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What are acne scars?

When your skin is damaged, it repairs itself. This process of reparation creates a newer formation of skin that can be uneven from the original layer, resulting in visual scarring. Acne scars are formed when your skin heals from a serious acne inflammation that has reached into the deeper dermis layer. Conversely, superficial infections such as blackheads and whiteheads rarely result in scars.




In this entry, we will learn about the different acne scar types and the various acne scar treatments that are available in Singapore.


[Link] Know your acne. Learn how to beat acne now.


One fact that must be highlighted beforehand is that complete removal of acne scars is medically unachievable.


The simple reason is that skin is unable to restore acne wounds, or any deep wounds for that matter, into its original state of uniform layers and textures.


The collagen and other tissues produced during the healing process cannot form a seamless layer of skin with the rest of the healthy tissue.


To date, current scar treatments do not possess the capability to create a seamless healing process in the skin.


[Link] Find out why there’s no such thing as “acne scar removal”


Acne Scar Types


Acne scars are mainly divided into two categories: atrophic scars caused by loss of tissue, and hypertrophic scars caused by an overgrowth of scar tissue.


There’s also a misconception that discolourations left behind by acne are acne scars; in fact, these are post-inflammatory hyperpigmentation (PIH) and will fade naturally over time.


Atrophic scars

Asian man with atrophic acne scarring on face (helioswoundsolutions.com)


When a scar heals below the normal level or layer of skin, a depression is formed. This is called an atrophic scar. This occurs when the skin is unable to regenerate tissue and collagen lost from an acne breakout.


The size and depth of an atrophic scar depends on the amount of inflammation there was in the acne. The more severe the inflammation, the bigger and deeper an atrophic scar gets.


Atrophic scars are commonly found on the face. Examples include ice pick, boxcar, and rolling scars.


[link] Learn more about atrophic scars.

Hypertrophic scars


Asian man with Hypertrophic Scar on face. (www.acne.org)


Collagen, a building block of the skin, is often produced as part of wound healing. However, the skin can at times also produce an excessive amount of collagen. This results in a mass of raised tissue on the skin’s surface – a hypertrophic scar or keloid.


Hypertrophic scars, while most commonly seen on the nose and on the body, can also appear on other areas of the face.


[link] Learn more about hypertrophic scars.


[lilnk] Not sure what type of acne scar you have? Find out here.


Your Acne Scar Treatment Options

While acne scars cannot be completely and perfectly removed, they can be reduced and minimised in appearance.


But Singapore patients often wonder what is THE best treatment for acne scars. The answer is that there is simply no one treatment that is the best in resolving acne scars.


First, not all acne scars are built or made the same. There is no one-size-fits-all acne scar treatment. Second, patients respond to treatments differently from others.


Hence, acne scar treatments are highly individualised; a treatment plan must be created by a doctor following a thorough consultation and understanding of the patient’s medical history and personal habits.


So what are your options in acne scar treatments? Read on to find out.

Skin Resurfacing for Atrophic Acne Scars

Due to the loss of skin tissue, atrophic acne scars appear sunken on the skin. As a result, treatments that resurface, or in other words level the skin from inside out, work best with atrophic acne scars.


SL Aesthetic Clinic currently offers several atrophic acne scar treatment options. Often times, the doctor will recommend a combination of more than one option for optimal results.


Option 1 ) Fractional CO2 Laser Skin Resurfacing


This treatment is considered the “gold standard” in laser acne scar skin treatment in Singapore. Fractional CO2 Laser is a non-surgical procedure adapted from the Carbon Dioxide Laser for use in medical aesthetics.


[Link] All you need to know about Fractional CO2 Laser Skin Resurfacing


The Fractional CO2 Laser fires beams of light into the deep layers of the skin, thereby creating a grid of tiny openings.


[Illustrations on how Fractional CO2 Laser works]


Your skin then repairs these openings by pushing out damaged and uneven skin. This is then replaced with younger, healthier skin. Residual heat generated by the light energy also helps remodel your skin’s collagen web.


