatments, including TCA CROSS, thanks to its combination therapy approach and skilled dermatologists.
➤ Popular TCA CROSS Combinations in Korea
- • TCA CROSS + Subcision + Filler → releases, fills, and resurfaces scars
- • TCA CROSS + CO₂ Laser → dual treatment for depth and texture
- • TCA CROSS + PRP or Rejuran Healer → enhanced healing and collagen stimulation
- • Customized multi-session programs → clinics tailor treatment for each patient’s scar type
➤ Why Patients Choose Korea
- → Expertise: Dermatologists with extensive acne scar revision experience
- → Innovation: Advanced combination therapies for faster, better results
- → Affordability: Lower cost compared to Western countries, with equal or higher quality
- → Medical tourism: Clinics cater to international patients with English support and recovery packages
