Acne Scars: What They Are, 6 Types, Causes and Treatments
Whether you’re looking for laser treatments or other forms of acne scar removal solutions in Singapore, we have you covered.
Looking for the Best Acne Scar Treatment?
Dr Justin Boey is an acne scar expert featured in local media such as Her World and The Peak.
He is a Key Opinion Leader for Enerjet 2.0 and a Physician Trainer in Southeast Asia for DermaSculpt Micro-Cannula Subcision.
Dr Boey is known for personalised acne scar treatments using laser and radiofrequency technology and more!
Acne scars are marks left on the skin when blemishes heal, and they are caused by the skin’s improper healing response to inflammation. Understanding the types, causes and treatments for acne scars can help you take appropriate steps to address them.
Incorrect treatment for mild acne scarring might even lead to more breakouts, and treating the scars requires a well-designed plan to see optimal results. This is especially important if you have severe acne scars, depressed acne scars (atrophic scars) and raised scars.
What are Acne Scars?
Acne scars occur when the skin fails to repair itself adequately after an acne breakout, especially with inflammatory or cystic acne. The road to healing is not always straightforward. Sometimes, everything goes well, and your skin goes back to normal. In some cases, scars form if the skin produces too much or too little collagen.
Many people ask, ‘Are acne scars permanent?’ While acne scars can linger, they are not necessarily permanent and can often be treated with various medical and cosmetic procedures that aim to reduce their appearance. Another common concern patients often tell us is, ‘How can I remove acne scars?’ Fortunately, numerous treatments are available for patients, which range from non-invasive options to surgical interventions designed to reduce the visibility of acne scars.
But don’t lose hope, as the right treatment approach can improve the skin’s appearance and restore a more even texture.
What are the Types of Acne Scars?
Knowing the different types of acne scars is important as they require different treatment approaches. Here is a breakdown of the most common types of scars:
Rolling/Atrophic Scars
Rolling scars are characterised by their wave-like appearance. These scars create a rolling or undulating effect on the skin’s surface. Severe acne damages the underlying skin structures, causing the skin to appear uneven.
Treatment of choice:
Ice Pick Scars
Ice pick scars are deep, narrow, pitted scars resembling small puncture marks. These scars penetrate deep into the skin and can be challenging to treat because of their depth. Ice pick scars are usually caused by severe inflammatory acne.
Treatment of choice:
Boxcar Scars
Boxcar scars are broad depressions with well-defined edges. They are similar to rolling scars but have sharper, more defined borders. Boxcar scars are caused by a loss of collagen due to acne inflammation.
Treatment of choice:
Post-inflammatory Erythema
Post-inflammatory erythema refers to red or pink marks left on the skin after the acne heals. Unlike scars, they result from damaged blood vessels, not collagen loss. Common in fair skin, they can worsen with sun exposure or irritation.
Treatment of choice:
Post-inflammatory Hyperpigmentation
Post-inflammatory hyperpigmentation (PIH) refers to dark spots on the skin after inflammation or injury, like acne, eczema or burns. It happens due to excess melanin production from skin damage. PIH is more common in darker skin tones and can worsen with frequent sun exposure.
Treatment of choice:
Hypertrophic Scars
Hypertrophic scars are raised, firm and thickened, raised scars resulting from excessive collagen production during healing. These scars are more common on the chest, elbows, back and shoulders.
Keloid scars are scars extending beyond the original acne lesion. They are thick, raised and often darker than the surrounding skin. Keloid scars can be painful and itchy.
Treatment of Choice:
- Corticosteroid Injections
What are the Causes of Scarring?
Several factors contribute to the formation of acne scars, and understanding these causes can help prevent and manage scarring.
Inflammation
Severe inflammation caused by acne lesions can damage the skin’s structure. The body’s immune response to inflammation can produce too much or too little collagen, causing various acne scars.
Picking at Pimples
Picking or squeezing pimples can worsen inflammation and increase the risk of scarring. They can push bacteria deeper into the skin and break the skin barrier, leading to more severe infections and prolonged healing.
It is essential to resist the urge to pick at pimples to prevent further damage to the skin. It also ensures that your skin heals properly without unnecessary complications.
Skin Type
Some people with darker skin types are more prone to scarring due to their skin’s response to acne and its healing process. People with darker skin tones may also experience more severe scarring as their skin produces more melanin, leading to post-inflammatory hyperpigmentation.
