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), Persistent Redness (caused by history of photosensitivity), Eye Complications (i.e. PubMed(10) Yug A, et al. (7), Since the CROSS technique was developed in 2002, researchers have confirmed its effectiveness in multiple clinical trials around the world. Dermatol Surg. Acne scarring and pore sizes are not changed, but the skin is now able to absorb medicated creams and moisturizers, making these appear less noticeable. Many of these treatments are better suited to treating deep icepick or boxcar scars that are too deep to be effectively treated by chemical peels. - And More, Close more info about 25% TCA Peel and Dermabrasion Significantly Improves Acne Scar Appearance, Evaluation of treatment of acne scars with 25% trichloroacetic acid chemical peel followed by manual dermasanding, Skin Care Products Improve Skin Barrier, Reduce Symptoms of Acne.

The average cost of TCA CROSS is roughly $200 a session as well (source: LA Skin MD). This patient also had a upper & lower blepharoplasty, full face fat transfer and a facelift. Created by Dr. Thomas B. Fitzpatrick in 1975, the Fitzpatrick scale (1-6) reflects the level of melanin pigment in your skin (darker skin types have more melanin). Microneedling Combined With Platelet-rich Plasma Or Trichloroacetic Acid Peeling For Management Of Acne Scarring: A Split-face Clinical And Histologic Comparison. The most common complication is post-inflammatory hyperpigmentation (PIH), but you can reduce your risk of getting it by taking adequate precautions, such as: Finally, it's a good idea to check if you have any of the following conditions: as these may increase your risk of potential complications. PubMed(21) Leheta TM, et al. After a TCA peel, this patient appears rejuvenated and youthful. Hypertrophic scars are created by an excess of collagen production during the acnes healing process and are raised above the skin. Dermatol Surg. This man had complaints of hyperpigmentation along both sides of his face.

Dermatol Surg. Treatment Of Atrophic Acne Scars With Combination Therapy Of Chemical Reconstruction Of Skin Scars Method And Fractionated Nonablative Laser: A Retrospective Analysis. What Kind of Chemical Peel Is Best for Acne Scars? PubMed(3) Anitha B. Chemical peels are divided into three broad categories: light, medium and deep. It is also important to avoid picking the skin layers that are peeling off. However, these peels will never have the same dramatic results as a professional chemical peel. 2014;40(8):825-831. These include skin-lightening agents such as hydroquinone and arbutin. Elsevier(17) Al-Waiz MM, et al. 2018;11(8):21-28. The chemical peel under the eyes and around the mouth provides improvement in the fine wrinkling. Registration is free. TCA was discovered as early as the 1880s (5) and was first documented by Monash (1945) as a potential treatment for acne scars, eczema, and other skin conditions. J Cosmet Dermatol. Al-Hamamy HR, AL-Dhalimi MA, Abtan AF. Following the peel, the fine lines are significantly reduced. J Clin Aesthet Dermatol. Evaluation Of Treatment of Acne Scars with 25% Trichloroacetic Acid Chemical Peel Followed By Manual Dermasanding. Adhering strictly to the pre-care and post-care instructions ensures TCA peels deliver optimal results without compromising your skin health. Cross Technique: Chemical Reconstruction Of Skin Scars Method. (3). - Full-Length Features PubMed(28) Ramadan SA, et al. PubMed(27) Kang WH, et al. Can Chemical Peels Prevent Acne Scarring? An Assessment of the Efficacy and Safety of CROSS Technique with 100% TCA in the Management of Ice Pick Acne Scars. The Journal of clinical and aesthetic dermatology, 10(9), 1223. J Cutan Aesthet Surg. Over time, this allows healthy skin to grow back and fill in the "gaps" of these scars. TCA peels are a widely performed and time-tested method of treatment for acne scars and pigmentation. (10, 11).

PubMed(12) Bhardwaj D, et al. Speak to your dermatologist to understand the risks before proceeding with a TCA peel. Consider the following chemical peel classification table by Gozali et al. To treat ice pick and boxcar scars, TCA can be administered in what is known as the CROSS technique. Register for free and gain unlimited access to: - Clinical Updates, with personalized daily picks for you Dermatol Surg. J Dermatolog Treat. scaring tca Clinical, cosmetic and investigational dermatology, 11, 365372. Topicals that treat post-acne skin issues usually target hyperpigmentation. Is There Any Evidence From Medical Studies?

