Acne Scars & Scars

Acne is perhaps one of the commonest skin condition known, affecting up to 80% of those from puberty to their early 20s and up to 10% of older adults. While it seldom impacts greatly on the general health of affected individuals, acne can have tremendous untoward bearings on the social and psychological well-being of many. The majority tend to recover from acne without any permanent effects, but a sizeable handful are left with disfiguring acne marks and scars. Scarring is our skins’ natural response to injury and when more severe acne lesions healed, scarring can be inevitable. If the hormonal upheaval of puberty had left its footprints though the teenage angst is long gone, here’s a round-up of the best ways to fix your acne scarring, to restore not just a flawed complexion, but the confidence to face the world with your best face forward.

Deep exfoliation with chemical peels
After an active acne lesion or a pimple healed, it can leave behind a dark or hyper-pigmented mark on the skin. Strictly speaking, this is not a real scar, but rather a post-inflammatory change known as Post Inflammatory Hyperpigmentation or PIH. This hyperpigmentation is seen as the skin goes through its healing and remodeling process, which can take up to 6 months or more especially for darker skinned individuals. If no more acne lesions develop in that area, the skin can heal normally and revert back to its original state and color. Chemical Peels are excellent not only for lightening these post inflammatory marks but help to reduce oiliness and control new acne outbreak at the same time. In addition, it tackles open pores, uneven skin tone and fine lines. A chemical peel is just as it sounds, different types of fruit acids are used individually or in combination to slough off dead skin cells from the surface so as to increase cellular turnover for new skin to regrow, and can be done at monthly interval by a qualified aesthetics physician to restore a blemish free complexion.

Intralesional steroid injection

Acne on the chest can leave behind unsightly keloid scars in individuals prone to keloid formation

Acne scars most often look like small indentations on the skin, but sometimes the reverse can occur. Most commonly seen on the chest and back, keloidal acne scars are disfiguring and notoriously difficult to clear. Intralesional steroid injections have been used since the mid-60s for the treatment of raised keloids, flattening scars by softening skin and shrinking down hard scar tissues. Seemingly simple at first glance, intralesional cortisone injection is not without its risks. The expertise and injection technique employed is just as crucial as the amount and dilution of the medication used, as there’s always a risk of fat atrophy with steroid injection(s) that can result in dimpling or converting the raised scars into atrophic scarring if not done properly. Generally speaking, usually three or more injections that are given one month apart are needed to achieve the desired results and therapy can continue for six months or longer, as there is up to a 50% chance that the symptoms of your raised scar will recur.

Yellow Dual Laser for red acne marks
Inflammatory acne often leave behind red marks that are due to neo-vascularization or increased formation of new blood vessels that persist after the active lesions heal. The red discoloration of these vascular acne scars usually fade with time but this is not always the case, with some individuals ending up with undesirable looking scars. Widely considered by experts as the gold standard for treating blood vessels related skin conditions, the FDA approved Yellow Dual Laser has the unique ability to deliver intense but gentle pulsed laser energy to selectively targeted blood vessels without adversely affecting the surrounding tissue, shrinking them to reduce the red skin discoloration. In addition, it helps control active acne by targeting acne-causing bacteria Propionibacterium Acnes found in abundance in the pores of acne prone skin and regulates overactive sebaceous glands for better oil control.

Textural gains with Pico Intense

The 3 different presentation of atrophic acne

Acne scars are classified as icepick, rolling, and boxcar based on their appearance. Here’s a brief description to help you roughly identify yours but this is best done by a qualified practitioner.

  • – Icepick scars are narrow and sharp, so called as they give the impression of the skin surface being punctured with an icepick. They are usually narrower than 2 mm and extend into the deep dermis.
  • – Boxcar or Boxed scars are round to oval depressions that have sharp vertical edges. Unlike icepick scars they do not taper to a point at the base.
  • – Rolling scars occur as a result of tethering of otherwise normal-appearing skin to the subcutaneous tissue below. This process gives the skin a rolling or undulating appearance.