Finally, your acne scar will be visibly reduced over a course of sessions as recommended by our doctor; your complexion will feel smoother to the touch. What’s more, your skin’s pore size will also be minimised.


[Enquiry button] Drop us a message to find out how many sessions you’ll need.


Quick Facts about Fractional CO2 Laser Resurfacing:


  • “Gold standard” treatment for atrophic acne scars
  • Best for Rolling/Boxcar scars
  • Immediately after treatment, skin feels sunburned and will peel for 2-7 days. Pinkness will remain for 3 to 6 weeks, depending on the individual
  • Plan for 3 to 5 days of downtime for lighter acne scars, or 7 to 10 days downtime for more severe acne scars
  • If you have light acne scarring, we recommend a course of 2 to 3 sessions. If you suffer from more severe acne scarring, you will require 4 to 6 sessions for better results.


Option 2) Subcision and Atrophic Scar Levelling with Dermal Filler


Subcision, also called subcutaneous incisional surgery, is a minor procedure to treat atrophic scars.


[Illustration on how Subcision is performed]


A hypodermic needle is used to perform a subcision. The needle’s edge is used to severe fibrotic strands holding the top layer of the scar to the underlying tissue.


Thereafter, your body naturally produces collagen to heal the wound, improving the appearance of the scar over time.


[Illustration on Dermal Filler being introduced to fill the gap]


At SL Aesthetic Clinic, we recommend a minute injection of Dermal Fillers (linked) to fill the gap of the newly released scar. This will optimise the results of the subcision and your scar will level out quicker this way.


[Link] Are you suitable for Acne Scar Treatment with Subcision? Find out now.


Quick Facts about Subcision and Atrophic Scar Levelling with Dermal Filler:


  • Minor procedure performed in our outpatient clinic
  • Best for Rolling/Boxcar scars, and more
  • Some bleeding will occur but will otherwise be very manageable
  • We recommend 3 sessions for most cases of moderate acne scarring, with at least 1 month between treatments


Option 3) TCA CROSS


The Chemical Reconstruction of Skin Scars (CROSS) using TriChloroacetic Acid (TCA), is a straightforward outpatient procedure that can be performed within the clinic.


This is done with the doctor dropping tiny amounts of TCA of between 70 to 100% concentrations onto your atrophic scar.


This triggers a very localised and controlled inflammatory reaction; your skin repairs itself from this, producing new collagen fibres.

As a result, your atrophic scars level out gradually.


[Link] The simplicity of TCA CROSS in Acne Scar Treatment


Quick Facts about TCA CROSS Atrophic Scar Treatment:

  • Minor procedure performed in our outpatient clinic
  • Best for Ice Pick, Rolling, and Boxcar scars
  • Scar surface will frost and whiten for up to 12 hours
  • Skin around treated sites will be red and sore for 24 to 48 hours
  • Scabs will develop after 2 to 3 days, and thereafter fall off after 3 to 7 days
  • We recommend 3 to 6 sessions of TCA CROSS for most cases of moderate acne scarring, with at least 2 to 8 weeks between treatments

Treatment for Hypertrophic Scars and Keloids


Simply put, numerous methods have been explored in the treatment of these abnormal scars. But to date, no optimal treatment option has been clinically established.


Some therapies such as creams and oils, silicone gel, pressure dressings, and steroid injections, have mixed results. And almost all are used purely for the management rather than cure of hypertrophic scars and keloids.


In general, a hypertrophic scar settles in time or with treatment, but a keloid may persist, re-occur, and prove resistant to treatment.


The tricky case of Keloids


Keloids can be difficult to diagnose and treatment. It can develop soon after injury, or appear several months after trauma.


Keloids may feel uncomfortable to touch for some and can grow to a size larger than its original wound. They can form anywhere on the body, though the upper chest and shoulders are statistically more prone.


Scientists are still investigating the precise reason for keloid formation. So far, two conclusions have been made.


First, most people never form keloids. But amongst those who do keloids appear easily; from the most minor wound or injury such as an insect bite or acne spot.