Percutaneous Collagen Induction Versus Full-concentration Trichloroacetic Acid In The Treatment Of Atrophic Acne Scars. acne scarring moderate scars face treatment grade Therapeutic Response Of 70% Trichloroacetic Acid Cross In Atrophic Acne Scars. It can also be used to reduce the appearance of fine lines and wrinkles around the eyes and mouth. (12, 13, 14). Additionally, its important to only use products from a reputable source and follow all instructions to avoid damaging your skin. Please login or register first to view this content. After having a chemical peel to her lower lids, an endoscopic browlift, upper eyelid surgery, and fat transfers to her lower lids she now looks much younger and brighter. This method is inexpensive and can be used in place of more expense laser treatments, they acknowledged. Kontochristopoulos, G., & Platsidaki, E. (2017).

(3), With proper precautions, research shows that the risk of complications can be minimized, even in darker skin types. PubMed(26) Al-Hamamy HR, et al. If possible, avoid direct sun exposure to achieve the best results. Your use of this website constitutes acceptance of Haymarket Medias Privacy Policy and Terms & Conditions. National Center for Biotechnology Information. PubMed(4) Nikalji N, et al. People with postinflammatory hyperpigmentation are good candidates for chemical peels. The following studies have found that TCA, with or without Jessner's solution, is a very effective treatment for atrophic acne scars, as shown by increased collagen formation and significant improvements in scar severity scores: Next up, the following studies on TCA CROSS highlight the effectiveness of this technique for pitted and ice pick scars: In addition to stand-alone studies on TCA, there's growing evidence that a combination approach with microneedling, subcision, and/or laser therapy yields the best results: Similarly, TCA CROSS has been used in combination therapy: You should be aware of the following potential side effects and complications. Stay tuned for more dermatology-related info and updates! The only peel that penetrates deeper is Baker-Gordon Phenol, which has fallen out of favor due to longer recovery times and a higher risk of complications. For this same reason, it should be avoided by people with dry skin. 2011;37(2):207-216. A more extreme form of hypertrophic scarring is called a keloid, which continues to grow over time. Focal Treatment Of Acne Scars With Trichloroacetic Acid: Chemical Reconstruction Of Skin Scars Method. (9). He had tried many different ways to lighten his hyperpigmentation without results. This helps reduce the downtime as healthy skin cells can migrate to the new wound to speed up the recovery process. J Cutan Aesthet Surg. Deep peels are not generally recommended for acne scarring. While microneedling can also stimulate collagen growth, it may not be as effective for deeper atrophic scars as the needles must penetrate into the papillary (upper) dermis in order to promote wound healing and collagen remodeling. Appearing as dark spots, hyperpigmentation isnt technically a scar but often occurs after an inflammation of the skin such as acne. Dermatol Surg. PubChem Database. Light chemical peels may be sufficient to reverse hyperpigmentation and smooth mild scarring, especially with multiple treatments. In terms of DIY options, lemon juice can be used to lighten hyperpigmentation. Following a combination of dermabrasion, CO2 laser and a chemical peel the pitted scars are much more superficial, and thus much less noticeable. (8), Further studies by Yug et al. Wear sunscreen every day without fail until the skin heals. You're welcome! How Much Does Laser Hair Removal Cost In Hyderabad? Dermatol Surg. Clinics in Dermatology, 35(2), 179182. After a series of light peels with a special formulation, this patient was very pleased with his results. (2015). (3, 4). For scars not treatable with chemical peels, a variety of at-home and in-office alternative procedures are available. PubMed(30) Nofal E, et al. Are There Any Side Effects Or Complications? A dermatologist will recommendchemical peelsmainly when pigmentation issues occur. Available in three different strengths light, medium, and deep, chemical peels treat a variety of common skin concerns such as acne, sun damage, and hyperpigmentation. When applied to the skins surface, this peeling agent helps facilitate the controlled removal of the upper layer of the skin. after the dermabrasion treatments, patients were instructed to use hydroquinone 4% nightly as well as hydrocortisone 1% ointment twice daily for one week. (2008) in the U.S. and Italy, respectively, showed that TCA CROSS produced long-term decreases in acne scar depth and increases in collagen fibers, as seen in skin biopsies and clinical examinations. Adv Wound Care (New Rochelle). The peeling process may continue for a maximum of one week, post the procedure. We hope youre enjoying the latest clinical news, full-length features, case studies, and more.

