Ice pick type
A deep depression with a narrow opening. This is the main target of TCA CROSS.
TCA CROSS
TCA CROSS
TCA CROSS
for deep acne scars
TCA CROSS applies trichloroacetic acid precisely to selected ice-pick and small boxcar acne scars.
Content
CONCERNS
TCA CROSS may be considered for
TCA CROSS may be considered for
Locally treats narrow and deep acne scars that are difficult to change with skin surface care.
01A dent that looks like a needle prickThe entrance is narrow and continues deep inside.
02Small rimmed depressionThe bottom and outline of the depression can be distinguished
03Partial acne scarsI am concerned about the limited depression between the eyebrows and cheeks.
04Deep scars left after treatmentDot-like depressions remain after treatment on the surface
05I don't know my scar typeI would like to discuss the differences between TCA, RF, and peeling.
06I want to narrow down the area and treat it.I want to treat the dents that bother me one by one.
SCAR TYPES
Acne-scar treatment depends on the shape of each depression
Acne-scar treatment depends on the shape of each depression
Multiple types may coexist within the same face. The TCA CROSS is selected in a shape that allows the drug to be confined to the inside of the dent.
Small boxcar type
A small depression with a distinguishable edge and bottom. Treatment is selected according to its shape and depth.
Rolling type
A wide, gentle depression with subcutaneous adhesions. Subcision or another adhesion-release treatment may be considered.
ABOUT TCA CROSS
What is TCA CROSS?
Select the target depression
Check the entrance, depth, and edge
Apply TCA focally
Confined to the base and inner walls
Allow the area to heal
Frosting followed by crusting
Reassess the scar shape
Compare the depression under consistent conditions
FOCAL CHEMICAL RECONSTRUCTION
To the bottom and inner wall of the depression,
To the bottom and inner wall of the depression,
Apply TCA in dots
TCA CROSS is a treatment in which trichloroacetic acid (TCA) is applied topically to the pits of acne scars. Unlike peels, which apply a wide area to the surrounding flat skin, deep dents are treated one by one.
The drug reaction triggers the rebuilding of scar tissue during the healing process. We adjust the concentration and number of treatments while looking at the shape and depth of the dent, history of post-inflammatory hyperpigmentation, and previous reactions.
- Select ice pick type or small boxcar type
- Treat in spots, avoiding surrounding normal skin
- Plan the next session according to scar shape and skin color after healing
Studies have reported improvement mainly in the ice pick type, but there are variations in study size and treatment conditions. It is not a treatment that will make the dent disappear in one session.
TREATMENT CHOICE
Select treatment according to the cause of each depression
Select treatment according to the cause of each depression
Depth, width, and subcutaneous adhesions are not the same. We will divide the roles of multiple treatments as necessary.
TCA CROSS
- Primary target
- Narrow and deep ice pick type, small boxcar type
- Treatment role
- Dot treatment on the inside of the dent
- Main reactions
- Frosting, crusting, redness, pigmentation
Subcision
- Primary target
- Rolling type with subcutaneous adhesions
- Treatment role
- Release firm fibrous adhesions beneath the skin
- Main reactions
- Swelling, bruising, pain
POTENZA PRIME
- Primary target
- Wide range of shallow unevenness, pores and texture
- Treatment role
- Broad radiofrequency treatment of the dermis
- Main reactions
- Redness, swelling, petechiae, crusting
TriFill Pro
- Primary target
- Dents with hard edges and local adhesions
- Treatment role
- Localized adhesion release and drug delivery
- Main reactions
- Swelling, bruising, punctate crusts
Applicability is determined by examining the shape and depth of the dent, active acne, skin condition, and treatment history.
CASE
TCA CROSS case
Direct English rendering of the Japanese text in the retained source image, in visual reading order (top to bottom and left to right within each row; Before/After panels and arrows remain in the image): TCA CROSS clinical case. Image order: Before at the initial visit → after TCA CROSS → five months after treatment. The patient was concerned about depressed acne scars between the eyebrows. Treatment: one session applying TCA CROSS to 20 points, together with ZO Skin Health high-concentration vitamin A. At five months, the depressions were less noticeable.
GLABELLAR ACNE SCARS
To the deep depression between the eyebrows
To the deep depression between the eyebrows
TCA CROSS 20 places once
We selected the ice pick-shaped and small boxcar-shaped depressions that gather between the eyebrows and applied TCA CROSS to 20 locations. Five months later, scar contours and shadows are compared after the initial pinpoint redness resolved.
In this case, high-concentration topical vitamin A was also used. The photo does not show the effect of TCA CROSS alone.
- Treatment details
- TCA CROSS 20 places/once, combined with high-strength topical vitamin A treatment
- Photography period
- Before treatment, after treatment, and after 5 months
- Cost
- TCA CROSS up to 20 locations ¥22,000 (tax included)
- Main risks
- Stinging pain, frosting, redness, swelling, crusting, pigmentation, depigmentation. In rare cases, infection, chemical burns, enlarged dents and worsening of scars.
