Is microneedling a good alternative to fractional lasers for moderately severe acne scars?

Doctor's Answers 4

Sunken acne scars are also known as atrophic acne scars. These are shown to benefit from two main types of procedures:

1. Skin resurfacing (microneedling, fractional radiofrequency, various fractional lasers)
2. Subcision with or without fillers and biostimulators

I would suggest a proper assessment by an experienced doctor who is familiar with all these options, especially if you have never been offered them before. Sometimes, a single session of subcision can help more than multiple sessions of skin resurfacing, and hence be much more cost-saving. There are also various fractional lasers that have different effects for different scar types.

I agree with Dr Justin that fractional radiofrequency can definitely help more than microneedling (even with good stem cell serums), and I own a fractional radiofrequency device at my clinic too. However, this device may not be suitable for all scars. It is useful for rolling scars, and other devices are still required for different scar types. Fractional microneedling also break the top layer of the skin and can cause increased downtime if used to deep depths, higher risk of infection/acne and also increased sensitivity initially (just like lasers).

If you have deep rolling or box scars, fractional non-ablative lasers like the erbium-glass laser are a proven better option than fractional radiofrequency according to this study (Comparative study on efficacy and safety of 1550 nm Er:Glass fractional laser and fractional radiofrequency microneedle device for facial atrophic acne scar.) A proper assessment is still crucial before any treatment.

It is a misconception that lasers make the skin thinner and more sensitive. If done appropriately and with proper rest intervals, lasers increase the thickness of the skin and can even decrease skin sensitivity. Similar to fractional radiofrequency and microneedling, the skin can be more sensitive during the initial healing phase, so proper post-care is also important.

Microneedling can be an alternative treatment since you are increasingly getting more sensitive to fractional CO2 laser. However, it must be known that you may need many more treatments and it may not be as effective for deeper scars. In my personal opinion, I do not think the cost will be a lot lower given the more sessions you may need but if sensitive skin is a major concern, then yes, it can be an alternative treatment.

Although fractional CO2 laser does not thin the skin, it certainly can make your skin more sensitive in some cases. The way to overcome that is not to do the fractional CO2 laser too closely and give enough rest time in between. The other important thing to note is the aftercare after fractional CO2 laser is of paramount importance in avoiding or reducing the chance of sensitivity. The power and level of fractional CO2 laser are also very important and depends on the expertise of the doctor in knowing how sensitive your skin is and what you will be able to handle for optimal results and yet with good safety margin.

From the thousands of fractional CO2 lasers done, I have only seen a small handful of patients getting sensitive and proper counselling, intervals of treatment and power used are very important.

Other alternatives to scar treatment include subcisions (for the brave ones) and dermal fillers. I do not think there is a place in fractional radiofrequency as the results are poor and I have seen the trend died almost as quickly as it appeared. Buying some of these machines is a waste of money and I think if we have a useless machine, we should just write it off instead of passing the cost to patients. As such if you think of the price, it's certainly not even cost-effective as well.

Micro-needling gives good results for superficial acne scars over multiple sessions. However, it is unlikely to give good results for deep acne scars.

For deep/severe acne scars, you would still need Fractional micro-needling Radiofrequency, like Infini, which can deliver RF energy to depths that Fractional CO2 cannot reach. Devices like Infini can deliver RF energy up to depths of 3.5mm, whereas Fractional CO2 delivers energy up to 1mm deep.

Please consult a doctor for a more detailed discussion. Hope that this helps!

Warmest regards,

Dr Justin Boey

Hello Jinnywong

Microneedling has been used for a long time but it is probably not enough to treat moderate to severe sunken acne scars.

The best acne scar treatment really depends on the type of scars you have

  • Ice pick - TCA cross
  • Tethered scars - Subcision
  • Box/ Rolling scars - Fractional laser resurfacing/ Microneedling RF

If your scars are predominantly ice pick and tethered rolling scars, you can expect improvement with just a few sessions of TCA cross and scar subcision. This will usually be cheaper than a few sessions of fractional laser/ microneedling RF. Consult a doctor to get an accurate assessment first before proceeding.

Hope this helps!

Regards

Dr Jiwei Wu

Similar Questions

Is PRP injection available for acne scarring in Singapore?

PRP at the present moment is not available in Singapore. It does help with acne scarring though, and you might have to go to neighbouring countries to do the treatment (including Malaysia). Having said that, you can consider Rejuran/skin boosters/microneedling that can help in a similar fashion. Your 2nd question on which is better — it depends on the severity and type of scars. But usually Fractional laser is the backbone of laser therapy. So consult your doctor early to discuss the available options.

Photo of Dr Winston  Lee

Answered By

Dr Winston Lee

Aesthetic

How many sessions of fractional laser is required for mild to moderate acne scars?

With regards to your question, The number of sessions really depends on 2 main factors: How your skin reacts to the treatment. For some individuals, good results may be seen after 3 sessions whilst others may require 6 or even more sessions. The depth of penetration of the laser. If mild settings are used then more sessions may be required and results may not be as satisfactory. Additionally, as Dr Chua CY has pointed out, combination treatments usually yield more effective results. I personally do not usually just stick with one kind of treatment modality to treat acne scars.

Photo of Dr Rui Ming Ho

Answered By

Dr Rui Ming Ho

Aesthetic

Ask any health question for free

I’m not so sure about a procedure...

Ask Icon Ask a Question

Join Human

Sign up now for a free Human account to get answers from specialists in Singapore.

Sign Up

Get The Pill

Be healthier with our Bite-sized health news straight in your inbox