Avoid sun exposure and apply adequate sunscreen during the day (SPF 30+). Characteristics of an individuals skin, like thickness or texture, may influence the effect of the treatment. Other factors include your skin tone and sensitivity: not all peels are safe for darker skin tones, while sensitive skin generally requires lower concentrations of acids to avoid irritation. First, a skin therapist will thoroughly cleanse the skin to remove any traces of dirt, grime and any skincare and makeup products. Agarwal, N., Gupta, L. K., Khare, A. K., Kuldeep, C. M., & Mittal, A. 1995;32(3):472-478. Good or excellent results were recorded in 100%, 93%, and 66% of patients, respectively. (8). 2008;21 Suppl 3:S29-S32. Therapeutic Response of 70% Trichloroacetic Acid CROSS in Atrophic Acne Scars. There are many OTC chemical peels on the market that you can apply yourself at home, often with good results. How To Protect Skin From The Sun In Summer? Their effectiveness depends on the type and severity of the scarring. The 6 month Skin Rejuvenation Program helps to smooth fine lines, even out the skin color and stimulate collagen. A Practical Approach to Chemical Peels: A Review of Fundamentals and Step-by-Step Algorithmic Protocol for Treatment. Microdermabrasion only provides surface-level exfoliation while IPL is about as expensive as most laser treatments (almost $2,000 after 3 sessions!).

According to RealSelf, the average cost of a full face TCA peel is about $200 a session (source: RealSelf). Copyright 2022 Haymarket Media, Inc. All Rights Reserved Dermatol Surg. However, its possible that no matter what precautions you take, you will still experience acne scarring. Solutions for Signs of Aging in the Lower Eyelids, Schedule a Consultation at The Rejuva Center in Albany, New York. Following combined resurfacing with dermabrasion, CO2 laser and chemical peeling the scars are lighten and much less noticeable. Peels are not suitable for use on the sensitive skin near the eyes. Subcision Plus 50% Trichloroacetic Acid Chemical Reconstruction Of Skin Scars In The Management Of Atrophic Acne Scars: A Cost-effective Therapy.

The chemical peel under the eyes and around the mouth provides improvement in the fine wrinkling. Korean Dermatological Association(33) Ahmed R, et al. Fortunately, chemical peels like trichloroacetic acid (TCA) are one of the best options to improve your scar appearance and promote a healthy-looking complexion. 2015;8(1):42-45. Following the post-procedure instructions, helps ensure faster healing and optimal results. After a stipulated time interval, the therapist will neutralise the peel with the use of cotton pads soaked in water. 2022 The Rejuva Center. - Drug Monographs Now, you know all about TCA peels. While chemical peels cannot treat all forms of acne scars, they can noticeably improve skin texture and appearance for many people. ), Active herpes simplex virus (open cold sores), Sensitive skin or a history of atopic dermatitis, Acne Scars (especially ice pick scars, see TCA CROSS below), Hyperpigmentation (including melasma, dark spots, post-acne marks), Sun Damage (including age spots, scaly patches), Itching, Burning, or Irritation (caused by sensitive skin, high TCA concentration, etc. Take a look at these chemical peel before and after photos that highlight the incredible results you can get from TCA chemical facial peels at The Rejuva Center in Albany, New York. J Cosmet Dermatol. doi:10.1111/jocd.13754, Continuing Medical Education (CME/CE) Courses. Here's an easy (and fun) way to identify your skin type from Game of Thrones: If you have darker skin (III-VI), research shows that you're more likely to experience some side effects including hyperpigmentation, hypopigmentation, demarcation lines, and even further scarring (yes, unfortunately). When administered professionally, TCA is considered a medium peel requiring up to two weeks of downtime.

