Ice Pick Scar Treatment in Malaysia: How TCA CROSS Works

If you have ice pick scars, you have probably noticed that they behave differently from your other scars. Laser sessions soften the skin around them. Your overall texture looks better. But the small, deep holes on your cheeks look almost the same as before.

That isn't bad luck. Ice pick scars have a shape that most resurfacing treatments can't reach properly, and they need a treatment that works on each scar one at a time. At Aglow Clinic, that treatment is usually TCA CROSS, performed by a doctor.

This guide explains why ice pick scars are so stubborn, how TCA CROSS works, what the research shows, and what to expect if your doctor recommends it.

What makes an ice pick scar different?

Ice pick scars are the narrowest and deepest of the three main types of depressed acne scars. The opening on the surface is usually less than 2 mm wide, but the scar runs down deep into the skin, often in a V shape. Seen from the side, it looks less like a dent and more like a narrow well.

They form when a deep, inflamed pimple or cyst destroys tissue along a narrow track. As the skin heals, it pulls down into that track and leaves a thin channel behind.

If you're not sure which scar types you have, our doctor's guide to rolling, boxcar and ice pick scars covers how to tell them apart. Most people have more than one type, which matters for treatment planning later.

A quick mirror check

You can get a rough idea at home before your consultation. Stand next to a window so daylight falls across your face from the side, and look at your cheeks in a hand mirror.

- Ice pick scars look like small, sharp pinholes or enlarged pores that stay dark in the centre. When you gently stretch the skin between two fingers, they barely change.
 

- Rolling scars look like soft, wavy shadows. They often flatten out noticeably when you stretch the skin.
 

-Boxcar scars are wider, with clear edges and a flat floor, a bit like a small crater.

This check isn't a diagnosis. Some large pores and small boxcar scars can look like ice pick scars, which is exactly why a doctor examines each scar under proper lighting before choosing a treatment.

Why lasers alone often fall short

Fractional lasers such as CO2 laser work by creating thousands of tiny treated columns across a patch of skin. The skin heals those columns with new collagen, and the whole area becomes smoother. This works well for boxcar scars and general texture, because those scars are wide and fairly shallow.

An ice pick scar is a different problem. Its walls are steep and its base sits deep. A laser pass spreads its energy evenly over the surface, so only a small share lands on the narrow opening of each scar, and it often doesn't reach the base where the rebuilding needs to start. The skin around the scar improves. The scar itself stays deep, and it can even look more obvious once the surrounding skin is smoother.

Pico laser is good for the dark marks that often sit alongside acne scars. It won't fill a deep channel on its own.

So when someone tells us, "I've done ten laser sessions and my holes are still there," the lasers usually did their job on the surrounding skin. They just weren't the right tool for the ice pick scars.

What is TCA CROSS?

CROSS stands for Chemical Reconstruction of Skin Scars. Dermatologists in Korea first described the technique in 2002, and it has since become a standard approach for ice pick scars.

Trichloroacetic acid (TCA) is a chemical peeling agent. In a normal peel, a low concentration is spread across the whole face. TCA CROSS works the other way round. The doctor uses a very fine applicator to place a tiny amount of high-concentration TCA directly into the base of one scar at a time.

The skin at the treatment site turns white for a moment. This is called "frosting" and shows the acid has reached the right depth. Over the following weeks, the controlled injury triggers new collagen inside the scar. The channel narrows and becomes shallower, rebuilding from the bottom up.

Because the acid only touches the scar and not the skin around it, the healthy skin nearby is left alone. That is also why the technique must be precise. Too much acid, or acid in the wrong place, can widen a scar instead of filling it. At Aglow, TCA CROSS is performed only by our doctors.

What does the research show?

The evidence for TCA CROSS on ice pick scars is encouraging, including on darker skin types like most Malaysian skin.

One pilot study in the Journal of Cutaneous and Aesthetic Surgery treated 12 patients with Fitzpatrick skin types IV and V. Their skin was prepared for two weeks with tretinoin cream and sunscreen, then treated with 100% TCA CROSS over four sessions, two weeks apart. Of the 10 patients who completed follow-up, 8 had more than 70% improvement and the other 2 had 50 to 70% improvement. Side effects were minor: one case of temporary lightening that lasted six days and one case of temporary darkening.

That study was small, and your own result will depend on how deep your scars are, how many you have and how your skin heals. It does show two things that matter here. The technique works on skin like ours, and the main risk, temporary pigment change, can be managed with the right preparation.

How TCA CROSS fits into your scar treatment at Aglow

Very few people have only ice pick scars. The usual picture is a mix: a few ice pick scars on the cheeks, some rolling scars along the jaw, some boxcar scars near the temples, plus brown marks from old breakouts.

That's why TCA CROSS at Aglow is one part of the ScarAway™ programme rather than a standalone treatment. After assessing each scar type, your doctor might combine:

- TCA CROSS for the ice pick scars

- Subcision to release rolling scars that are tethered underneath

- CO2 fractional laser or microneedling with PDRN for boxcar scars and overall texture

- Pico laser for post-acne pigmentation

ScarAway is the programme behind Aglow's Malaysia Book of Records certification for Most Scar Treatment Sessions in a Year: 45,986 sessions in 2025, across 19 clinics and 26 MOH-certified doctors. At that volume, our doctors see ice pick scars every day, in every combination.
 

