Acne Scarring

What is acne scarring?

Acne scarring refers to the indentations, or marks, that are left on the skin following chronic acne breakouts. These scars can vary in appearance and severity, ranging from shallow depressions to deep pits or raised areas on the skin.

There are several types of acne scarring, including textural changes (atrophic and hypertrophic scars) and colour changes (post-inflammatory hyperpigmentation, post-inflammatory erythema):

Acne scar textures

• Boxcar scars (atrophic scars): boxcar scars are broad, box-like depressions with sharp, fine edges. They are typically wider than icepick scars and can vary in depth.
• Icepick scars (atrophic scars): icepick scars are deep, narrow scars extending into the dermis. They typically resemble small holes or punctures in the skin. Cystic acne is the usual cause of icepick scars.
• Rolling scars (atrophic): rolling scars have a wave-like appearance and are caused by the tethering of the skin to the underlying tissues. As such, they create a rolling or undulating texture on the skin.
• Hypertrophic scars: hypertrophic scars form when the body produces excess collagen during the healing process, resulting in raised, thickened areas of skin. Hypertrophic scars are usually found on the jawline, chest, shoulders, and back.
• Keloid scars: keloid scars are similar to hypertrophic scars but extend beyond the original wound site. They are usually more challenging to manage than hypertrophic scars.

Acne scar colour

• Post-inflammatory hyperpigmentation (PIH): brown to grey marks left behind when acne lesions resolve due to hyperactivity of the pigment cells when there is inflammatory acne or trauma from picking at active acne.
• Post-inflammatory erythema (PIE): pink to red marks that remain when acne lesions resolve, owing to increased blood flow to the skin as part of the healing process.

What causes acne scarring?

Factors such as skin type and severity of acne determine the extent of scarring. Genetics also play a role in why some people have acne scars, and some do not. To top it all off, picking or squeezing acne lesions can worsen inflammation and increase the likelihood of scarring.

Atrophic acne scars are formed when the inflammation, as a result of acne, causes an upregulation of an enzyme called collagenase. Collagenase breaks down collagen in the skin, which leads to a depressed scar when the skin finally heals.

Conversely, hypertrophic and keloidal acne scars form when the healing process is overly aggressive and an excessive amount of collagen is laid down.

Finally, PIH and PIE form as a result of inflammation in the skin. PIH is more likely to happen if there is excessive sun exposure and in individuals with darker skin types, while PIE is more common in lighter skin types.

What are the benefits of acne scarring treatment?

Acne scarring treatment in Singapore offers many benefits, such as:

• Boosts self-esteem and confidence level
• Improves skin texture and appearance
• Minimises and reduces the appearance of acne scars
• Minimises pore size

We understand how acne scars can impact a person’s mental and emotional well-being. If you have been struggling with acne scars and are looking for a solution to make them less noticeable, you have come to the right place.

Dr Evelyn will assess your acne scars and offer the best treatment plan to help you. Schedule an appointment today to start your journey to healthier, smoother, and more radiant skin.

What are the treatment options for acne scars?

At Lumine Dermatology & Laser Clinic, an array of treatment options are available to help minimise and reduce their appearance. Some of these options include:

• Subcision: subcision can be done using a needle or cannula to release the fibrous bands that tether down the skin. This is particularly useful for rolling scars and is best done in combination with the infiltration of collagen-stimulating fillers or polynucleotides.
• Collagen-stimulating treatments: at Lumine Dermatology & Laser Clinic, we mostly incorporate poly-L lactic acid or polynucleotides for acne scar treatment, in combination with subcision for the best results.
• TCA cross: we offer TCA cross for ice-pick or shallow boxcar scars, often combined with energy-based devices.
• Punch excision: punch excision involves surgically removing small and deep scars and stitching them up in a line. This often leaves a barely noticeable scar with better cosmesis than the original acne scar.
• Lasers: lasers such as picosecond lasers and fractional carbon dioxide lasers can target atrophic acne scars. In contrast, pulsed dye lasers and picosecond lasers can target PIE and PIH, respectively.
• Radiofrequency microneedling: radiofrequency microneedling is a low-downtime alternative that uses small needles that deliver radiofrequency to stimulate collagen production and help smooth out scars.
• Botulinum toxin injections: botulinum toxin injections have been used to reduce the appearance of hypertrophic and keloidal acne scars.
• Steroid injections: intralesional steroid injections are often used to reduce inflammation and help flatten raised scars, such as hypertrophic and keloid scars.

What results can I expect from acne scar treatment?

Acne scar treatment often requires a series of treatments, as the entire collagen remodelling process takes time. In general, combination therapy targeting different types of acne scars with various depths of scarring works the best. One can expect about 50-70% improvement after a series of 4-6 combination treatments. This will also depend on your skin type, the severity of acne scarring, and the type of treatment you select.

How many acne scar treatment sessions do I need?

A series of 4-6 treatment sessions is recommended. These do not have to be spaced strictly 4 to 6 weeks apart. We can develop a treatment strategy that works around your lifestyle and expectations. However, it can take between 1 and 2 months (depending on the treatment method) for patients to see initial improvements to their skin.

It is essential to consult with a dermatologist to determine the most appropriate treatment approach for your skin condition. At Lumine Dermatology & Laser Clinic, Dr Evelyn will thoroughly analyse your skin condition before suggesting the best treatment options to help heal your acne scars. If you are interested in discovering how Dr Evelyn can help improve your acne scars, get in touch with us today.

Frequently asked questions

Can all acne scars be treated?
Yes, all acne scars can be treated. A combination of lasers and devices (fractional CO2, picosecond laser, radiofrequency microneedling), physical methods (e.g., subcision, TCA cross), and even surgical punch excisions are effective for treating acne scars.

Can acne scars be permanently removed?
Certain procedures, like punch excisions, can remove acne scars. However, most procedures, such as lasers, radiofrequency microneedling, subcision, and TCA cross, will only improve acne scarring and not permanently remove it.

Will acne scar treatments cause any pain or discomfort?
Most acne scar treatments, like laser resurfacing, can be slightly uncomfortable. However, we employ a combination of topical and local anaesthetics to help make the process as comfortable as possible.

How long does one treatment session take?

• Laser treatments (fractional carbon dioxide laser, picosecond laser)- 20-30 minutes
• Microneedling radiofrequency- 30 minutes
• Subcision- 15-30 minutes
• TCA cross- 15-30 minuttes
• Surgical punch excision- 15-20 minutes

Are there any home remedies I can try to complement my treatment?
Certain home treatments, such as microneedling, can stimulate collagen to help improve the appearance of acne scars. We call this collagen induction therapy. Before starting any at-home remedies, consult your dermatologist to decide the best treatment for you.

How can I prevent acne scarring?
Generally, you can prevent acne from scarring by:

• Refraining from popping or squeezing acne.
• Treat acne in the most appropriate way possible. For example, one should not wait to “grow out” of acne. If off-the-counter solutions are not helping, seek help from a dermatologist for more medical-grade solutions. The best treatment for acne scars is prevention and timely intervention.