As a skin restoration specialist based in Newport Beach, California, I focus on treating some of the most challenging skin conditions—acne, scars, and pigmentation issues. Every day, I walk into my clinic with one goal: to help my patients feel confident and comfortable in their skin. Today, I want to share my approach to treating acne scars with TCA Cross and other common concerns while answering some of the most frequently asked questions I receive from patients.
My Approach to Treating Acne Scars (TCA Cross and Volume)
Acne scars are more than just physical marks—they can deeply affect someone’s self-esteem and quality of life. I often see patients who have tried countless treatments without success. One of the cases I’m particularly proud of involves a patient who had significant oil production, active acne, and boxcar scars. The transformation was remarkable, and it wasn’t achieved through one single treatment but rather a combination of modalities tailored to her needs.
For this patient, we started with an Accure laser to address her excessive oil production. Then, we moved on to TCA cross for her deeper scars, followed by laser resurfacing and subcision to break up tethered scar tissue. Finally, we added Bellafill to restore lost volume. This multi-step process is essential because no single treatment works universally for all types of scars. Each scar requires a customized plan based on its depth, width, and the patient’s skin type.
The Role of Water Quality in Skin Health
One topic that surprises many of my patients is how water quality impacts their skin. People often ask if cold water helps with acne scars, and while the temperature itself doesn’t directly improve scars, the mineral content in your water might play a role. In areas like Orange County, where hard water is common, the high mineral concentration can cause inflammation, delay collagen production, and even exacerbate conditions like rosacea.
I recommend switching to distilled or bottled water for washing your face, especially after procedures. Some of my patients have seen improvements simply by installing advanced water filtration systems, such as Japanese purifiers, which remove impurities at a molecular level. Clean water reduces post-treatment inflammation and supports better healing outcomes.
Treating Diverse Skin Types
A question I hear often is, “Do you work on melanin-rich skin?” Absolutely, yes. In fact, the majority of my patients—about 90%—have Fitzpatrick skin types 4 and above. Treating darker skin tones requires precision and expertise to avoid complications like hyperpigmentation or hypopigmentation. For example, when performing TCA cross, I adjust the acid concentration based on the scar's depth and the patient’s unique skin characteristics. Using the wrong concentration or technique can lead to uneven results, so meticulous care is non-negotiable.
The Emotional Journey of Scar Treatment
Beyond the technical aspects, treating acne scars is deeply personal. Many of my patients share stories of bullying, insecurity, and missed opportunities due to their scars. Helping them regain confidence isn’t just about improving their appearance—it’s about shifting their life trajectory. When they look in the mirror and finally feel happy with what they see, it’s incredibly rewarding for both of us.
One patient stands out in particular. He had severe scarring from years of untreated acne and had undergone multiple ineffective treatments, including seven sessions of subcision and ten sessions of CO2 laser, without proper volume replacement. After a detailed consultation, we addressed his deep scars with phenol peels and dermabrasion, combined with subcision and Bellafill. The emotional relief he experienced during the treatment was palpable—he felt like he was shedding years of trauma tied to his scars. It’s moments like these that remind me why I chose this path.
Navigating Insurance and Payment Plans
Many patients wonder if insurance will cover scar treatments. Unfortunately, acne scar correction is rarely covered by insurance, as it’s considered a cosmetic procedure. However, we offer flexible payment plans to make treatments accessible. Contrary to popular belief, most financing options don’t require a hard credit check, making it easier for patients to invest in their skin health without financial stress.
Questions Answered
Here are answers to some of the questions I received during the live session:
Question: Do you work on melanin-rich skin?
Dr. Qazi: Yes, absolutely. Most of my patients have Fitzpatrick skin types 4 and above. Treating darker skin safely and effectively is a priority in my practice.
Question: What was done for this patient?
Dr. Qazi: We used a combination of Accure laser, TCA cross, laser resurfacing, subcision, and Bellafill to address her oil production, acne, and scars. It’s a multi-step process designed to tackle each issue comprehensively.
Question: Can you use biostimulators to treat necklace lines? I heard Sculptra has a high risk of nodules in that area.
Dr. Qazi: Sculptra isn’t ideal for the neck due to the risk of nodules. Instead, Radiesse or hyaluronic acid fillers are better options for tech neck creases.
Question: Can you do Bellafill in the temple?
Dr. Qazi: Yes, I recently treated a patient with Bellafill in the temples, and the outcome was fantastic. It’s a safe and effective option for restoring volume in that area.
Question: Does cold water help acne scars?
Dr. Qazi: Cold water itself won’t heal scars, but the mineral content in tap water can irritate the skin. Switching to distilled or filtered water can reduce inflammation and promote better healing.
Question: What is the best treatment for post-inflammatory erythema (PIE)?
Dr. Qazi: Start with sunblock to prevent hyperpigmentation, followed by azelaic acid. For persistent PIE, lasers like Excel V or VBeam are highly effective.
Question: What percentage of TCA Cross do you use?
Dr. Qazi: I use anywhere from 30% to 90%, depending on the scar’s depth and width. Customization is key to achieving optimal results.
Question: Do you have to neutralize after the TCA application?
Dr. Qazi: No, TCA is self-neutralizing, but precision is critical. Applying it correctly ensures safety and efficacy.
Question: How can I achieve a cure for scars?
Dr. Qazi: While there’s no true “cure,” combining treatments like TCA cross, laser resurfacing, subcision, and Bellafill can dramatically improve scar appearance over time.
Question: Do we need good credit for payment plans?
Dr. Qazi: Not necessarily. Many financing options don’t require a hard credit check, making treatments accessible to more patients.
Question: What’s the downtime period for Accure laser?
Dr. Qazi: There’s virtually no downtime with Accure laser. Patients can resume their daily activities immediately.
Question: I have bumps on my nose from picking at it in high school. Would there be something that makes them go away?
Dr. Qazi: Yes, CO2 laser can smooth down those bumps precisely. It’s a great option for textural irregularities caused by scarring.
Question: Can you explain how electric shavers cause acne scarring?
Dr. Qazi: Electric shavers create friction, leading to hypertrophic scarring or keloids, especially along the jawline. Switching to manual razors and gentle cleansers minimizes this risk.
Question: What’s the best treatment for static depressed frown lines aside from filler, CO2, or RFM?
Dr. Qazi: Volume replacement with biostimulatory products like Sculptra or Bellafill is crucial. Combining these with Botox and subcision yields excellent results.
Question: What’s a different percentage of TCA for cross, and how do you decide when to use phenol cross over TCA cross?
Dr. Qazi: I use 30%-90% TCA based on the scar’s depth. Phenol cross is rarely necessary; TCA offers greater flexibility and fewer risks.
Question: Is it best to correct acne scars before a facelift?
Dr. Qazi: Yes, addressing scars beforehand improves texture and prepares the skin for resurfacing, enhancing overall facelift results.
Final Thoughts
If you’re considering treatment for acne scars or other skin concerns, remember that patience and proper guidance are key. At my clinic, we offer virtual consultations and transparent pricing to make the process as seamless as possible. Whether you live locally or travel from across the country, we’re here to support you every step of the way.
Click here to self-schedule a consultation or give us a call at 949-336-7293 for more information. Together, we can transform your skin and empower you to embrace your natural beauty.