"I always examine the scars under proper lighting first, because the scar type decides the treatment. If I see ice pick scars, those narrow, deep pits that can look like large pores, TCA CROSS is usually the most suitable option." -Dr Hazel, Aglow.

What to expect: sessions, downtime and results

Before your first session. Your doctor will take photos of your scars under consistent lighting, so you can compare progress honestly later. You may be asked to pause strong exfoliating products, such as retinoids or acid toners, for a few days beforehand, and to avoid getting sunburnt in the week before. If you've had cold sores around the treatment area, mention it, as your doctor may want to plan around it.

The session. After cleansing, your doctor applies TCA to each ice pick scar individually. Most people feel a brief sting at each spot. Treating a cheek full of scars takes minutes, although the full visit, including consultation and any other treatments, usually runs 60 to 90 minutes.

The first week. Treated spots turn white, then darken and form tiny crusts over the next few days. These usually flake off naturally within about a week. You can generally go back to work and daily life straight away, but don't pick the crusts. Picking is the most common reason for dark marks afterwards.

How many sessions. Most people need several sessions, because each round lifts the scar base a little further. At Aglow, sessions are usually spaced four to six weeks apart to give collagen time to form. How many you need depends on how deep your scars are and how many there are, so your doctor will give you a realistic number after examining them.

When you'll see change. Early improvement often shows at four to eight weeks. Collagen keeps remodelling after that, so the most visible change usually comes at the three to six month mark.

What "better" looks like. TCA CROSS makes ice pick scars shallower and less noticeable. A scar that looked like a hole should become a soft, shallow dip that catches less light and is easier to cover. Complete erasure is uncommon, and any clinic promising it is overselling.

Protecting Malaysian skin from dark marks after treatment

Asian skin is more likely to develop post-inflammatory hyperpigmentation, meaning brown marks that appear after any injury to the skin. Chemical treatments like TCA carry this risk too. The steps that keep it low:

- Preparing the skin first, often with a few weeks of prescribed skincare before the first session

- Strict sun protection before and after treatment. Malaysia's UV index is high year-round, so sunscreen is part of the treatment itself.

- Leaving crusts alone until they fall off naturally

- Treating active acne first. New breakouts mean new inflammation, and new inflammation means new marks.

If you do develop some darkening, it is usually temporary and your doctor can treat it.

Who shouldn't have TCA CROSS (yet)

Your doctor will check for anything that makes it better to wait or choose another option, including:

- Active acne or infection in the area to be treated

- A history of keloids or raised scars

- Recent isotretinoin (Roaccutane) use

- Very sensitive or irritated skin at the time of treatment

Please don't try this at home

Online sellers offer high-strength TCA for home use, and some videos show people applying it themselves. Please don't. At the concentrations used for CROSS, TCA can burn deeper than intended, widen the scar you're trying to fix, and leave white or dark patches that are harder to treat than the original scar. Getting the depth right for each scar is the skilled part, and you can't see it clearly on your own face in a mirror.

Frequently asked questions

What is the best treatment for ice pick scars? TCA CROSS is one of the most effective treatments for ice pick scars because it targets each scar's deep base directly. Most people also have other scar types, so the best results usually come from a combined plan put together after a doctor's assessment.

Is TCA CROSS painful? Most people feel a short, sharp sting at each spot that fades within seconds. It is generally well tolerated.

How many TCA CROSS sessions will I need? Most people need several sessions, spaced four to six weeks apart. The exact number depends on how deep and how many your scars are.

How long is the downtime? Treated spots crust over and usually heal within about a week. Most people return to normal activities the same day.

Can pico laser remove ice pick scars? Pico laser works well on post-acne pigmentation and can improve texture, but it usually can't fill deep, narrow ice pick scars on its own. It is often used alongside TCA CROSS instead.

Will my ice pick scars disappear completely? TCA CROSS can make ice pick scars much shallower and less visible. Complete removal is uncommon, and your doctor will explain realistic results for your skin before treatment starts.

Is TCA CROSS safe for Asian skin? Yes, when it is done by a trained doctor with proper skin preparation and aftercare. Studies on darker skin types have reported good results with only minor, temporary side effects.

Try Aglow ScarAway™ Signature Scar Program, 2 treatments at RM388 only!

Your first treatment is the starting point. Your second is where your doctor sees how your skin responds and adjusts accordingly. Skin is not one-size-fits-all — the optimal solution for yours only becomes clear once we observe the reaction, recovery, and early results. Two sessions is the minimum required for an honest clinical recommendation, and that is exactly what we are here to give you. >> Click Here <<

Aglow Clinic is an LCP-certified medical aesthetic clinic. All treatments are performed by MOH-certified medical doctors. Results vary depending on skin condition, scar type and aftercare.

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