acne scar removal specialist in singapore

Acne Scar Removal in Singapore

Restore your skin with SAFE AND EFFECTIVE CUSTOMISED TREATMENTS

Acne scar removal depends on your scar type, skin type and depth of your scars.

atrophic acne scars on cheeks
Atrophic acne scars on cheeks

Table of Contents

What determines the best Acne Scar removal?

TREATMENT TYPE
ICE PICK SCARS
ROLLING SCARS
BOXCAR SCARS
TCA CROSS
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Subcision
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Fillers
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RF Microneedling
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Pico fractional laser
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Ablative fractional laser
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Non-ablative fractional laser
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Punch excision
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Your acne scar type, scar grade, existing skin condition are factors that determine the best approach to acne scar resurfacing.  Over the past decade, a greater understanding of the science of acne scarring has led to the development of various techniques to address the various acne scars types and grades. 

OUR APPROACH TO ACNE SCARS

HOW DOES DR.NG TREAT ACNE SCARS?

Every single case of acne scar is unique and everyone is treated individually based on your acne scar morphology, scar type and your treatment goals. With a carefully planned patient-tailored combination approach, this will lead to more significant improvements in your acne scar appearance. Drawing upon the latest acne scar techniques coupled with his wealth of experience, Dr. Ng will help craft a personalised treatment plan for you to help repair your acne scars and restore your skin.

What Causes Acne Scars?

Scar are a consequence to trauma to the skin, and acne scars are no exception. While acne scarring is common to acne patients, it can directly affect an individual’s confidence and quality of life.

  1. Inflammation as a consequence of acne drives a modified wound healing response within the skin. This disparity between collagen breakdown and collagen synthesis contributes to the type of acne scars you would have. Acne that is more severe and prolonged will lead to more severe acne scar formation.
  2. The imbalance of the skin remodelling will result in an inadequate healing response. When there is more collagen breakdown than synthesis, depressed atrophic acne scars will be more apparent. On the other hand, over-synthesis of collagen will result in more hypertrophic or keloid scarring. 
man with deep acne scars

LOOK

A skin analysis under direct and indirect lighting will determine the acne scar type, acne scar grade and depth. A careful examination personalises your treatment plan based of your unique acne scar type and skin condition.

acne scar consultation with doctor

PLAN

The planning stage involves discussing acne scar removal treatment options based on your acne scar type during consultation. The treatment plan is customised with a detailed discussion of treatment benefits, downtime and side effects.

pico laser acne scars treatment

TREAT

The treatment stage involves treating your acne scar subtypes with evidence based procedures. These can range from TCA CROSS, subcision, fractional resurfacing lasers and RF microneedling devices.

HOW COMMON ARE ACNE SCARS?

Acne is one of the most common inflammatory skin conditions globally. It is the 8th most common disease to affect individuals worldwide. Despite affecting more than 85% of adolescents, acne may persist well into adulthood. Conversely, the adult-onset acne variant tends to be challenging to treat as it tends to be more persistent. 

One of the most distressing consequences of acne is acne scarring. Acne scarring affects more than 90% of acne sufferers, and about 30% of cases are classified as severe. The effects of acne scarring pervade across one’s psychological well-being, social life, academic performance and employment opportunities. Hence, effective treatments for acne scar removal in Singapore are essential to prevent and reduce the appearance of acne scars and are always part of your treatment plan.

While it is of interest to individuals to receive early treatment for their acne breakouts, they should also be aware of the acne scar treatments available at the moment.

deep acne scars treatment
90% of Acne Scars are Atrophic/Depressed
back acne keloid scars
10% of Acne Scars leads to Keloids

What are the types of Acne Scars?

Types of acne scars for acne scar removal
Diagrammatic representaion of acne scars

Acne scar types are classified into two broad categories: atrophic and hypertrophic/keloid scars. While atrophic acne scars make up more than 80% of cases of acne scars, the hypertrophic and keloidal scar variants are commonly encountered in our local population.

Atrophic scars are subdivided into ice pick, rolling and boxcar scars. Amongst the atrophic acne scars subtypes, ice pick scars are most common (60-70%), followed by boxcar scars (20-30%) and rolling scars (15-25%).

Acne scars are also graded based on their colour, whether red (erythema), brown (hyperpigmentation) or white (hypopigmentation). The degree to which the scar appears to flatten when you stretch the skin gives some indication of the depth of your scar.

In practice, most individuals would have a mixture of the different scar types, scar depths and scar colour. The treatment objective would be to identify the predominant scar type so that the most suitable acne scar removal treatments can be recommended.