Genetic Factors
Genetics can contribute to acne scarring. Some individuals may have a genetic predisposition to developing severe inflammatory acne and scarring, which can lead to post-inflammatory hyperpigmentation.
This predisposition can make the skin react aggressively to inflammation, leading to significant damage and a higher likelihood of permanent scarring. Additionally, family history plays a role, as those with parents or siblings who have experienced severe acne are more likely to encounter similar skin issues.
Delayed Treatment
Allowing severe acne to go untreated for an extended period can increase the likelihood of scarring. Prompt treatment can help manage inflammation and prevent the development of scars.
How to Remove Acne Scars? (Treatment Options for Acne Scars)
Various treatment options are available for acne scarring, ranging from non-invasive (laser therapy, chemical peels, etc.) to minor surgical procedures (subcision, punch excision, etc.). The choice of treatment depends on the type and severity of the scars. This often makes patients wonder, ‘What is the best acne scar removal treatment?’
Laser therapy, microneedling and chemical peels are all highly effective treatments for acne scars. However, the best approach depends on individual skin types, acne severity and specific scarring patterns.
A thorough consultation with an aesthetic practitioner can help determine the most appropriate treatment for effective results.
Laser Therapy
Laser treatments target scarring with focused light energy, promoting skin repair, making the surface more even and reducing discolouration. Different laser wavelengths are configured based on the scar type we’re dealing with.
Patients often ask us, “How many treatments do I need, and how long will it take to see visible results?”
Generally, multiple scar treatment sessions are necessary, and they are typically spaced a few weeks apart. Visible improvements can usually be observed after the first few sessions, with more significant results appearing after subsequent treatments.
Lasers for acne scar treatment include:
Laser Skin Resurfacing
Laser skin resurfacing removes the outer layer of the skin and stimulates collagen production, improving texture and reducing the visibility of scars. Potential side effects of laser resurfacing include redness, swelling and temporary discomfort. Downtime can range from a few days to a few weeks for full recovery.
An ablative laser that targets deeper scars by removing layers of damaged skin.
This targets superficial and deep skin layers, treating various acne scarring types.
It targets scars with ultra-short energy pulses to break down scar tissue without damaging the surrounding skin cells.
This laser therapy targets skin blood vessels to reduce redness and prevent pigmentation issues like post-inflammatory erythema.
Erbium YAG Laser
It resurfaces the skin by removing the top layer and boosting collagen production, making it ideal for shallow scars.
Non-Ablative Fractional Lasers
This helps boost collagen by targeting deeper skin layers without producing surface damage.
Radiofrequency (Microneedling or Nano-Fractional)
Radiofrequency treatments, including microneedling or nano-fractional techniques, utilise controlled heat energy to stimulate collagen production in the deeper layers of the skin. This non-invasive technology is effective for improving skin texture, reducing the appearance of acne scars and tightening the skin.
EndyMed Intensif™ Fractional Radiofrequency
This is a microneedling technique combined with radiofrequency. It helps stimulate collagen production and improves scar texture.
Fractional Radiofrequency
Fractional radiofrequency uses heat energy to reach deeper skin layers, stimulating collagen production and enhancing the texture of acne scars like box car, rolling and ice pick scars.
It has minimal downtime, which may include redness and swelling for a few days. Potential side effects are mild discomfort and temporary skin irritation.
Chemical Peel
Chemical Peels
Chemical peel treatment uses a chemical solution to exfoliate and remove the top layer of skin, encouraging new growth. While effective, these chemicals may cause mild discomfort, but numbing creams can help make it more comfortable.
TCA Cross (Trichloroacetic Acid Chemical Reconstruction of Skin Scars)
TCA Cross applies a high concentration of trichloroacetic acid to individual scars, stimulating collagen production and enhancing their appearance. It is particularly effective for ice pick and boxcar acne scars. Potential side effects include redness, swelling and temporary discolouration. Downtime is minimal, with recovery typically taking a few days.
Subcision + Dermal Fillers
Subcision combined with dermal fillers is a powerful treatment designed to address depressed acne scars. Subcision releases the fibrous bands pulling the skin down, while dermal fillers restore volume and smooth out the skin’s surface. This dual approach provides immediate improvement and encourages long-term collagen production.
When you undergo subcision, your aesthetic practitioner gently inserts a needle under your skin to break up the fibres holding the scar tissues together. The procedure disrupts the fibrous bands that pull the skin down, allowing the surface to rise and smooth out.