CASE GALLERY
TCA CROSS case photographs by facial area
TCA CROSS case photographs by facial area
These are cases where the skin has different thicknesses and curves, such as the forehead, between the eyebrows, cheeks, temples, and around the nose. We identify the entrance of the dent and perform needling and apply TCA only to the selected scar.
Direct English rendering of the Japanese text in the retained source image, in visual reading order (top to bottom and left to right within each row; Before/After panels and arrows remain in the image): TCA CROSS clinical case. Panel order: Before → After. This source creative prints no treatment count, elapsed interval, fee, or risk statement; those details are provided in its linked case article and the surrounding page section.
FOREHEAD / GLABELLA
Forehead/Glabella
Instead of spreading it over the entire surface, select the ice-pick scars with a narrow, deep opening.
Direct English rendering of the Japanese text in the retained source image, in visual reading order (top to bottom and left to right within each row; Before/After panels and arrows remain in the image): TCA CROSS clinical case. Panel order: Before → After. This source creative prints no treatment count, elapsed interval, fee, or risk statement; those details are provided in its linked case article and the surrounding page section.
INNER CHEEK
Cheek near the nose
Stretch the skin to check the entrance of the depression and limit the treatment area to deep punctate scars.
Direct English rendering of the Japanese text in the retained source image, in visual reading order (top to bottom and left to right within each row; Before/After panels and arrows remain in the image): TCA CROSS clinical case. Panel order: Before → After. This source creative prints no treatment count, elapsed interval, fee, or risk statement; those details are provided in its linked case article and the surrounding page section.
OUTER CHEEK / TEMPLE
Outer cheek/temple
Choose a small boxcar type and reserve other treatments to wide adhesions or shallow irregularities.
Direct English rendering of the Japanese text in the retained source image, in visual reading order (top to bottom and left to right within each row; Before/After panels and arrows remain in the image): TCA CROSS clinical case. Panel order: Before → After. This source creative prints no treatment count, elapsed interval, fee, or risk statement; those details are provided in its linked case article and the surrounding page section.
CHEEK
Multiple punctate scars
Even if there are a large number of dents, we will avoid normal skin and treat the selected dents individually.
Direct English rendering of the Japanese text in the retained source image, in visual reading order (top to bottom and left to right within each row; Before/After panels and arrows remain in the image): TCA CROSS clinical case. Panel order: Before → After. This source creative prints no treatment count, elapsed interval, fee, or risk statement; those details are provided in its linked case article and the surrounding page section.
TEMPLE / CHEEK
From temple to cheek
After the scab and redness have subsided, recheck the depth and consider only the remaining dents for the next treatment.
Direct English rendering of the Japanese text in the retained source image, in visual reading order (top to bottom and left to right within each row; Before/After panels and arrows remain in the image): TCA CROSS clinical case. Panel order: Before → After. This source creative prints no treatment count, elapsed interval, fee, or risk statement; those details are provided in its linked case article and the surrounding page section.
NOSE
Nose and perinasal area
Taking into account the curved surface and skin thickness, TCA and needling are performed precisely in a narrow area.
About case photos Photos are a comparison before and after treatment. There are individual differences in treatment effects, healing period, and course of redness and pigmentation. The main risks are irritating pain, frosting, redness, swelling, crusting, post-inflammatory hyperpigmentation, depigmentation, and rarely infection, chemical burns, enlarged pits and worsened scarring. The cost is ¥22,000 (tax included) for up to 20 TCA CROSS locations.
View cases and treatment ideas in columns (Japanese page)
OUR TCA CROSS
Characteristics of our clinic's TCA CROSS
In addition to carefully applying high-concentration TCA, a plastic surgeon will identify the entrance, depth, and adhesions of the dent, and perform everything from treatment to protection and next treatment selection as a single plan.
Classify dents using frontal and diagonal light
In addition to the width of the entrance, the shadow at the bottom, and the angle of the edge, assess changes when the skin is stretched and check for subcutaneous adhesions.
Fine needling for selected scars when needed
In addition to just placing the drug, the doctor checks the entrance and depth one by one, performs fine needling in the necessary depressions, and then applies TCA.
Confined high-concentration TCA application that avoids normal skin
Place a small amount on the bottom and inner wall of the selected depression, making sure not to spread it onto the surrounding flat skin. Concentration and number of treatments are adjusted based on depth and previous reaction.
Protect the treated area with AirWall film
During the transition from frosting to scabbing and redness, AirWall film protects the treated skin and reduces UV rays, makeup contamination, and friction.
Select the next treatment after healing
After the surface has stabilized, compare the dents and color tone under the same conditions, and select the addition of TCA, POTENZA PRIME, subcision, etc. according to the remaining shape.
