CROSS is a technique using high concentrations of trichloroacetic acid (TCA) or lower case of Phenol acid focally into the acne scars depressions to induce inflammation, which is then followed by new collagen formation. This can lead to reduction in the appearance of scars and an overall cosmetic improvement.

  • Ice pick and box scars need CROSS and a (Laser or Microneedling) resurfacing treatment.
  • Rolling scars need (Subcision) and CROSS.

TCA or Phenol, applied at a very high concentration stimulates collagen formation from the bottom of a deep acne scar. This collagen formation is gradual, and over 2-3 treatments, collagen fills up from the depths of the pick scar. The concentration of TCA will vary between skin types, and depth of scarring. CROSS range from 30% TCA to 100% TCA or Phenol/Stone 100, therefore there are different recovery times and expectations for different scars and skin types. CROSS could be combined with other prodecures : Rejuvapen, lasers, etc.

Expected recovery

A dark red crust will last 3-5 days. Make up can be used by the 5th day in most of the cases. Then the treated area will appear worse on the next 7-10 days due to the redness and appearance of a bigger hole, at this point do not be worried because the dark/red spot will begin to lighten and the hole will begin to fill in by the 2nd-4th week. The healing time depends on the size of the lesion and the strength of the acid. If redness persists after week 4, V-beam pulsed dye laser can be performed for a discounted price starting at $50 dollars.

For mild cases 2-3 treatments are required, for severe cases 3-5 treatments, depending on the strength of the acid used. These are usually spaced 1-3 months apart. The results are not immediate and are slowly progressive, with optimal improvement visible over a three to four month period. This slow time frame allows for complete healing of damaged tissue with new collagen and elastin.

Post procedure products that should be used daily

  • Zinx oxide based sunscreen SPF 30-50
  • Hydrocortisone with aloe vera
  • Aquaphor or Vaseline
  • White vinager compresses (1 teaspoon of white vinegar to a cup of cold ice water) every hour as needed for redness, burning, itching, pain, or discomfort.