If you chanced on this post with the question "How to get rid of acne scars?", you're not alone. It's one of the most common skin problems that patients send in an enquiry on DoctorxDentist for.
Dealing with acne in your youth is bad enough, but the scars it leaves behind can be a real nightmare. Don't waste your time and money on treatments that don't work. Before coming to see me, it’s not uncommon for patients to try completely ineffective methods, from DIY home treatments to beauty spa facials and underpowered lasers.
I decided to write this comprehensive guide to increase awareness about your best options when it comes to treating acne scars in Singapore, based on my personal experience over the years. Bear with me as it's a long read (3000+ words in total), but I promise to tell you everything you need to know about getting rid of those pesky scars.
First things first...
What is an acne scar?
You may have an acne mark (not permanent), instead of an acne scar (permanent). My patients often mistake dark acne marks for acne scars. It's important to distinguish between the two.
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 and sunscreen.
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 are the types of acne scars?
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?
This is the million-dollar question my patients often ask.
In a nutshell, the answer is 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 and topical creams.
If you want to prevent acne before you encounter any symptoms, I usually give these lifestyle tips to my patients:
- Diet - avoid food and drinks that are high in sugar  and dairy products 
- Stress is a known trigger of acne. Lead a healthy lifestyle to help to de-stress.
- Stick to cosmetics and skin-care products that are suitable for your skin.
- Go light on makeup
Most important tip: Do NOT squeeze or pop your pimples! It’s tempting but please do not pop your pimples as the infection might spread and the injury might cause worse scarring.
If you think your acne might be starting to scar, or you have family members with acne scars, see your doctor or skin specialist ASAP 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 has with acne scar treatment?
- Number of treatments required
- 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 3 - 5 x sessions of laser resurfacing, 1 x subcision and 1 x non-ablative laser at a total cost of $4000.
To give you a sense of the average price range:
- Mild to moderate acne scar treatment in Singapore costs: $1800 - $3000
- Severe acne scar treatment in Singapore costs: $2800 - $5000
How much improvement can I expect after acne scar treatment?
In 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. The law of diminishing returns applies - eg. after achieving 90%, it's much more difficult to attain another 5 - 10% of scar improvement.
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:
- Laser treatment eg. fractional CO2 laser, fractional erbium lasers
- Radiofrequency (RF) microneedling eg. INFINI
- Chemical peels eg. TCA CROSS
- Punch excision/grafting
- Dermal fillers eg. Restylane, Juvederm, Rejuran S, Stylage
Each of these treatments targets a specific type of acne scars.
If you have multiple types of scars, you will require a comprehensive and customised acne scar treatment that consists of lasers, peels and injectable procedures like subcision and fillers.
2 or 3 types of treatments can be performed per treatment session to target each type of acne scar that you have. For example, if you have rolling scars and box-scar acne scars, your doctor might perform subcision to release the fibrous bands under your skin followed by general laser skin resurfacing using Fractional CO2 lasers or INFINI Micro-needling Radio-frequency.
If you have more serious scarring, other treatments might be needed at the same time as well.
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 removal treatment should I pick?
The best acne scar removal treatment results that you’ll get require specialised treatment for each scar.
To obtain the best results, you need a customised 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 microneedling. Punch grafting and dermal fillers are also good options.
- Tethered and anchored scars are best treated with subcision.
Confused? I would be too, in your shoes. You should, therefore, let your doctor advise you on the right acne scar treatments.
My role is just to give you an overview of all the effective treatments so that you have all the information you need in discussions with your doctor.
How to get rid of acne scars in Singapore?
1. Laser Treatments
Laser treatments can be helpful for both acne scars and acne marks (post-inflammatory hyperpigmentation).
Pulse-dye lasers are useful in reducing the redness associated with acne marks/PIH and have minimal downtime.
Fractional C02 laser is effective for treating most kinds of atrophic acne scar and has a downtime of 5 - 10 days. It's by far one of the most common acne scar treatments in Singapore because it works. 
Pico + Hexa MLA laser is effective in treating both shallow and deep acne scars. This is a new skin laser equipment that is able to target the scars with more precision, 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.
Laser treatment cost in Singapore are as follows:
- Pulse-dye laser costs $250 - $400/session.
- Fractional laser costs $500 - $1000/session.
- Both require 2 - 3 sessions for the best results.
2. Radiofrequency Microneedling
Radiofrequency (RF) microneedling treatments, such as the Venus Viva and INFINI system use small needles to deliver heat energy to the skin. This stimulates collagen production and acne scar remodelling.