The information on our website is intended for educational purposes only. If you have severe acne scars youd like to address, a professional chemical peel may be an effective solution. Although chemical peels cant address the hormonal causes of acne, they may help mitigate the damage acne can do to the skin. PubMed(23) El-Domyati M, et al. 2014;3(7):445-464. TCA peels have many benefits that go beyond improving the texture and tone of the skin. (2002) in South Korea showed that the targeted application of high concentration TCA (65% or 100%) led to good or excellent results in 27 of 33 patients in the 65% group (82%) and 30 of 32 patients in the 100% group (94%). Dermatologists use peels of a lower concentration on the face as they involve a lesser downtime. 2014;16(1):8-13. Scores 5 through 9 were considered mild, 10 through 14 were considered moderate, and 15 through 20 were considered severe. Chemical peels involve applying an acid or mixture of acids to the face to remove the top layers of skin, revealing new skin underneath and stimulating collagen growth to improve the skins appearance. due to accidental spillage), Infections (such as reactivation of herpes simplex virus due to picking the skin), Post-Inflammatory Hyperpigmentation (most common in darker skin types), Follow a priming regimen of 2-4% hydroquinone (or a product like, Apply sunscreen religiously before and after the peel, During the peel, apply a touch of Vaseline to the corners of your eyes, nose, mouth, and any particularly sensitive areas, Always start with a lower concentration and work your way up, After using a chemical peel neutralizer and/or thoroughly washing with cold water, apply a sheet mask like this one by, In the following 5-7 days, use your regular moisturizer or cream while your skin peels and new skin cells are pushed up (this is called "re-epithelialization"). In my opinion, this depends on 3 factors: If you have atrophic acne scars (such as rolling, boxcar, or ice pick scars), a TCA peel is an excellent way to remove the damaged scar tissue and stimulate collagen growth.

Trichloroacetic Acid (TCA) is a popular, effective, and highly versatile chemical peel. SA is a beta-hydroxy acid (BHA) that exfoliates the skin while promoting collagen production to improve skin texture. Although the combined treatment of chemical peeling and dermabrasion of the face for treatment of acne scars has been widely accepted since 1972, the efficacy of 25% TCA with dermabrasion has not yet been determined.

The higher the strength, the deeper is the penetration of the peel. TCA or Trichloroacetic Acid is one of the chemical peels commonly used to treat damaged skin. I like to use. 2022 Copyright Derm Collective. 2010;3(2):93-96. SA is more than an acne treatment it can reduce post-inflammatory scarring as well. Combination Therapy In The Management Of Atrophic Acne Scars. The depth of the peel ranges from superficial, medium and deep depending on the percentage of TCA used. This patient appears more youthful and rejuvenated after her peel. It works well for people with oily skin as it temporarily reduces the production of sebum, the oil produced by the skin. A Randomized Controlled Trial.

If, however, you have raised acne scars (such as hypertrophic scars and keloids), TCA might not be as effective since your main problem here is actually excess collagen. The CROSS technique was originally developed by South Korean doctors in 2002 and has been widely proven in the medical literature as an effective and inexpensive method of removing ice pick scars (narrow and deep puncture marks). 2010;3(3):186-188. This man had complaints of hyperpigmentation along both sides of his face. A TCA peel is a simple and effective way to rejuvenate your skins appearance. Single Session Treatment of Rolling Acne Scars Using Tumescent Anesthesia, 20% Trichloracetic Acid Extensive Subcision, and Fractional CO2 Laser. TCA Peel for Acne Scars: Should You Get One?

(2015) (7): Depending on the concentration and number of coats, TCA can be classified as a: In addition, as we'll see later in the medial literature, TCA is increasingly being combined with adjacent therapies (most notably, microneedling) to produce a deeper peel than what would normally be achieved by TCA alone.

This patient complained of looking tired. Options outside of chemical peels can also help fade acne scars. Our specialists will revert to answer all your queries. Now, if you're comfortable with doing a TCA peel or CROSS at-home, you can save a lot on expensive dermatologist visits (because you're really paying for their time and expertise, not the actual material cost of the chemical peel). She will then apply an ointment to help the skin heal faster. doi. 2014;5(1):95-97. Atrophic Acne Scar Treatment Using Triple Combination Therapy: Dot Peeling, Subcision And Fractional Laser. PubMed(15) Nelson BR, et al. Depending on the severity of scarring, they may not be possible to fully eliminate, but improvements can be made. Clin Cosmet Investig Dermatol. The results of this study showed the researchers that a superficial TCA peel followed by manual dermasanding significantly reduces the appearance of acne scars. A deeper physician Strenghth peel was performed on this patient. - Conference Coverage 2020;10.1111/jocd.13754. PubMed(22) Garg S, et al. The patient has evidence of sun damage with fine wrinkling under the eyes and areas of hyperpigmentation (sun spots). For a 10-15% TCA peel for beginners, it costs under $30 for a 1.0 oz bottle which should last (conservatively) at least 10 treatments: For a 20-30% TCA peel for CROSS, it costs less than $60 for 1.0 oz (6 bottles of 0.17 oz) which could last a while depending on how many scars you're treating: I wouldn't be called The Derm Detective if I didn't have any actual evidence. Immediately after undergoing the TCA peel, the skin may appear dry and frosty. (1), For beginners and at-home usage, however, I recommend starting with a 10-15% TCA peel which will provide a similar level of exfoliation as 50-70% glycolic acid. After undergoing the TCA peel, your skin may become more sensitive to the sun for a while. Chemical peels in active acne and acne scars.

