Acne Scar Removal in Singapore - should I get it?

Rolling Scars

• broad depressions with sloping edges
• commonly stuck down to the underlying Superficial muscular aponeurotic system (SMAS) layer by networks of fibrous scar tissue
• subcision and filler should be done first for tethered scars
• Fractional Radiofrequency, Fractional Lasers, Fractional Microneedling Radiofrequency will improve rolling scars. Dr Wan feels that Fractional Microneedling Radiofrequency gives the optimal balance between downtime and results

Ice Pick Scars

• deep, narrow, pitted scars
• CROSS reliably produces significant improvements
• targeted CO2 laser can also be used
• deep, larger isolated ice pick scars may be better treated with excision

Read more about our approach to the various ice-pick scar removal options.

Box Car Scars

• broad depressions with sharply defined edges
• can be stuck down to the deeper layers - these require subcision and filler
• small boxcar scars can be treated with CROSS
• isolated boxcar scars may be treated with excision, depending on the size and area

Papular Scars

• soft skin coloured elevations around hair follicles
• ablative laser can produce flattening

Post Inflammatory Erythema (PIE)

• localized skin redness following skin inflammation that may progress to scarring
• should be understood as a scar with erythematous components and not as a simple erythematous or vascular lesion
• Fractional Radiofrequency, Fractional Lasers, Fractional Microneedling Radiofrequency improve both PIE and concomitant active acne and scarring
• if there is low risk of progression to depressed scarring, vascular may be suitable

Hypertrophic / Keloid Scars

• steroid injections combined with vascular laser or fractional laser / radiofrequency
• topical silicone and steroids, pressure
• certain keloids may be treated by excision combined with steroid injections / fractional laser

Read more about our approach to the various keloid scar removal options.

Fractional Infrared Lasers for Acne Scar Removal

Fractional laser resurfacing scar removal treatment involves the deposition of a pixelated pattern of microscopic laser wounds surrounded by healthy tissue resulting in both greater efficacy and shorter downtime compared to non-fractionated treatments. It can be further subdivided into ablative and non-ablative. Ablative fractional lasers have longer wavelengths (e.g. CO2 10600nm) and lead to full-thickness destruction of skin, whereas non-ablative fractional lasers have shorter wavelengths (e.g. Erbium Glass 1550nm) and leave an intact skin surface. CO2 has greater efficacy compared with Erbium Glass but longer recovery time and a higher risk of complications.

Fractional Co2 Lasers have a good body of research evidence demonstrating safety and efficacy for deep acne scar removal in Singapore. These laser treatments are the gold standard treatment for scarring against which other treatments are compared.

Fractional Picosecond Laser - Discovery Pico Plus

Discovery Pico Plus is a second-generation triple wavelength picosecond laser that generates the highest peak power in the world. A special microlens array further focusses the energy into numerous micro-beams 2mm under the skin. The highly concentrated energy produces laser-induced optical breakdown (LIOB) stimulating scar remodeling.

One of the biggest advantages of Fractional Picosecond Laser treatments is that it stimulates collagen production with almost no downtime at all. This is due to the nature of the treatment and instrument that keeps damage to the skin layers to the very minimum. This also allows a shorter recovery period for you!

Fractional Bipolar Radiofrequency for Acne Scar treatment

Fractional Radiofrequency creates a pyramidal thermal injury zone (a relatively large coagulation zone deep in the skin with minimal surface damage) as opposed to the columnar shape of ablative lasers. Hence Fractional Radiofrequency has a favourable side-effect profile (such as downtime, post-inflammatory hyperpigmentation) in comparison to fractional lasers.

Fractional Microneedle Radiofrequency for Acne Scar removal

Scar remodelling requires heat delivery to the deep part of the skin. However, in most machine-based treatments for scarring such as lasers, much of the energy is dissipated at the skin surface and little reaches the deep layers. Fractional microneedle radiofrequency overcomes this using insulated microneedles to spare the upper part of the skin and deliver radiofrequency energy precisely up to 4mm deep in the skin, resulting in faster recovery, higher efficacy and increased safety in treating acne scars.

Vascular lasers / Intense Pulsed Light Treatments

Vascular lasers (such as pulsed dye lasers, yellow lasers, long-pulsed diode or NdYAG) target haemoglobin in blood vessels destroying them. They are useful for hypertrophic / keloid acne scars and fresh stretch marks. Intense Pulsed Light used for acne scar removal in Singapore together with special vascular filters can be used for similar purposes as well but is generally less powerful. The advantage of IPL is its minimal downtime -- you could get this procedure done during your lunch break and head straight back to work.

It is suitable for patients with mild to moderate acne scarring.

For best results on your IPL procedure, it will be good to avoid sun exposure in the days and weeks before and after the treatment.

CROSS for Acne Scar removal

Chemical Reconstruction of Skin Scars (TCA CROSS) uses the precise placement of highly concentrated chemical peel (such as Trichloroacetic Acid) to lift the base of deep scars.

Subcision and Filler

In subdermal incision (subcision), surgical tools inserted under the skin via small needle punctures are used to release tethered skin scars stuck down to the deeper fascia by abnormal scar fibres.

Filler is then interposed to prevent the two layers from sticking back together during the healing process.

This subcision and filler process is suitable for scars with depressions, or pitted scars, with the main goal of improving your skin's appearance by releasing the fibrotic tissues responsible for the uneven skin.

Typically, these scars are thought to be the hardest to get rid of. Subcision happens to be the exact technique required to effectively correct these scars.

Usually, I would recommend subcision for patients with:

• Rolling Acne Scars
• Box-Car Scars
• Some Ice Pick Scars

Scar Excision for Acne Scar treatment

Excision is used for isolated ice pick scars or narrow boxcar scars. The scar is removed and the skin closed with either a skin graft or sutures.

Intralesional steroid injections for Acne Scar treatment

Corticosteroid injections decrease over-active inflammation and collagen synthesis hence improving the appearance and symptoms of keloid or hypertrophic scars.

Dr. Wan believes that a combination approach is essential for effective acne scar removal treatments. The complex and varied nature of acne scars means there is no one-size-fits-all treatment. Only through a detailed examination of a patient’s condition and with a multimodal approach can a truly effective treatment protocol be designed.

The core factors Dr. Wan looks at when he assesses an acne scar patient includes:

• Scar configuration
• Skin type
• Patient’s Lifestyle & Habits
• Budgetary concerns

Proper identification of the acne scars is key. Dr. Wan tailors his treatments based on the depth and the visibility of the patient’s scars and is keenly concerned with the final look of the patient post-treatment.

Dr Wan Chee Kwang

FOUNDER / MEDICAL DIRECTOR