You’ve had one of your worse outbreaks and have battled a few weeks to try and get rid of the acne with lots of different cleansers, creams, and you have won the battle. The relief is huge. But it isn’t over. Depending on how severe the episode, you can be left with different degrees of scarring. This can range from red patches of the skin to deep marks that are very obvious and hard to hide.

Don’t worry, you are not alone, by mid-teens more than 40% of people have acne and/or acne scarring that requires treatment by a medical professional and this spills over to adult-hood. So how do you get out of it? No worries, as we’ve got you covered with our Ultimate Guide to Acne & Scarring Treatments.

Dive into our guide to help kick-start your acne-fighting journey and bid goodbye to the scars. And no, we don’t mean by applying concealers and foundation because your skin is just recovering and many cosmetic products can prolong that process, or cause another outbreak.

So let’s understand how acne scars are formed and in the second half, we will share the types of treatments that will help to reduce these scars.

 

Formation of Acne Scars:

The cause of Acne Scars is as its’ name suggests, Acne. Acne lesions or pimples happen when the hair follicles or ‘pores’ on the skin become plugged with oil, sebum and dead skin cells. A plugged follicle is the perfect place for bacteria to grow, cause inflammation and create pus-filled red bumps known as pimples. The prolonged and deep-seated inflammation in the dermis layer of your skin, caused by acne, results in the formation of acne scars.

As the wound/ pimples heal, there is an alteration of the normal skin architecture with accumulation of scar-type cells in the area affected thus resulting in scar formation.

 

Types of Acne Scars:

There are many different types of acne scars. Understanding and identifying the type(s) of acne scars that you have is possibly the MOST important step in the treatment of Acne Scars.

This is because different scars will require different types of treatment(s) as there is NO one-size-fits all treatment method.

For eg. Some scars will respond to fractional lasers while others may not.

The illustration below explains the different types of acne scars.

Types of Acne Scars

Acne Scars Examples

Different types of acne scars and their appearance

Rolling Scars:  Wide base, rounded edges

Ice Pick Scars: Small entry point with sharp steep edges; like a “V”

Boxcar Scars: Wider base, sharply demarcated edges; like a box; They can be superficial or deep.

Pigmented scars: Dark spots /discoloration left behind by acne.

Hypertrophic scars and Keloids: Raised, thick scars

Many a time, we are affected not just by 1 scar type but a combination of scar types.

For example, I have seen many patients who had previously been treated with multiple sessions of just 1 treatment method and found results disappointing with many having lost hope. This was because of 2 main reasons:

  • The treatment method used was not appropriate for the type of scars that the patient had (it is common to see the Fractional Laser being used for all types of scars although it MAY NOT be the ideal treatment of choice for some scar types)
  • The patients had a combination of different types of scars and the 1 treatment method that was offered to them was NOT able to treat all the different types of scars optimally.

Another example would be a patient of mine who had paid a huge sum for multiple treatments of Microneedle Radiofrequency/ Infini for his Ice Pick and Box scars but ultimately only had minimal results. This boils down to wrong treatment method for the wrong type of Scars.

Every scar in itself is different and unique, and as such, different treatments and techniques will be required to treat each individual scar type so as to achieve optimal results.

There are many different types of acne scar treatments available and each type of treatment may be applicable to some but not others. As such, a consultation with a medical professional experienced in scar treatments is much advised.

 

When should we treat Acne Scars?

Treating Acne Scars early often results in the best results. New and freshly formed Acne Scars generally react best to treatment with better results obtained. So do not delay treatment for too long if possible.

 

Can Acne Scars be treated together with Active Acne or when I am on oral Isotretinoin (ie. Roaccutane / Acnotin / Oratane)?

Absolutely! I often treat patients with scars whilst treating their active acne at the same time. Conditions do vary amongst individuals and an examination would have to be performed first to determine suitability. Additionally, there is new research that show that Acne Scar treatments can be safely administered while on Oral Isotretinoin. 

So, How do we treat these scars?

As mentioned earlier, Acne itself is the precursor or cause of Acne Scar formation. It is thus very, very important to treat Acne as soon as possible in its’ early stages so as to prevent scar formation. Rest assured that no matter how severe your acne is, do not give up and lose hope as there are many effective treatments available nowadays. 

Treating Acne Scars as you all know by now is dependent on the type of scar.