A customized approach to acne scars

Every individual is unique, and so will the acne scar type and distribution. There is no standardised treatment for your acne scars. The acne scars treatment is a dynamic process because the response to treatment, scar types, previous treatments, skin type/condition and downtime greatly differs across individuals. 

What has been agreed on by a recent international consensus on acne scars is that a combined treatment approach to tackle mixed acne scarring will yield better results.

The numerous types of treatment for acne scar removal in Singapore can be confusing. Indeed, acne scar revision can be a complex process as often you have more than two different scar types requiring different treatments. There is no single method to treat the various scar types. For example, fractional ablative lasers such as CO2 laser will not improve deep ice pick scars and tethered scars very much. On the other hand, surgical procedures like subcision is not suitable for superficial boxcars and rolling scars.

Generally, the treatment of pigmentation and erythema (redness) is tackled with first to improve the skin tone. Subsequently, deep acne scars (if any) removal treatments are performed to detach the underlying fibrous tissue, stimulate collagen and enhance dermal remodelling before performing a full face fractional resurfacing to even out your skin tone and texture. 

The treatment options will also have to depend on your skin type and colour. Individuals with a darker skin tone will benefit from gentler treatments over time, as there is an increased risk of pigmentation with overly aggressive treatments.

What are the Types of Acne Scars Removal Treatment?

Acne Scars Case Examples:

Mixed Atrophic Acne Scars (Grade 3-4)

man with acne scarring

Treatment Recommendation:

  • TCA CROSS for deep ice pick scars
  • Subcision for selected deep rolling scars
  • Fractional resurfacing
  • Fillers or Rejuran S to augment effects after fractional resurfacing

Mixed Atrophic Acne Scars (Grade 4)

man with deep acne scars

Treatment Recommendation:

  • Subcision of deep tethered scars should be done first to release the deep scars
  • Fractional resurfacing
  • Fillers or Rejuran S should be done four weeks after fractional resurfacing

Mild Acne Scars with Hyperpigmentation

woman with post inflammatory hyperpigmentation

Treatment Recommendation:

  • Pico laser to reduce post-inflammatory hyperpigmentation first.
  • Fractional resurfacing with Pico-second laser, INFINI, and Genius treatments are safer to minimise epidermal damage for individuals with darker skin phototypes.

Can My Acne Scars Be Treated While On Oral Isotretinoin?

isotretinoin and acne scars treatment
Spring LK et al. (2017)

For many years, it was the view that actively treating acne scars whilst on oral isotretinoin could lead to abnormal scarring and poor wound healing. Individuals were told to wait at least 6 to 12 months before starting acne scar procedures. This led to delays in initiating acne scars treatment and prolonging the negative physical, emotional and social implications associated with acne scars.

However, an expert consensus in 2017 found that it was not necessary to halt all forms of acne scars treatment.

Treatments that are not recommended to be carried out while on oral isotretinoin or shortly after completely oral isotretinoin therapy include:

  • Mechanical dermabrasion
  • Fully Ablative Laser 

Treatments that do not have compelling evidence to support delaying treatment and may indeed be safely carried out include:

  • Manual dermabrasion
  • Superficial chemical peels
  • Fractional ablative lasers
  • Fractional non-ablative lasers
  • Laser hair removal
  • Skin surgery

Can My Acne Scars Be Treated While Having Acne?

active acne on jawline
Inflammatory acne on lower face

Individuals who have active acne are at an increased risk of developing acne scars and early intervention is recommended.  Individuals with moderately-severe Acne Vulgaris who are often on oral and topical medications may consider acne scars treatment to reduce inflammation, reduce scarring potential and increase the effectiveness of the acne medication.

Various laser and energy based devices may be used concurrently and safely to prevent further scarring and enhance the effects of acne medication. These may include Pulsed Dye Lasers, Nd:YAG Lasers, Fractional ablative and non-ablative lasers and Fractional RF microneedling. Fractional RF microneedling treatment such as the INFINI and Genius have been found to reduce acne lesions and sebum production and improve the appearance of acne scars.

What is the downtime from the Acne Scar Removal program?

This depends on the type of treatments, your skin type and individual healing times. While some treatments such as fillers have very little downtime, some are associated with more significant social downtime, which requires treatment to be planned in advance to suit your schedule.

With a focus on efficacy and safety, we seek to offer treatments planned around your schedule, fitting with your recovery and lifestyle.

Examples:

  • Dermal Fillers: Usually minimal downtimes. Mild swelling post fillers for 2-3 days. Bruising is usually mild and fades in 1-2 weeks.
  • Subcision: Redness and swelling lasts a few days, bruising may take at least 1-2 weeks to subside.
  • TCA CROSS: Redness and swelling lasts a few days, scabs will typically fall off within a week.
  • Fractional Resurfacing (Pico, Genius, INFINI) : Redness and swelling lasts 2-3 days. Most individuals heal within 5-7 days. Downtime is longer with more intense treatment parameters.