Connolly, D., Vu, H. L., Mariwalla, K., & Saedi, N. (2017). While both treatments use the same types of chemicals, licensed clinicians use peels with much higher concentrations than can be sold over the counter (OTC). For comparison's sake, the average cost of microneedling is $100-$200 a session, microdermabrasion is $175 a session, and intense pulsed light (IPL) is $600 a session. The TCA peel improved the appearanc After a TCA peel, this patient appears rejuvenated and youthful. The TCA peel improved the appearance of her aging skin by reducing the fine wrnkles as well as giving her a fresher glow.

Around the mouth it especially targets the vertical furrows around the lips. They are a result of new tissue not being created when the acne lesions healed, and are grouped into three broad categories depending on their appearance. However, contrary to popular belief, rubbing vitamin E on acne scars is unlikely to have any effect.

J Dermatolog Treat. (2018) (1). Dermatologic Surgery, 41(5), 597604. Dr. Williams will often perform cosmetic facial peels in conjunction with other cosmetic procedures. Dr. Williams will often perform cosmetic facial peels in conjunction with other cosmetic procedures. The chemical peel particularly targeted the fine wrinkles around her eyes. Glycolic acid is perhaps the most popular chemical peeland can be used to treat acne scars. You may have heard of "Fitzpatrick skin type" at your dermatologist's office before. J Cosmet Laser Ther. While SA can treat mild scarring, it isnt very effective for deep atrophic scars. Techniques such as microdermabrasion and microneedling may be effective at treating mild scarring. When the solution cools down its action begins. Hypertrophic acne scars, which are not treatable with peels, can be addressed instead with cryotherapy, corticosteroid injections or excision.

J Cutan Aesthet Surg. PubMed (6) Monash, S. The Uses Of Diluted Trichloroacetic Acid In Dermatology. That's why I've summarized 27 medical studies on TCA and TCA CROSS. OTC chemical peels can work in a variety of ways, often involving multiple steps. Do you know they show dramatic results in treating conditions like melasma, superficial acne scars and ageing issues? Tell us a little more about yourself so we can deal with your enquiry. I know I definitely don't want to pay $1,000+ per session for laser treatments when there are more cost-effective options available (source: PlasticSurgery.org). PubMed(25) Deprez P. "Anterior" Chemabrasion For Acne Scars Treatment. For at-home peels, always start with a low concentration (10-15%) and work your way up. PubMed(24) Taylor MB, et al. Acne Scarring-Pathogenesis, Evaluation, and Treatment Options. Acne Extraction: Why Medical Extraction By Dermatologist Is Suggested? PubMed(11) Fabbrocini G, et al. J Cosmet Laser Ther. A TCA peel can be used to treat atrophic scarring along with hyperpigmentation. These cosmetic facial peels stimulate collagen, tighten wrinkles, remove sun spots and improve the texture and tone of the skin. 2014;25(2):130-136. The dermatologist makes this decision before the procedure based on the extent of skin damage and the size of the target area. Indian Dermatol Online J. Do Combined Alternating Sessions Of 1540 Nm Nonablative Fractional Laser And Percutaneous Collagen Induction With Trichloroacetic Acid 20% Show Better Results Than Each Individual Modality In The Treatment Of Atrophic Acne Scars? PubMed(31) Kaur J, et al. - Evidence-Based Guidance These peels can be used to address a wide number of skin issues, including some forms of scarring due to acne. If you wish to read unlimited content, please log in or register below. Number of dermasanding treatments depended on need and consent.