Below is a guide that depicts the different treatments that work for each scar type:

1 . Ice pick scars:

 

Treatments:

  • TCA CROSS
  • Punch Excision
  • Refinement with Fractional Lasers

2. Box Scars:

Treatments:

  • Subscision +/- Collagen stimulators (for certain types of Box Scars)
  • Fractional CO2 Lasers
  • Fractional Erbium Lasers
  • Fractional Radiofrequency
  • Fully Ablative Lasers
  • Punch Excision
  • Fillers (certain types of Box Scars)

3. Rolling Scars

 

Treatments:

  • Subscision +/- Collagen stimulators
  • Fractional CO2 Lasers
  • Fractional Erbium Lasers
  • Fractional Radiofrequency
  • Microneedle Radiofrequency
  • Filler

4. Pigmented Scars

Treatments:

  • Pigment specific Q-Switch Lasers / Pico Lasers
  • Topical lightening creams

 5. Hypertrophic Scars/Keloid

Treatments:

  • Injectable steroids
  • Fractional Lasers

As you can see, there are many treatments available and it can be confusing but as long as the right/ appropriate treatments are used on the right type of scar and with the right settings, they can be very effective with good results.

That being said, the outcome of all Acne Scar treatments are dependent on the person administering the treatment so be sure to seek a medical professional experienced in Acne Scar treatments.

For example, there are hundreds of different settings for each type of laser and different ways to administer the laser (angled/ non-angled/ overlapped/ non-overlapped/ coverage/ pulse widths etc). Sub-optimal settings and/or the wrong treatment method for the wrong type of scars will not produce significant (if any) results.

 

What kind of results can I expect after acne scar treatments?

Good results can be in the range of approximately 80 – 90%.

For Acne Scars, the normal skin architecture has been lost and as such it is not possible to guarantee a 100% removal of Acne Scars.

 

So, What is the best Acne Scar treatment available now?

There is NO best Acne Scar treatment. Every type of scar has to be examined and treated according to what is most effective for it.

For example, there are tons of acne scar machines around but most importantly, only in the right hands and with the right machine settings can good results be achieved.

So do be wary with advertisements that claim to have the best acne scar machine because Acne Scar treatment results are largely operator-dependent and there is NO one machine that can offer the best results for all scar types.

 

Additional: Brief Explanation on the different Types of treatment to treat acne scarring

Subscision

 subcision 

This is a method whereby the scar tissue is manually released by using a needle to loosen the scar tissue beneath the skin. This method is sometimes essential in treating certain scar types and is commonly used in combination with other treatment modalities such as collagen stimulators/ spacers.

Subscision may look simple but it is a manual method that really requires good technique and when done correctly, it can yield effective results.
 

How is this procedure performed?

First, an anaesthetic is administered to the area that is to be treated to ensure maximum comfort. Then, the scar is released by loosening the scar tissue beneath it via a needle.

The process takes around 30 mins, is comfortable and there is minimal downtime.

Is it painful?

This procedure may look and sound scary, but we have had customers actually fall asleep during this procedure! It is generally a comfortable procedure.

How many sessions is required?

It can range from just 1 session to 3 or more sessions.

 

eCO2 Fractional Laser

The eCO2 laser is the premier fractional ablative laser that delivers exceptional, effective results using advanced technology to minimize downtime, increase patient safety and maximize comfort. 

Multiple Micro-Ablative Columns are emitted to destroy and break up scar tissue and regenerate collagen so as to smoothen the skin and remove acne scars.

Controlled Chaos Technology (CCT™) that creates Micro-Ablative Columns deep into the scars to achieve excellent results.

 

How is the procedure performed?

Numbing cream will first be applied before the procedure to ensure maximum comfort during the procedure.

The procedure itself is quick and takes about 15 mins.

What should I expect after the procedure?

Redness is to be expected after the procedure followed by micro-crusts and should resolve in a week.

When will I see the results?

Results can be seen with each session and subsequent sessions may be required to achieve optimal results.

How often can this procedure be performed? 

Each Acne Scar treatment interval is 4 – 6 weeks.

 

Venus Viva Radiofrequency Skin Resurfacing

The Venus Viva is a Radiofrequency (RF) machine that utilises its Nanotechnology to effectively treat different scars with less downtime as compared to the CO2 or Erbium laser treatment.

Multiple columns of RF energy are emitted into the scars to break the scar tissue up AND stimulate new collagen. This effectively evens out the scars and improves the texture of the scarred areas. Additionally, there is also a firming effect due to collagen remodeling.

Treatment itself is quick (about 15 – 30 mins) and numbing cream will be sufficiently applied to ensure that it is comfortable.