RF microneedling is ideal for rolling, atrophic, mixed, and tethered scars. Healing time is quicker than lasers - often within 48 hours. There's also less chance of hyperpigmentation. Improvements are expected up to 6 months post-treatment.
Further reading on RF microneedling:
- Is microneedling a good alternative to fractional lasers for moderately severe acne scars?
- Is it safe for a beauty salon to carry out a microneedling or dermarolling procedure?
3. Chemical Peels
Many doctors don't like chemical peels because results can be unpredictable. Some types of acne scarring require a deeper peel, while certain parts of the face also absorb the chemical peel more than others. 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 $130/session, and $350 for 3 sessions. 2 - 3 sessions are usually required for the best results.
4. Subscision of scars
Acne scars are sometimes depressed due to fibrous scar tissue that pull 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 subscision 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.
Subscision cost in Singapore: Typical prices are around $100 - $300/session, for up to 5 sites. Optimum results may require 1 - 4 sessions.
- How effective is subcision without fillers?
- Why are multiple subcision sessions required for acne scars?
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: $200 - $350/session, depending on the number of sites.
6. Dermal Fillers: Restylane and Juvederm
Fillers such as Restylane, Juvederm and Rejuran 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.
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. 
Dermal fillers cost in Singapore: Restylane, Juvederm, Rejuran and Stylage costs about $700 - $1000/syringe. 2 syringes are typically used per session, which costs from $1400.
7. Any new treatments available?
The forefront of acne scar removal is in the realm of Regenerative Medicine.
While lasers and subcision improve scars through controlled injury to your skin, regenerative medicine technologies improve your skin via a different method - they improve your skin’s healing ability.
The latest treatments involve using cell-conditioned media serums which contain growth factors to boost your skin’s recovery after acne scar treatments like lasers, chemical peels and subcision.
Objectively, acne scars were reduced by 23.5% with the use of stem cell conditioned media after Fractional CO2 laser versus 15% with laser treatment alone. 
This new development is important because patients with stubborn scars might find that their results have plateaued with just traditional treatments alone.
Brands of growth factors and cell-conditioned media in Singapore include AnteAge and Calcium.
What does recent research say?
The latest research shows that a combination of acne scar laser treatments at medium settings gives better results and more safety than using 1 type of treatment at high settings.
In this study, the 2 laser treatments are Fractional CO2 Laser and Fractional Microneedling RF. Fractional CO2 Laser is an ablative laser which is good for resurfacing shallow scars and pores while Fractional Microneedling RF is a non-ablative laser which is better for collagen stimulation and scar remodelling at the deeper aspects of your skin. Some Fractional Microneedling RF devices such as INFINI can go up to 3.5mm deep. 
I routinely combine 2 types of lasers per treatment session for better results. In fact, the recovery time is shorter when I use 2 types of lasers at medium settings compared to using 1 type of laser at high settings.
Should you see a dermatologist or aesthetic doctor for acne scars?
Acne scars can be treated by dermatologists and doctors with a special interest in aesthetics. Some plastic surgeons also perform acne scar revision treatments.
This is because the treatment of acne scars requires treatments and skill-sets which are very broad. For example, apart from lasers and chemical peels, dermal filler injections are also used to improve the appearance of scars.
While these groups of doctors are all qualified to perform acne scar treatments, It’s worth noting that not every doctor has a focus on treating acne scars.
Apart from training and experience, it is also important to choose a doctor who has a comprehensive set-up of lasers and treatments for acne scars in their clinic. Ultimately, it is important that you find a sincere doctor who is passionate about the treatment of your acne scars and that you are comfortable with.
In fact, even the convenience of your doctor’s clinic also plays a big part in your decision. After all, acne scar treatments are every 1-2 months and 5 to 10 sessions of treatments might be needed. This means that you should find a doctor that you are comfortable seeing for the next 6 to 18 months.
Make your decision wisely!
Ok, how do I find the best acne scar doctor in Singapore?
The improvements in your acne scarring depend on your doctor and the specialised technology or treatments that are available at his disposal.
I give my patients this analogy:
An acne scar doctor is much like a painter. A painter requires quality paint and paintbrushes to produce a world-class painting. For a painter is only given blank ink, all his paintings will be in black and white. If he is given red, green and blue ink, he can produce a multi-colored painting in almost any color.
An acne scar doctor should have these qualities:
- Detail-oriented - You don’t want your doctor to miss any scars!