It is particularly effective for treating rolling and depressed scars. Expect enhanced skin texture and reduced scar visibility for acne and surgical scars. Temporary bruising and swelling may occur after the procedure, but rest assured that recovery time is minimal.
Dermal fillers, such as hyaluronic acid, collagen and poly-L-lactic acid, fill in depressed scars, creating a more even skin surface. Hyaluronic acid provides immediate volume and hydration, while collagen promotes natural skin repair. Last but not least, poly-L-lactic acid stimulates collagen production for longer-lasting results.
These dermal fillers effectively treat acne scars, such as ice pick, boxcar and rolling scars. They are selected based on the specific characteristics of the scar, ensuring effective acne scar treatment results.
- Hyaluronic acid fillers. Hyaluronic acid fillers are commonly used for acne scarring. This substance naturally occurs in the body and maintains skin hydration and elasticity. They’re ideal for treating shallow to moderate scars.
- Collagen fillers. Collagen-based fillers were among the first to be used in aesthetic treatments. Collagen is a protein that provides structure and support to the skin. Injecting collagen-based fillers into acne scars can help restore volume and smoothness, particularly in older scars with diminished collagen production.
Poly-L-lactic acid fillers. This offers longer-lasting results compared to their temporary counterparts. It contains substances that stimulate collagen production in the skin, providing ongoing improvement even after the filler has been absorbed.
Other Categories
Microneedling uses fine needles to create micro-injuries in the skin and stimulate collagen production. This treatment can improve the texture and appearance of acne scars. It has potential side effects like redness and minor swelling, but downtime is minimal, which typically lasts a few days.
Topical retinoids are vitamin A derivatives that promote cell turnover and improve skin texture, which can help reduce the appearance of acne scarring with consistent use. Potential side effects include dryness, irritation and redness, but there is typically no downtime.
Light Therapy
Light therapy targets acne scars using specific wavelengths of light, promoting skin repair and reducing discolouration. It is a non-invasive procedure with minimal downtime, involving potential temporary redness or irritation.
Dermabrasion
Dermabrasion involves using an abrasive instrument to exfoliate the outer skin layer. This process can enhance the appearance of superficial scars, particularly those caused by acne. However, potential side effects include redness, swelling and sensitivity. Recovery time usually ranges from a few days to a week.
Surgical Excision
Surgical excision, which involves directly removing scar tissue, is typically reserved for deeper, isolated scars and requires more downtime for healing. One common question about these procedures is, ‘How long is each session?’ Sessions can vary significantly; punch excision, for example, may last a few minutes to an hour, while scar revision surgery might extend for several hours, depending on the complexity and extent of scarring.
Punch Excision
Punch excision uses a small, circular instrument to remove individual, deeper scars. This procedure specifically targets minimising the appearance of deep, narrow scars such as ice pick scars.
Scar Revision Surgery
Scar revision surgery involves more extensive resurfacing to address significant scarring. It is suitable for reducing the visibility of large or complex scar areas.
Type of Acne Scar Treatment | Most Suitable For | Not Suitable For |
|---|---|---|
Fractional CO2 Laser | Rolling, Atrophic, Ice Pick, Boxcar Scars | N/A |
Fraxel Dual | Acne Scars or Post-Acne Spots | Hypertrophic Scars or Marks |
Fractional Pico Laser | Shallow Skin Scars, Rolling & Atrophic Scars, Post-Inflammatory Hyperpigmentation | N/A |
Pulse-Dye Lasers | Acne Marks and Post-Inflammatory Hyperpigmentation | N/A |
Picosecond Gold Toning (595nm) | Post-Inflammatory Erythema | N/A |
Radiofrequency (RF) Microneedling | Various Scar Types | Hypertrophic Scars |
Chemical Peel (TCA Cross) | Boxcar Scars | Hypertrophic Scars |
Subcision with Fillers | Boxcar Scars | N/A |
Corticosteroid Injection | Hypertrophic Scars | N/A |
Treatment Considerations
When choosing a treatment for acne scars, consider the following factors:
- Severity and Type of Acne Scars: Different treatments are suited to different types of scars, such as ice picks, rolling, or boxcars. One may ask, “What kind of acne scars are most suitable for the treatments?” Typically, ice pick scars respond well to TCA Cross or punch excisions, rolling scars to subcision and fillers, and boxcar scars to laser resurfacing.
- Individual Skin Type and Response to Treatments: Everyone’s skin reacts differently, so what works for one person may not work for another.