FLOW
TCA CROSS treatment flow
- 01
Examination/confirmation of scar type
We will check for the presence of active acne or dermatitis, the shape and depth of the depression, treatment history, and history of pigmentation.
- 02
Face washing/Photography/Marking
Remove sebum and makeup and take a photo with frontal and oblique light. Select the dents to be treated one by one.
- 03
Needling when required and confined TCA application
Perform fine needling to the selected depression, apply TCA little by little to the bottom and inner wall, and check for white change.
- 04
Protection with AirWall film
Protect the treated area with AirWall film, reducing UV rays, makeup contamination, and friction. We will also guide you on how to stop and restart your face wash and topical medications.
- 05
Re-evaluation after healing
After the scab and redness subside, we compare the dents under the same conditions and decide on the method and timing of additional treatment.
PRICE
TCA CROSS fees
TCA CROSSFree medical treatment
Up to 20 locations22,000Yen (tax included)
Additional charges may apply if examinations, topical products, or combination treatments are required. Please check the price list for the latest prices before making a reservation.
TREATMENT DETAILS
Treatment overview and precautions
Treatment timeDepends on the number of treatments. The required time, including examination and preparation, will be informed at the time of reservation.
AnesthesiaIt is usually performed without anesthesia. Cooling etc. will be applied depending on how the pain is felt and the scope of treatment.
After treatmentFrosting, redness, and dotted crusts occur. At our clinic, we protect it with an air wall. Do not forcefully remove the scab and avoid exposure to UV rays and friction.
Number of times/intervalIt may be performed multiple times depending on the depth of the dent and healing response. I will consider the next treatment after the previous skin reaction has subsided.
Face wash/makeupDepends on the condition of the treated area. On the day of your procedure, please follow the instructions provided at the hospital.
Main risks and side effects
- Irritating pain, burning sensation, frosting
- Redness, swelling, crusting, dryness
- Post-inflammatory pigmentation, hypopigmentation
- In rare cases, infection, delayed healing, chemical burns, enlarged dents, worsened scarring
Conditions in which treatment should be postponed or treated with caution
- Active acne, infection, or severe dermatitis
- There is a wound or sore in the treated area
- Scabbing, redness, and pigmentation reactions from last time remain.
- Keloid constitution, pregnancy/lactation, oral or topical medication, etc.
Self-pay treatment and medications used
TCA CROSS is not covered by Japan's public health insurance. The TCA used in this treatment is not a drug approved in Japan intended for acne scar treatment. It is used under the responsibility of the treating physician. We will explain the drug's acquisition route, domestic approval status, whether or not there are domestically approved products with the same ingredients, and safety information in other countries during your consultation. If you use unapproved medicines, etc., you may not be eligible for the Japan's Relief System for Sufferers from Adverse Drug Reactions.
FAQ
TCA CROSS FAQ
Which acne scars are suitable for TCA CROSS?
The main candidates are an ice pick type with a narrow and deep entrance, and a small boxcar type that allows the drug to be confined to the bottom and inner walls. Consider other treatments for wide rolling dents or dents that are mainly caused by adhesions.
How painful is TCA CROSS?
There may be spot-like irritation or a sensation of heat when applied. Cooling etc. will be applied depending on the treatment area and how the pain is felt.
How long will the redness and scabs last after TCA CROSS?
The treated area will turn white and then form a dotted scab, which may fall off naturally in about a week. Subsequent redness and pigmentation may last for weeks to months.
Can TCA CROSS be completed in one session?
You may feel a change after just one session, but depending on the depth of the dent and your reaction, you may need to do it multiple times at intervals. Each time, we look at the shape and color after healing and decide on the next treatment.
Can I apply makeup after TCA CROSS?
Guidance will vary depending on the condition of the treated area. Do not rub the scab, moisturize and protect yourself from UV rays, and follow the clinic's instructions for washing your face and applying makeup on the day of the procedure.
How much does TCA CROSS cost?
The fee is ¥22,000 (tax included) for up to 20 locations. Additional charges may apply if consultation, combined treatments, or topical products are required.
CONSULTATION
From treatment that fits the dent,
From treatment that fits the dent,
Organize together
Acne scars are not limited to one type. We will examine the dents that are suitable for TCA CROSS, and depressions better suited to subcision or radiofrequency treatment, and suggest a reasonable order.
Direct English rendering of the Japanese text in the retained source image, in visual reading order (top to bottom and left to right within each row; Before/After panels and arrows remain in the image): Two physicians from Minato Motomachi Beauty and Plastic Surgery Clinic stand on either side of the clinic emblem. The only words printed in the image are the English wordmark “NIE CLINIC,” centered below the emblem; there are no Japanese labels, numbers, comparisons, or arrows in this photograph.
MEDICAL REVIEW
Writing/Medical confirmation
Ie Nie, MD
Board-certified plastic surgeon, Japan Society of Plastic and Reconstructive Surgery
Drawing on experience treating scars, we plan treatment while checking the shape of acne scars and the healing response.