Acne Scar Treatment Singapore
How Common Are Acne Scars?
Acne scars are often associated with acne vulgaris. Although most adolescent will experience acne of varying severity in their lifetimes, a significant proportion of individuals will have moderate to severe acne scarring which they find distressing. In cross-sectional survey of individuals age 15-24 years, about 30% of individuals considered it a major problem and burden.
What Are The Acne Scar Types?
The most common acne scar types are Atrophic acne scars. In most individuals, there is often a mixture of ice pick, boxcar and rolling acne scars. We call this Mixed atrophic acne scars or Polymorphic atrophic acne scars.
Ice pick scars are most common, they are less than 2mm in diameter, and taper as it extends to the deep dermal layer of your skin. Ice pick scars are the deepest and poses the most treatment challenge.
Boxcar scars are wider than ice pick scars, having a sharper vertical border. Variant of boxcar acne scars may either be shallow or deep in depth.
Rolling scars have wider surface combined with sloping borders. Rolling scars can be superficial or deeply tethered to the deep dermal layer of the skin.
Two Important Factors that Acne Scar Treatment Hinge Upon
From clinical experience in our local context, the 2 most important criteria for planning any acne scar treatment would be your skin phototype and acne scar type.
Individuals with darker skin types should go for treatments that have lesser risk of post-inflammatory hyperpigmentation (PIH). PIH occurs when the skin is inflammed or irritated, leaving dark marks on the skin. Fractional ablative laser treatment such as the Carbon dioxide (CO2) and Er:YAG lasers are associated with prolonged downtime and a higher incidence of post-inflammatory hyperpigmentation. This is due to the laser disrupting the epidermal-dermal junction as it penetrates the skin. Over the last few years, advances in fractional resurfacing technology have managed to substantially reduce the risk of PIH by bypassing the epidermal layer. Fractional microneedling radio-frequency treatments such as the Genius and INFINI are able to precisely deliver energy into the dermis while minimising injury to the epidermal layer of the skin. This greatly reduces the chance of PIH.
A proper examination of your skin is integral to determining the acne scar type. Although most individuals will have a mixed atrophic acne scar phenotype, the variations and the dominant scar type will influence the type of acne scar treatments you will need. No single treatment modality will address all your acne scars, a combined approach gives the best acne scars treatment results.
Acne Scar Treatment Options
There is a variety of acne scars treatment being offered in Singapore. These are categorised broadly into the following:
- Topical treatments e.g. chemical peels, TCA CROSS
- Lasers and energy-based devices e.g. Fractional CO2 laser, Genius, INFINI
- Injectables e.g. Fillers, Rejuran S
- Surgical e.g. Subcision, punch excision
For ice pick scars, procedures such as TCA CROSS or punch excision are good options. TCA CROSS involves the focal application of concentrated acid to promote collagen remodelling via coagulation necrosis and wound healing. Punch excision involves the use of an instrument to surgically remove the ice pick scar which is then stitched together, but this will result in another scar.
Superficial rolling and boxcar scars respond better to energy based and laser resurfacing treatments. Studies have shown increased collagen synthesis, elastin fibers and dermal remodelling with laser and energy based devices for acne scars. Fractional microneedling radio-frequency treatment is safer in individuals with darker skin phototypes.
Deeper rolling acne scars are mostly released via subcision. Subcision is a surgical technique to release the tethered scars that are pulling your acne scars downwards.
Multimodal Approach for Mixed Acne Scar Types
From our experience, many individuals in Singapore have mixed atrophic acne scar type and darker skin phototypes. A multimodal approach to acne scar treatment that maximises treatment efficacy while minimising side effects is recommended.
The principles would be to treat the deeper scars such as ice pick and deeply tethered scars. Once these deeper scars have surfaced, fractional microneedle resurfacing is carried out to treat rolling and boxcar scars.
As this combined approach is highly customisable, the specific treatment parameters can be adjusted according to your acne scar type, downtime and treatment goals in mind.
Triple Acne Scars Treatment
Acne Scar Treatment Singapore
It depends on the type of acne scar treatment. TCA CROSS is a tolerable procedure, a stinging sensation is felt for only a few minutes. For subcision and fractional microneedle treatments, the procedure is performed under local and topical anaesthesia respectively. This optimizes your comfort during the procedure.
From Dr Ng’s experience, these treatments are conceptualized for all skin types, especially individuals with darker skin phototypes.
This would depend on individual acne scarring pattern and healing response. In general, for deep ice pick scars, you may need at least 3-6 treatments. Subcision is carried out for selected deep rolling scars, and often 2-3 treatments should suffice. The majority of individuals will see good improvement in their acne scar appearance after 4 sessions of fractional microneedle radio-frequency treatments.
It is necessary to keep the skin clean after the procedure with regular cleansing. An antibiotic ointment may be prescribed for certain procedures. Sun exposure and protection is pivotal to reduce post-inflammatory hyperpigmentation.
Most individuals will notice an improvement from 6 months onwards. Collagen stimulation, the restructuring of the dermal architecture and remodelling takes place over months. An expectation of improvement within days or few weeks would be unlikely and unrealistic.
- Szepietowski, J., Wolkenstein, P., Veraldi, S., Tennstedt, D., Machovcová, A. and Delarue, A. (2018), Acne across Europe: an online survey on perceptions and management of acne. J Eur Acad Dermatol Venereol, 32: 463-466.
- PETERSON, J.D., PALM, M.D., KIRIPOLSKY, M.G., GUIHA, I.C. and GOLDMAN, M.P. (2011), Evaluation of the Effect of Fractional Laser with Radiofrequency and Fractionated Radiofrequency on the Improvement of Acne Scars. Dermatologic Surgery, 37: 1260-1267. https://doi.org/10.1111/j.1524-4725.2011.02110.x
- Benefits of fractional radiofrequency treatment in patients with atrophic acne scars – Literature review. J Cosmet Dermatol. 2021; 20: 381– 385. https://doi.org/10.1111/jocd.13900 , , , .
- Rullan, Peter P et al. “A Combination Approach to Treating Acne Scars in All Skin Types: Carbolic Chemical Reconstruction of Skin Scars, Blunt Bi-level Cannula Subcision, and Microneedling-A Case Series.” The Journal of clinical and aesthetic dermatology vol. 13,5 (2020): 19-23.