- Good understanding of laser technology and skin
- Experience in acne scar treatments
It is equally important to look at the lasers and technology available in his clinic. This is because there are many different types of acne scars and each type of scar will require specialised treatments for optimal results. Acne scar treatments and lasers that a specialised acne scar clinic should offer are:
- Fractional CO2/ Erbium Lasers
- Pico Laser
- Fractional Microneedling Radiofrequency
- Dermal Fillers
- TCA Cross chemical peel
There are other acne scar treatments that can treat acne scars but those are more niche.
What happens during the first acne scar consultation?
Acne scar treatments start with a detailed consultation and skin analysis with your doctor. Price of acne scar consultations in Singapore can range from $50 to $120.
During my consultations, I discuss the following issues and concerns:
Your expectations and goals from acne scar treatments.
E.g. How much improvements are you expecting?
Any timeline or deadlines that you are working towards?
E.g. Working towards smoother skin in time for your wedding in 9 months time.
Your ability to take social downtime.
Most acne scar treatments have some redness, swelling or even bruising that can last from 1 to 5 days. It is best to discuss your ability or willingness to take social downtime during your post-treatment recovery phase.
Acne scar treatments can range from $500 for 1 treatment session to more than $6000 for a comprehensive course of 10 treatment sessions with each session involving multiple types of treatments.
I believe that everyone can benefit from smoother skin. A good acne scar doctor will be able to advise you on the best treatments to achieve the maximum benefit with your budget.
Past medical history
Previous acne scar treatments: More than 50% of my patients who come to me for acne scar treatments have tried treatments elsewhere before. Based on their results and recovery from their previous treatments, I customise a treatment plan to further improve their skin and fade their scars.
Often times, what has NOT worked well for my patients is equally important as the treatments that have worked. Understanding this allows me to tailor a treatment plan that works well.
During the first consultation your acne scar doctor will do a thorough skin analysis:
During my skin analysis, I will look out for the following:
Types of Acne Scars
The type of acne scars that you have will determine the types of treatment that you need. For example, hypertrophic scars will require cortisone injections while box-car scars will require subcision and fractional lasers.
The severity of Acne Scars
The severity or depth of your acne scars will determine that number of treatment sessions that you need. For example, shallow rolling scars will require 2-3 sessions of fractional CO2 Lasers while deeper rolling scars can require close to 10 sessions of fractional CO2 Lasers.
Also, if your rolling scars are very deep, you might need more than laser treatments. You might need subcision and fillers to get satisfactory results.
Location of Acne Scars
The location of your acne scars determines the number of sessions of treatments that you need too. For example, box-car scars at your nose are harder to treat than those at your cheeks.
The density of Acne Scars
If your acne scars are clustered in a small area, you might be able to have a smaller treatment area. For example, if your scars are only at your nose, we can perform laser treatments specifically at the nose region. This reduces the recovery time and social downtime that you have to bear with.
Scars can look more obvious under certain lighting. For a detailed analysis of your skin, your doctor should look at your skin and scars with lighting shone from different angles. It is possible to miss out smaller scars without assessing your skin under angled lighting.
Your biggest concerns
Everyone has some scars and it might not be practical to treat all scars. Ultimately, I focus on treating the scars that bother my patients the most.
Some of my patients are very concerned about that scars that they feel are hardest to conceal or are in the most visible location. These scars that bother you might be different from those that your doctor proposes to treat.
Clear communication is the key to establish your treatment goals.
What questions should I ask my acne scars doctor?
An essential question is “How much improvements/results can I expect?”
Your doctor should be able to answer the estimated amount of improvement in your scars with the number and types of treatments that you undergo.
Another important question is “What are the complications/ side-effects?”
Acne scar treatments are medical treatments and not merely cosmetic procedures. All medical treatments carry benefits and risks. Your acne scar doctor should give you a clear understanding of the risks and potential complications of each type of acne scar treatment that you undergo. More importantly, he should also be able to tell you how he will rectify or troubleshoot complications, should they occur.
You wouldn’t want new scars from your acne scar treatment, would you? Entrust your skin to an expert.
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.
There are no set rules for achieving a perfect result, but there are certainly poor techniques that ensure suboptimal results. Always consider seeking the opinion of multiple doctors before proceeding with any treatment.
Dr Justin Boey is a medical doctor with Sozo Aesthetic Clinic. Dr Boey has a special interest in Facial Aesthetics relating to pigmentation, acne scars, and facelift, as well as Hair Loss.