The Effect Of TCA Chemical Peel On Acne Scars. How to perform a Chemical Peel for Acne Scars at Home, Professional Chemical Peels for Acne Scars, Alternatives to Chemical Peels for Acne Scars, https://pubchem.ncbi.nlm.nih.gov/compound/Glycolic-acid, ncbi.nlm.nih.gov/pmc/articles/PMC5749614/, Jowls: Causes, Prevention and How To Get Rid of Them, Puffy Eyes: Causes, Treatments, Home Remedies, and Prevention, Puffy Eyes Causes: Lifestyle, Environmental, Medical (And How to Prevent Them), How to Get Rid of Puffy Eyes: 10 Effective Ways, Plus Dos and Donts, Puffy Eye Creams: How to Pick One That Works for You, How to Get Rid of Puffy Eyes Fast: 5 At-Home Remedies and How Quickly They Work, Rosacea 101: What It Is, Symptoms, Causes and Treatments, Icepick (small, deep, narrow; occur after deep infection), Boxcar (wider, round or oval; caused by collagen loss after breakouts), Rolling (shallow; skin texture appears wavy; caused by fibrous tissues pulling unevenly on epidermis). The 5 patients who had 3 dermabrasion sessions saw a 40% reduction from the post-TCA score (P <.000012). It is a weak alpha-hydroxy acid (AHA) that dissolves the uppermost layer of skin to reveal fresh skin beneath and is safe for all skin types, including dry or sensitive skin. (27+ Studies That Say Yes). These clients do not personally endorse the services or treatments. The procedure involves spot-treating individual depressions in the skin to reconstruct scar tissue. Notice the improvement in the texture, tone and over all brightness of his skin. Dermatol Surg. TCA peels in dermatology come in a range of concentrations between 10% and 50%. The fine wrinkles are reduced, her skin tone is tighter, and skin texture is smoother and softer. OTC products such as gels, pads and wipes can help fade hyperpigmentation and smooth skin texture. Ice-pick scars (a type of acne scars), peri-oral (around the mouth) or peri-orbital (around the eye) pigmentation, freckles, cases of melasma,acanthosis nigricans,which is a velvety texture seen on the skin due to obesity, can also be treated effectively through TCA peels. She has a rich experience of over 11 years in performing advanced laser treatments for hair reduction, skin resurfacing and skin lightening, scar and Read More. The peel the clinician chooses for you will depend on what kind of scarring you have and its severity. 2002;28(11):1017-1021. This acid is recommended for people with darker skin as its slower mechanism of action makes it less likely to cause skin discoloration. PubMed(34) Dalpizzol M, et al. Should You Get A TCA Peel For Acne Scars? This patient sought treatment for acne scarring of the cheeks. PubMed(2) Gold MH, et al. The patient has vertical fine lines radiating out around her mouth. The patient has extensive wrinking under the eyes. Within a week to ten days after the peeling session, you will notice new, softer and radiant-looking skin beginning to appear. Acne scars can be classified as one of two forms: atrophic or hypertrophic. Dr. Williams sees marked improvements in patients skin by combining multiple methods that produce collagen. The pictures displayed here are approved and authorized by few of our actual clients, to be used for reference. 2005;7(4):251-255. (12, 13, 17, 26, 31, 32). Thanks for visiting Dermatology Advisor. Inch Loss Treatment Before & After Results, Know More About Effective Chemical Peel Treatments, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6122508/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4411592/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921757/, Melasma Types, Causes, Symptoms, Treatments and Prevention Tips, What Are Ice Pick Acne Scars Treatments, Cost, Before & After Results, Mens Skin Care Regimen For Healthy & Nourished Skin. 2014;40(8):864-873. The pulsed dye laser targeted her spider veins and rosacea to obliterate the veins and to decrease the redness of her cheeks. J Cosmet Dermatol. Effective Treatments Of Atrophic Acne Scars. Lastly, laser treatments (which includes a variety of lasers) can also treat many forms of acne scarring. Randomized Clinical Trial Of CO Laser Pinpoint Irradiation Technique Versus Chemical Reconstruction Of Skin Scars (CROSS) In Treating Ice Pick Acne Scars. Deep Peeling Using Phenol Versus Percutaneous Collagen Induction Combined With Trichloroacetic Acid 20% In Atrophic Post-acne Scars; A Randomized Controlled Trial. Atrophic scars are indents in the skins surface.