Day 8: Almost of the scabs have fallen off. I continued using antibiotic ointment on the remaining few scabs, but for the rest of my face I used Isotrex gel (0.05% isoretinoin, not available in the US – my mom purchased it in Asia). I don’t have access to a hydroquinone/tretinoin product which is standard, so I ordered some Alpha Hydrox Spotlight Targeted Skin Lightener with 2% hydroquinone, 10% glycolic acid (was on closeout clearance because the company changed their name to Alpha Skincare; the same product is now “Dual Action Skin Lightener“) and am planning to alternate the Isotrex with the Spotlight.
Day 3: Not much change from yesterday. There definitely is some scabbing going on but it’s soft, possibly because I’ve been moisturizing more religiously than the recommended 2x/day. Started washing with a mild cleanser again.
Day 4: Some of the scabs are starting to itch. Absentmindedly scratched my nose this morning and accidentally tore off a scab. Whoops. First day getting out of the house since doing the Cross. Tried covering up the scabs up makeup because I needed to leave the house today, with less-than-satisfactory results in part because after hiding from the sun for a while my skin is now not quite the same shade as my powder foundation or BB cream. When I wash my face now I feel like a couple of the scabs could peel off at any moment.
Day 5: Scabs are itching more and starting to fall off. I had planned to wake up early and get some work done before heading to Ulta to pick up a free sample (magazine coupon for Benefit ka-BROW! gel or BROWVO! primer) but I overslept and then decided I didn’t feel up to facing the world with a scabby peeling face.
Day 6: Briefly forgot about the scabs and accidentally peeled one off when I dried my face a little too roughly. Others are starting to fall off on their own, though, so I’m hoping the one I dislodged was ready to go anyway. Underneath, the scars look pinkish. Some seem more prominent than pre-TCA, which I expected.
Day 7: Most of my scabs are falling off – several came off when I washed my face in her morning and then more came off while I was applying BB cream (because I’m super gentle when washing my face, but gotta apply a little more force/friction to put on sunscreen/makeup). I had to leave the house today and ended up putting on a full face of makeup because the heavier coverage on my cheeks/nose felt odd without fully done eyes/brows.
TCA CROSS (that’s “trichloroacetic acid chemical reconstruction of skin scars”) is a well-established procedure for diminishing the appearance of atrophic acne scars. It originated in Korea, which is surprising to exactly no one given the Korean obsession with perfect skin.
Basically, most acne scarring forms sunken areas in the skin due to damage/loss of collagen. These atrophic scars are further classified as “icepick” (narrow/deep), “boxcar” (wide depressions with steep vertical sides), or “rolling” (rolling/undulating appearance of the skin). TCA causes coagulative necrosis of cells and collagen in the upper layers of the skin which causes sloughing of the damaged layers followed by repair/remodeling from the adjacent non-damaged cells, with increased collagen, glycosaminoglycan, and elastin leading to an increase in dermal volume, reducing the appearance of the atrophic scar.
The technique itself is straightforward: apply high-concentration TCA to the base of a scar until it frosts (reflecting epidermal/dermal protein coagulation and indicating that the TCA has penetrated to the desired depth), cover with an occlusive dressing, then let it heal. Avoid the sun and use some sort of anti-hyperpigmentation regimen, usually hydroquinone + tretinoin.
Still, it’s a procedure with non-negligible risks, chiefly related to the use of TCA (which its MSDS helpfully points out is hazardous to skin). So uh, don’t try this at home? (This is my official statement that I am not recommending that anyone else try this, just documenting what I myself did.)