When your skin is damaged, it repairs itself. This process of repair creates a newer formation of skin that is 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.
There are different types of acne scars, and acne scar treatment is personalised to the type and severity of the scarring. A person suffering from acne scarring can present more than one type of acne scar. Hence, multiple types of acne scar treatments are combined to produce the best result. In this entry, we will learn about the different acne scar types and the various acne scar treatments that are available in Singapore.
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. Scarring is a permanent condition. Treatments may improve the condition, but rarely remove it.
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 with the rest of the healthy skin tissue.
To date, current scar treatments do not possess the capability to create a seamless healing process in the skin. This is why the aim of acne scar treatments is to improve the appearance of acne scars, not to cure or remove them.
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.
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 icepick, boxcar, and rolling scars.
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, as well as the neck and the back.
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.
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. Oftentimes, the doctor will recommend a combination of more than one option for optimal results.
|Type of Treatment||Icepick Scars||Rolling Scars||Shallow Boxcar Scars||Deep Boxcar Scars||Offered at our clinics (Y/N)|
|Laser (Fractional Er:YAG)||N|
|Laser (Fractional CO2)||Y (from $500)|
|Augmentation/Fillers||Y (from $749)|
|Subcision||Y (from $350)|
|Punch Excision||Y (price TBA)|
|Chemical Peels||Y (from $188)|
|TCA CROSS||Y (from $300)|
|Platelet Rich Plasma||Unapproved by HSA|
Fractional CO2 Laser is a non-surgical procedure using carbon dioxide as a medium, and adapted from the Carbon Dioxide Laser for use in medical aesthetics. The Fractional Er:YAG Laser uses erbium-doped yttrium aluminium garnet as its medium.
All you need to know about Fractional CO2 Laser Skin Resurfacing
Learn more about Fractional Er:YAG Laser Skin Resurfacing
Both lasers fire beams of light into the deeper layers of the skin, thereby creating a grid of tiny openings.
Fractional Laser Skin Resurfacing Process
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.
Drop us a message to find out how many sessions you’ll need.
Quick Facts about Fractional CO2 & Er:YAG Laser Resurfacing:
Subcision, also called subcutaneous incisional surgery, is a minor procedure to treat atrophic scars.
A hypodermic needle is used to perform a subcision. The needle’s edge is used to sever 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.
Are you suitable for Acne Scar Treatment with Subcision? Find out now.
Quick Facts about Subcision and Atrophic Scar Levelling with Dermal Filler:
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.
The simplicity of TCA CROSS in Acne Scar Treatment
Quick Facts about TCA CROSS Atrophic Scar Treatment:
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.
Keloids can be difficult to diagnose and treat. 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.
At SL Aesthetic Clinic, we believe in tried and tested ways of 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.
Unless done by a professional with the right gear, picking at your acne will likely result in scarring.
This is because of several factors:
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.
Read more about Preventing Acne here.
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.
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.
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.
(may vary by the individual)
|Fractional CO2 Laser|
Suitable for atrophic scars such as rolling and superficial boxcar scars.
Suitable for atrophic scars such as rolling as well as bound-down and tethered scars, chickenpox scars, and stretchable scars from injury or surgery.
Suitable for atrophic scars such as boxcar, rolling and ice-pick scars.
[21 Apr 2021] Written by Dr. Wei Xiang
Dr Wei Xiang has been heavily involved in the arts throughout his life. During his formative school years, he studied fine arts under the prestigious Art Elective Programme, where he developed his artistic talent and creative expression across various media, including painting, charcoal, digital media and photography.
After graduating from the Yong Loo Lin School of Medicine in 2014, Wei Xiang pursued postgraduate surgical training in a residency programme, where he honed his surgical skills over the years. His artistic side remained strong, and he constantly yearned to express a greater aesthetic element in his work. In 2019, he left his surgical career in search of his calling.
A fateful encounter with Dr Kelvin Chua brought Wei Xiang into the world of Aesthetic Medicine. It was in Aesthetic Medicine where Wei Xiang found his “ikigai” of sorts. Under Kelvin’s mentorship, Wei Xiang grew steadily and became adept at a wide range of aesthetic procedures including Botox, fillers, lasers, HIFU, Thermage, Ultherapy and PicoCare Laser. His keen eye for beauty, coupled with his steady hands, allows him to bring out the best in his patients.
Wei Xiang occasionally still creates artwork in his free time, when he is not spending time with his wife and daughter, or jamming and making music.
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