Dealing with acne in your youth is bad enough, but the scars left behind can be a real nightmare.
New patients often ask me 2 common questions about acne scars and their treatment:
- “I’ve tried one laser session before. Why don’t I see results yet?”
- “I still have acne scars and uneven skin texture despite 10 sessions of chemical peels. Why?”
Don't waste your time and money on treatments that don't work
From DIY home treatments to beauty spa facials, and underpowered lasers; you name it, they've tried it.
First things first, what exactly is an acne scar?
- You may have an acne mark (not permanent), instead of an acne scar (permanent)
First of all, you must know that it's important to distinguish between the two. My patients often mistake dark acne marks for acne scars.
- Acne marks are also known as post-inflammatory hyperpigmentation (PIH)
These dark coloured spots are left behind when a pimple goes away and can be red or brown coloured. They generally disappear on their own within 3 - 6 months.
You can expedite the process with a diligent treatment of topical retinoid cream, sunscreen, and pico laser treatments.
Also read: A Complete Guide To Pico Lasers In Singapore
- Acne scars are permanent depressions or elevation on the skin
They can result from cystic acne (big, red, and tender pimples) or inflamed pustular acne (whitish pus-filled pimples), especially if you pick/pop them!
What kind of acne scar do you have?
- Atrophic acne scars appear as depressions in the skin.
The 3 main categories of atrophic scars are:
- Ice pick scars: Deeper than they are wide, with a narrow opening
- Boxcar scars: Broad, rectangular depressions with steep, defined edges
- Rolling scars: Broad depressions that have rounded, sloping edges
- Acne scars can also be elevated.
This includes raised hypertrophic scars and keloid acne scars. Acne scarring may also appear as very enlarged pores.
Is acne scarring preventable?
Yes! If scarring acne (usually cystic or pustular acne) is stopped early in its tracks with aggressive treatment, you can avoid acne scars completely.
This usually involves treatment with oral isotretinoin, topical creams, and laser treatments.
Hence, if you think your acne might be starting to scar, or you have family members with acne scars, see your doctor or dermatologist as soon as possible to get started on the appropriate treatment. 
Who should you find in Singapore for acne scar treatment?
In Singapore, dermatologists and doctors with an interest in the skin can help with acne scar treatment. It's useful to seek the opinion of a few doctors.
In particular, you should find out:
- How much experience he or she has with acne scar treatment
- Number and types of treatments that you require
- Set-up of lasers and/or technology that he has for acne scars
- Realistic expectations of outcomes and improvement - ask him to show you a couple of before and after photos of patients he has treated
How much does acne scar treatment in Singapore cost?
This depends on the type and extent of scarring you have, and the nature of treatment required.
To illustrate: For severe and extensive acne scars, your doctor may suggest three to five sessions of laser resurfacing, one session of subcision, and one session of non-ablative laser treatment at a total cost of $5,000.
After surveying more than 30+ clinics that offer acne scar treatments, the average price range of acne scar removal in Singapore is:
- Mild to moderate acne scar treatment in Singapore costs: $1,800 - $3,500
- Severe acne scar treatment in Singapore costs: $2,800 - $8,000
How much improvement can I expect after acne scar treatment?
From my experience, most patients can expect an average improvement of 50 - 70% after treatment. For the majority of cases, patients see a 70 - 80% improvement in acne scars.
However, the law of diminishing returns applies. For example, after achieving 90%, it's much more more difficult to attain another 5 - 10% of scar improvement.
Therefore, the first few treatments often result in the greatest improvements.
The amount of improvement also depends on:
- the type and extent of acne scarring you have
- your skin type and skin response to treatment
For example, dark-skinned patients with atrophic scars may only see improvements of 50%, while patients with ice-pick scars or shallow box-car scars can see improvements of up to 80%.
What's the best acne scar treatment in Singapore?
The best acne scar treatments available in Singapore are:
1. Laser treatment eg. fractional CO2 laser
2. Radiofrequency (RF) microneedling eg. INFINI
3. Chemical peels eg. TCA CROSS
5. Punch excision/grafting
6. Dermal fillers eg. Juvederm, Restylane, Rejuran, Stylage
The treatment recommended by your doctor depends on:
- the type and extent of acne scarring you have
- the amount of downtime after treatment you're willing to accept
Which acne scar treatment should I pick?
To obtain the best results, you'll need a tailored approach to target your combination of acne scar with the ideal treatments.
- Ice pick scars and narrow boxcar scars respond well to TCA CROSS.
- Rolling scars and craters can be effectively treated with fractional lasers and RF micro-needling. Punch grafting and dermal fillers are also good options.
- Tethered and anchored scars are best treated with subscision.
Confused? I would be too if I were in your shoes. Therefore, you should let your doctor advise you on the right acne scar treatments.
How to get rid of acne scars?
1. Laser treatments
Laser treatments can be helpful for both acne scars and acne marks (post-inflammatory hyperpigmentation).
Fractional C02 laser is effective for treating most kinds of atrophic acne scars and has a downtime of 5 - 10 days. It is by far one of the most common acne scar treatments in Singapore because it works.
Fractional Pico lasers are also effective in treating both shallow and deep acne scars. This is a non-ablative skin laser resurfacing treatment that doesn’t damage the top layer of your skin (epidermis), resulting in shorter recovery time.