Frequently Asked Questions About Acne Scar Removal

Acne scars are classified into several types, including atrophic scars (such as ice pick, boxcar, and rolling scars), hypertrophic scars, and keloid scars. Each type of scar has its own unique characteristics and may require different treatment approaches.

While it may not be possible to completely remove all acne scars, various treatments can help improve their appearance, texture, and color. With appropriate treatment and patience, many individuals can achieve significant improvement in the appearance of their acne scars.

The timeframe for seeing results from acne scar treatment varies depending on the type of treatment used, the severity of the scars, and individual factors such as skin type and response to treatment. Some treatments may produce noticeable improvement within a few weeks, while others may require several months to see optimal results.

Side effects of acne scar treatment may include temporary redness, swelling, bruising, or discomfort at the treatment sites. In rare cases, more serious complications such as infection, scarring, hyperpigmentation, or hypopigmentation may occur. It’s essential to discuss potential risks and benefits with a dermatologist or healthcare provider before undergoing treatment.

Yes, acne scar treatment can often be combined with other dermatological procedures or skincare treatments to achieve more comprehensive results. For example, combining laser therapy with microneedling or TCA CROSS may enhance the overall effectiveness of treatment.

Acne scar treatment should be performed by a qualified and experienced doctor  who has expertise in treating acne scars. It’s essential to choose a reputable provider and discuss your treatment goals and concerns during a consultation to develop a personalized treatment plan tailored to your needs.

Dr Moses Ng dermatologist

Acne Scar Revision

Acne scarring is a very common condition due to a delay in treatment and often an underestimation of the severity of the acne process. Acne scarring is usually a mixed pattern of scars. Each specific scar type will respond better to a corresponding treatment. A combination approach that synergizes the different treatment modalities safely and effectively to bring about the most optimal outcome is the desired goal.

My focus is on improving your skin the best way possible, taking into account your skin type, skin colour, downtime, lifestyle and budget. While it can be confusing sometimes to determine which treatments to go for, given the vast number of available options, I take a pragmatic approach and advise you accordingly the best approach available based on the latest evidence and clinical experience. With the acne scar removal program, individuals can expect an improvement in their acne scars over a 6-12 month period.

schedule a consultation for acne scar treatment in singapore

We treat a range of acne and acne scars at both our clinics in Woodlands and Kovan. Contact us today to schedule a consultation, so Dr. Ng can develop a personalized treatment approach for resolving your skin concerns and helping you to achieve long-term improvements in the health and appearance of your skin.

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Get in touch with us with any questions, pricing, or bookings.

Or give us a call at +65 6769 6007 | WhatsApp us +65 9855 3022

Related Information:
References:
  1. Monstrey S, Middelkoop E, Vranckx JJ, Bassetto F, Ziegler UE, Meaume S, et al. Updated scar management practical guidelines: non-invasive and invasive measures. J Plast Reconstr Aesthet Surg. 2014 Aug. 67(8):1017-25.
  2. Connolly DL, Ha LV, Nazanin S, Kavita M.  Acne scarring-pathogenesis, evaluation and treatment options.  Journal of Clinical and aesthetic dermatology 2017 10(9)L 12-23.
  3. Gold MH, McGuire M, Mustoe TA, Pusic A, Sachdev M, Waibel J, et al. Updated international clinical recommendations on scar management: part 2–algorithms for scar prevention and treatment. Dermatol Surg. 2014 Aug. 40(8):825-31.
  4. Alster TS, Lupton JR. Nonablative cutaneous remodeling using radiofrequency devices. Clin Dermatol. Sep-Oct 2007. 25(5):487-91.
  5. Salameh, FShumaker, PRGoodman, GJSpring, LKSeago, MAlam, M, et al. Energy-based devices for the treatment of Acne Scars: 2022 International consensus recommendationsLasers Surg Med20225410– 26. doi:10.1002/lsm.23484
  6. Jacob CI, Dover JS, Kaminer MS. Acne scarring: a classification system and review of treatment options. J Am Acad Dermatol. 2001;45:109–17.
  7. Spring LK, Krakowski AC, Alam M, et al. Isotretinoin and Timing of Procedural InterventionsA Systematic Review With Consensus RecommendationsJAMA Dermatol. 2017;153(8):802–809.
  8. Zeng R, Liu Y, Zhao W, Yang Y, Wu Q, Li M, et al. A split‐face comparison of a fractional microneedle radiofrequency device and fractional radiofrequency therapy for moderate to severe acne vulgaris. J Cosmet Dermatol. 2020;19(10):2566–71.