Our Pico Intense treatment engaging advanced Picosecond laser technology is a revolutionary way to treat mild to moderate atrophic acne scarring without the downtime associated with traditional laser resurfacing techniques. Tailored to the specific needs of different individuals, bespoke settings dictating specific intensities are customized to generate controlled damage at a specific depth beneath the topmost layer of the skin, stimulating collagen and elastic tissue production with appreciable improvement in textural irregularities of atrophic acne scars, pore size, skin pigmentation and uneven discoloration. The PicoSure system is an unprecedented innovation in laser technology, allowing the use of light as the unfiltered, direct energy source by virtue of its speed of delivery, achieving similar, or perhaps even better end results; with comparably lowered risk of possible side effects such as hyper or hypopigmentation, often a limiting factor when handling darker skinned Asian.

Resurfacing lasers are the game changers
Resurfacing lasers have completely revolutionized the approach to acne scar treatment, offering new found hopes to not being scarred for life. The most popular laser types used are the carbon dioxide (CO2) and erbium (Er:YAG) lasers, proven to date to be the gold standard for treating severe acne scarring. Resurfacing lasers work by essentially burning the top layers of skin to a precise depth, replacing the burned layers with newer appearing skin as natural healing takes place. Using the Sciton laser skin resurfacing mode and our fractional eCO2 laser in combination, we are able to achieve visible results that meet patients’ expectations. The lasers smooth old scars and stimulate the process of collagen renewal, treating not only acne scars, but with collagen renewal benefits to “un-scarred” skin tissue as well. In effect, there’s total rejuvenation and skin re-birth, with patients reporting noticeable tightening of skin after the resurfacing laser treatment.

Minor surgical correction

Subcision gives good results against rolling acne scars when done correctly

There are two minor surgical procedures that can be employed to enhance the results achievable from laser resurfacing techniques alone.

  • – Subcision is used to break up the fibrous bands that cause rolling scars. Subcision is performed under topical +/- local anaesthesia by inserting a beveled needle under the skin so that it is parallel to the skin surface. Staying in the plane between the dermis and the subcutaneous tissue, the needle is gently advanced and retracted in a piston-like motion to cut or break the tethering bands. This procedure causes bruising which may take 5 to 7 days to fade away.
  • – Punch excision is another method of surgically correcting acne scars especially for deep ones such as icepick and deep boxcar scars. This procedure uses a punch biopsy tool which is basically a round, sharp “cookie-cutter” instrument. The size of the tool is matched to the size of the scar to include the walls of the scar and under local anaesthesia, the scar is excised with the punch tool and the skin edges are sutured together. The newly produced scar eventually fades and may not be noticeable.
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FAQ on Acne Scars Treatment:

Is laser acne scars treatment suitable for all skin types?
Over the years, we find that most patients are suitable, subject to a proper evaluation in clinic.

Is the treatment painful?
A numbing cream is applied for 30 minutes before the laser treatment and this makes the procedure bearable. Our patients liken the experience to a mild heating sensation and very slight discomfort. It is highly tolerable.

Is there any downtime for this treatment?
In order for scars to be effectively treated, the laser has to penetrate to the appropriate depth. There will be a recovery time of 3 days. During this period, the treated area will appear reddish and there will be mild flaking. Light make-up can help.

Should I avoid any activities after the treatment?
It is important to avoid excessive sunlight exposure as the new skin is vulnerable to the harmful ultraviolet rays of the sun. We also advice against strenuous exercise for the first 3 days post-treatment.

How many treatments will I need?
Depending on the condition of the scars and skin type, most patients will benefit from 4 to 6 sessions of laser acne treatment. These treatments are usually spaced 6 weeks apart for optimal outcome.

Combine with Needle subcision and Skinboosters/Rejuran injections
Needle subcision is a process we often perform to improve deeper scars. Combined with laser resurfacing, it is very effective to bring about an improvement to the skin. Performed under local anesthesia, this process is painless. This is often combined with Skinboosters filler injections to fill in depressed scars, and/or Rejuran microinjections to promote healthy skin healing. There may be mild swelling and redness for 1 day which will resolve spontaneously without any further treatment. Over time, you will notice an improvement to the scars. In addition, speak to us about full-face Skinboosters/Rejuran treatment, to get that enviable radiant, smooth and hydrated appearance.

If you have acne or chicken pox scars, make an appointment today and see how our Sciton/eCO2/Skinboosters resurfacing treatment will make a more confident and beautiful you.

Call +65 6735 8180 to speak to us about your concerns today
Click To Enquire About Treatment of Acne Scars

*Due to MOH guidelines in Singapore, accredited medical clinics are not allowed to show before and after photos on websites and marketing materials. We apologize for that. We would be delighted to showcase our photographs and actual results during the consultation in our clinic.

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