Laser treatment for acne scars takes considerable expertise to perform well. Experienced doctors know how to adjust the power setting of the laser according to the depth of acne scarring, and the part of the face being worked on.
Pulse-dye lasers are useful in reducing the redness associated with acne marks/PIH and have minimal downtime.
Laser treatment cost in Singapore: Pulse-dye laser costs $250 - $400/session. Fractional laser costs $500 - $1000/session. Both require 2 - 3 sessions for the best results.
2. Radiofrequency micro-needling
Radiofrequency (RF) micro-needling treatments, such as the INFINI system use small needles to deliver heat energy to the skin. This stimulates collagen production and acne scar remodelling.
RF micro-needling is ideal for rolling, atrophic, mixed, and tethered scars. Healing time is quicker than lasers - often within 48 hours.
Furthermore, there's also a lower chance of hyperpigmentation. This is because RF Micro-Needling is non-ablative - it doesn’t damage the epidermis.
Improvements are expected up to six months post-treatment.
Radiofrequency micro-needling cost in Singapore: Infini costs about $800 - $2000/session in Singapore. Three to five sessions are normally recommended.
3. Chemical peels
This makes calibration of a chemical peel extremely tricky - get it wrong, and it's ineffective at best, and disastrous at worst!
In my practice, I like to use a hybrid technique called TCA CROSS. This involves using a toothpick or needle to place TCA solution into deep acne scars, one at a time. The TCA solution stimulates collagen production, which levels out deep acne scars.
Time-consuming? You bet it is, but ice pick scars respond very well to this method. One treatment generally improves the scar by 30 - 40%. The deeper and narrower the scar, the better the results.
Chemical peel cost in Singapore: TCA CROSS costs roughly $200/session. 2 - 3 sessions are usually required for the best results.
4. Subcision of scars
Acne scars are sometimes depressed due to fibrous scar tissue that pulls down the surface of your skin.
In this situation, all the lasers and chemical peels in the world will have limited effect, as your skin surface is "tethered down" by these scar tissue.
With subcision, a small needle is used to release the fibrous scar tissue beneath the scar. As the area heals, the new collagen also helps to push the base of the acne scar up.
Scar subcision works best for shallow scars with a broad base, rather than on ice pick scars. You'll usually see small improvements in your acne scars after each treatment. The downside to subscision is the bruise that's left right after the procedure, which can last for 1 - 2 weeks.
Subcision cost in Singapore: Typical prices are around $100 - $300/session, for up to 5 sites. Optimum results may require 1 - 4 sessions.
5. Punch excision/grafting
Punch excision involves using a tiny hole-punch like device to cut out the acne scar. The wound is then sutured close, with the stitch removed within a week. It's best suited for icepick scars that have a narrow opening but are deep.
In punch grafting, after the scar is excised, a small piece of skin is taken from another site on the body (often from behind the ear).
The piece of skin removed is then placed into the hole where the acne scar once was. Both sites are then sutured closed, or held in place with surgical tape and allowed to heal on its own.
Punch excision cost in Singapore: $300 - $450/session, depending on the number of sites.
6. Dermal fillers: Juvederm, Restylane, Rejuran
Bellafill is the first FDA-approved dermal filler for permanently correcting moderate to severe acne scars. It's unfortunately not available in Singapore yet at the time of writing.
Fillers such as Restylane and Juvederm fillers are used to elevate shallow, broad-based acne scars. They are less commonly used in Singapore as the results are temporary, requiring repeat treatment every 6 - 8 months.
Expert Tip: Post-Treatment Recovery Skin Care is Essential
Post-treatment recovery skincare is essential for every laser treatment. They reduce recovery time, minimise side effects, and give better overall results.
This is particularly important for acne scar treatments because powerful lasers are used on skin that has a poorer healing ability.
An expert acne scar doctor will prioritise post-treatment recovery skincare highly.
Acne scar experts estimate that up to 30% of the final results of acne scar treatments are determined by good post-treatment recovery.
Common post-treatment recovery methods include:
- Regenerative medicine skincare which contain purified growth factors and cytokines shorten recovery time and improve skin healing: e.g. Calecim, AnteAge.
- Topical steroids reduce inflammation and reduce risks of post-inflammatory hyperpigmentation (PIH).
- Sun protection reduces risks of PIH too. Post-treatment skin is compromised skin which is more prone to PIH.
- Hydration using recovery masks
To sum up, treating acne scars is a complex field. I often see patients come into my practice requesting for one particular acne scar treatment that they had researched extensively.
It's important to bear in mind however that acne scar treatment is not a one-size-fits-all.
The best outcomes usually result from a combination of different methods, individualised to your skin type and scar.
Dr Justin Boey’s practice of aesthetic medicine centres around the busy modern individual. He is experienced in Facial Aesthetics (lasers and injections) and hair loss treatments. Learn more about him here.
He is a Key Opinion Leader and Physician Trainer in Southeast Asia for multiple aesthetic technologies including Stylage fillers, Enerjet and DermaSculpt micro-cannula. He is also a pioneer in Singapore for PicoPlus laser and Regenera Activa hair loss treatments. He believes in empowering patients with candid insights on aesthetics in his personal blog.