Acne Scarring

Acne scarring is a common consequence of inflammatory acne and can affect both the appearance and texture of the skin long after active acne has resolved. At our clinic, Professor Firas Al-Niaimi offers a range of evidence-based acne scar treatments tailored to the type and severity of each patient’s scars. One of the most effective treatments for selected scar types is TCA CROSS (Chemical Reconstruction of Skin Scars).

Acne scars develop when inflammation damages the deeper layers of the skin during the healing process. Patients who are still experiencing active acne may first benefit from Acne Treatment before treating the resulting scars. Acne scars are broadly classified as either atrophic scars (loss of tissue) or hypertrophic scars (raised scars). Facial acne scars are most commonly atrophic and are divided into three main subtypes:

• Rolling scars, which create an uneven, wave-like appearance.
• Boxcar scars, which have well-defined edges and a broad, flat base.
• Ice pick scars, which are narrow, deep scars extending into the skin.

TCA CROSS is particularly effective for treating ice pick scars and small boxcar scars, helping to stimulate collagen production and gradually improve skin texture.

TCA stands for trichloroacetic acid, while CROSS stands for Chemical Reconstruction Of Skin Scars. Although trichloroacetic acid is widely used in dermatology at lower concentrations for chemical peels, TCA CROSS uses much higher concentrations (typically 70-100%) applied directly into individual acne scars. This controlled application stimulates the skin’s natural healing response and encourages new collagen formation, leading to progressive improvement in the appearance of acne scars.

The procedure is straightforward and is performed in the clinic. After cleansing the skin with an appropriate antiseptic solution, each scar is gently stretched and a small amount of TCA is precisely applied to the base of the scar using a toothpick or fine-gauge needle. A temporary white appearance, known as frosting, develops within seconds and indicates the treatment has been successfully applied. A protective barrier cream is then applied before detailed aftercare instructions are provided.

Within two to three days, a small scab forms over the treated area and typically falls away naturally within five to seven days. It is important not to remove the scab prematurely and to keep the skin clean and moisturised by applying the recommended barrier cream daily. Initially, the treated scars may appear pink or red before gradually fading as healing progresses.

Because collagen remodelling occurs gradually, improvement develops over several months. Treatments are usually repeated every four weeks, with the total number of sessions depending on the severity, depth and number of scars, as well as the individual’s response to treatment. TCA CROSS is frequently combined with other acne scar treatments to achieve the best possible cosmetic outcome.

TCA CROSS is frequently combined with Microneedling, Fractional Laser, Subcision, and Fillers For Acne Scars to achieve the best possible cosmetic outcome. Depending on the type of scar, Punch Excision For Acne Scars may also be recommended for selected deep scars. Patients with a combination of different scar types often benefit from a personalised treatment plan that combines several techniques to achieve the best results.

Professor Firas Al-Niaimi has published numerous scientific papers on the treatment of acne scars, reflecting his extensive experience and expertise in this field. These publications can be found in the Publications section of this website.