Some redness is to be expected for a few days to a week.

 

 TCA Cross Technique

 

This is a technique where by TCA acid is carefully applied to individual acne scars to “fill” up the depression and make the scar less depressed.

This technique is especially useful in Ice-pick scars and some Box-car scars.

The number of sessions required will depend on the severity of the scar.

The concentration of acid used in this technique is very high and as such should only be administered by a medical professional to ensure maximum safety.

 

Micro-Needle Radiofrequency treatment

 

For deeper/ rolling scars, the Micro-Needle Radiofrequency Treatment can be used. This method of treatment is effective for stubborn/ deeper rolling acne scars as it can penetrate more deeply into the skin.

Gold-plated ultra-fine needles first smoothly penetrates deep acne scars before emitting radiofrequency energy to break up the scar tissue and stimulate collagen.

It is a great treatment for acne scars that requires deeper penetration of energy and a more intense approach.

Despite being able to penetrate more deeply, downtime is actually still kept to a minimum of a few days to a week.

 

Punch Excision

Punch Excisions can be used for Ice Pick Scars and Box Scars. The treatment method involves removing the entire scar unit but requires closure of the wound with sutures. As such, the depressed scar is replaced with a linear scar due to closure of the wound during the Punch Excision. The linear scar can subsequently be treated with skin resurfacing techniques to make it less obvious.

 

Fillers

In certain cases, fillers can be used to fill up depressed scars to smoothen out the skin surface. This is especially effective for Rolling Scars and certain Box Scars.

Anaesthetic is first administered to the entry point of the area that is to be filled, and then the filler is administered via the entry point to raise the depressed scar.

The advantages of fillers are that effects are seen immediately, and MINIMAL to NO downtime is required.

Do note that Filler results are NOT PERMANENT and generally lasts 9 – 12 months.

 

Spectra XT Laser

 

The Spectra XT is called “The Extended Platform” because of its widely-extended clinical indications and applications as compared to previous similar devices.

The procedure is safe on all skin types and is a fantastic way to treat Acne Scar pigmentation and redness without downtime as compared to the other laser treatments.

Benefits:

  • Brightens & lightens acne scar pigments
  • Reduces all types of acne
  • Controls sebum production
  • Reduces redness from inflamed acne

Common mistakes people make when they have acne

Here are some common mistakes people make, subconsciously, which does not help in reducing acne scars.

Not patient when receiving acne removal treatments

Skin takes time to respond to treatment. Even if the acne came on fast, it still requires time to heal. That usually takes between 6 and 12 weeks. In some cases, your skin might feel a bit irritated the first couple of weeks of treatment.

Trying too many products at one time

One thing you shouldn’t do to deal with acne scars is load up your face with too many differnet products, masks or fancy lotions — these won’t help and may irritate your skin further, making the scars redder and even more noticeable.

Over-scrubbing

Acne is not dirt. Constant scrubbing will only leave your skin red raw and more inflamed than before. Use gentle, non-oily cleansers on a daily basis and professional treatments as recommended by doctors.

Popping and overtouching the face

Popping and picking pimples prolongs healing time, causes more inflammation and increases the risk of scarring. Infected material can also lead to more swelling and inflammation.

Not applying sunblock

Sunblock helps to protect our skin from the harmful UV and UVB rays. Exposure to UV rays causes more skin damage, delays healing and can worsen acne scar pigmented marks, therefore wearing a good sunscreen is important, and yes, we mean everyday, regardless of whether indoor or outdoor.

 

Conclusion

In a nutshell, treating acne scars is a complex field. One may often request for one particular acne scar treatment that they had researched extensively, however as mentioned in the article, treating Acne Scars successfully is determined by 2 main factors:

  • Expertise
  • Using the correct treatment for the right scar type

 There are no fixed rules to achieve perfect results, but there are certainly poor techniques that ensure suboptimal results. 

I hope this guide has managed to shed some light on Acne Scars and its’ treatments whilst giving you a broader understanding and perspective on this condition.

Dr Ho Rui Ming brings with him a wealth of experience and qualifications, combined with a deep passion for all things aesthetics related, especially Acne Scar and Acne treatments.

He also has been awarded several Certificates of Competence, recognised by the Singapore Aesthetic Practice Oversight Committee ensuring Dr Ho’s skillsets and practices are in full adherence to strict standards.

There are many different types of acne scars. Different scars will require different types of treatment(s) as there is NO one-size-fits all treatment method.

Enquire within now.