Second, those with darker complexions are also at higher risk of keloid formation.

With that said however, keloids generally pose no harm to a person’s health and do not become cancerous.


Management Options for Hypertrophic Scars and Keloids


At SL Aesthetic Clinic, we believe in tried and tested ways in achieving safe, reliable results.


In managing mild to moderate hypertrophic scars, we recommend applying emollients such as creams and oils for most patients. This helps soothe and alleviate the condition.


We advise patients with more severe hypertrophic scarring or keloid formation to manage the conditions with steroid injections, repeating treatment once every few weeks.


[Link] Unsure which Acne Scar Treatment Is Suitable for You? Learn More here. {THIS CAN BE A BLOG ARTICLE BY A DOCTOR = Detailed description and comparison including after-care and cost in visual representation $$$ and what to expect in the treatments, possible results (complete/partial, number of sessions) available: Fractional CO2 Laser, Subcision with Dermal Filler, TCA Cross. Include a video of doctor explaining or graphic. Key highlight is that it may take more than ONE single treatment for good results.}


Frequently Asked Questions


  1. I have a habit of picking at my acne. Will this cause my acne to scar?

Almost always.


Unless done by a professional with the right gear, picking at your acne will likely result in scarring.


This is because of several factors:


  • Bacteria exist on your hands and underneath your nails, washed or not. Picking at an acne can introduce even more bacteria into it, resulting in greater infection and inflammation


  • Professionals such as trained facial therapists have the skills and the know-how in extracting acne without causing further harm or scarring. Manual removal by untrained hands can push infected material deeper into the skin, or even cause cellulitis – a bacterial skin infection that, if left untreated, can be life threatening


  • Picking at an acne can cause infected material to spill out onto surrounding skin and result in even more acne forming


  1. If I don’t pick at my acne, can I avoid acne scars from forming?

Scarring can still occur even if you do not pick at your acne.


Inflammation caused by the bacterial infection in the acne will result in damaged skin cells. The inflammation can damage and destroy skin cells that result in an acne scar. This is especially true for cystic acne.


As the saying goes, prevention is better than cure.


Apart from patients genetically prone to keloid scarring, the rest of us should practice sound skincare and diet. Prevent acne from forming and avoid acne scarring altogether.


[Link] Read more about Preventing Acne here.


  1. Are acne scars permanent?


Yes. There is currently no way to perfectly restore scarred tissue to their former selves.


But existing acne scar treatments such as Fractional CO2 Laser and Subcision can reduce and refine the appearances of acne scars to a degree that they cease to be a source of insecurity for patients.


  1. Is there a natural or DIY method to removing acne scars?


The Health Sciences Authority of Singapore has warned consumers of the dangers of cosmetic products marketed as “natural”, saying that “natural”, “organic”, “contains no preservative” or “100% herb” cosmetic may not necessarily be “better” or “safer”… because they contain plant ingredients, which are conducive for bacterial growth.


Always seek a medical professional’s advice when it comes to a serious condition such as acne scars.


Professional treatments performed by doctors are that; professional. They’re based on well-researched technologies that are consistently peer-reviewed for safety and efficacy.


  1. Why does my acne leave a brown spot even after healing? Is this an acne scar?


These spots are the result of an inflammation caused by bacterial infection, hence its name Post-Inflammatory Hyperpigmentation (PIH).


And contrary to popular belief, these are pigmentation concerns and not considered acne scars. Hence its name.


After healing over, all wounds will have differences in skin tone, pigmentation, and even texture compared to surrounding skin.


Amongst fair individuals, these spots tend to appear as red or purple “splotches”. This is because broken blood vessels from the aftermath of an acne breakout remain in the healed over area.


Conversely, those with darker skin tones are more prone to developing brownish marks or hyperpigmentation.


Always avoid prolonged sun exposure to prevent PIH from appearing if you have wounds that are healing.

[Treating acne scars is complex and highly individualised. Speak to our doctors for a personalised treatment plan and restore your confidence today.][:]