- Desired Downtime and Recovery Time: A common concern is, “Is there any downtime?” Non-invasive treatments have minimal downtime, while surgical options may require longer recovery.
- Cost of Treatment: Patients frequently ask, “How much does it cost?” Non-invasive treatments like chemical peels and light therapy may be less costly compared to more invasive procedures like laser treatments and surgical options. Costs can vary widely based on the type of treatment and the number of sessions required.
- Importance of Consulting a Dermatologist: Seek personalised advice from a skin specialist to choose an effective and safe treatment plan.
Acne Scar Prevention
Proper skincare plays a crucial role in minimising inflammation and promoting healing, which in turn helps reduce the risk of scarring from acne. Establishing a gentle yet effective skincare routine can prevent the development of severe acne and the scars that can follow.
Essential skincare practices include:
- Gentle Cleansing: Use mild cleansers to remove impurities without stripping the skin of its natural oils, which can provoke further irritation.
- Consistent Use of Sunscreen: Protect the skin from UV damage, which can exacerbate the visibility of scars and hinder the healing process.
- Avoiding Picking at Spots: Refrain from squeezing or picking at acne, which can deepen inflammation and increase the risk of scarring.
- Maintaining a Healthy Diet: Although optional, a balanced diet rich in vitamins and minerals can support skin health and reduce acne outbreaks.
What is the best acne scar removal treatment?
Laser therapy, microneedling and chemical peels are all effective acne scar removal treatments. However, the best approach depends on the type of acne you’re dealing with, your skin type and individual needs. Talk to a trusted aesthetic practitioner so they can help you determine the most suitable option.
Is it painful?
There might be some discomfort during most procedures, and some may require local anaesthesia or the application of topical numbing cream. But generally, most acne scar treatments are tolerable and manageable with proper care.
How long is each session?
Sessions usually last between 30 minutes to an hour, depending on the type of treatment for acne scars being administered. The duration can vary based on the size and severity of the scarring.
How many treatments do I need, and how long will it take to see visible results?
Typically, multiple treatments are required before you can see any noticeable change. Visible results typically appear in a matter of weeks to months.
| Type of Acne Scar Treatment | Most Suitable For | Not Suitable For |
|---|---|---|
| Fractional CO2 Laser | Rolling, Ice Pick & Boxcar Scars | N/A |
| Fraxel Dual | Acne Scars or Post-Acne Spots | Hypertrophic Scars or Acne Marks |
| Fractional Pico Laser | Shallow Scars, Rolling & Atrophic Scars, Post-Inflammatory Hyperpigmentation | N/A |
| Pulse-Dye Lasers | Acne Marks and Post-Inflammatory Hyperpigmentation | N/A |
| Picosecond Gold Toning (595nm) | Post-Inflammatory Erythema | N/A |
| Radiofrequency (RF) Microneedling | Various Scar Types | Hypertrophic Scars |
| Chemical Peel (TCA Cross) | Boxcar Scars, Ice Pick Scars | Hypertrophic & Keloid Scars |
| Subcision with Fillers | Boxcar Scars, Rolling Scars | N/A |
| Corticosteroid Injection | Hypertrophic & Keloid Scars | N/A |
Treatment Considerations
When choosing a treatment for acne scars, consider the following factors:
- Severity and type of acne scars. Different treatments are suited to different types of scars, such as ice pick, rolling, or boxcar scars. You might be wondering about what kind of acne scars are most suitable for the treatments. Typically, ice pick scars respond well to TCA cross or punch excisions, rolling scars to subcision and fillers, and boxcar scars to laser resurfacing.
- Individual skin type and response to treatments. Every person’s skin reacts differently, so what works for one person may not work for another.
- Desired downtime and recovery time. A common concern for many patients is, ‘Is there any downtime for any of these treatments?’ The answer is that non-invasive treatments have minimal downtime, while surgical options may require longer recovery.
- Cost of treatment. One of the most frequent questions patients ask is, ‘How much does it cost?’ Noninvasive treatments like chemical peels and light therapy may be less costly than more invasive procedures like laser treatments and surgical options. However, costs can vary widely based on the type of treatment and the number of sessions required.
- Importance of consulting an aesthetic practitioner. Seek personalised advice from a skin specialist to choose an effective and safe treatment plan.
Acne Scar Prevention
Proper and consistent skincare plays a crucial role in minimising inflammation and promoting healing, which in turn helps reduce the risk of scarring from acne. Establishing a gentle yet effective skincare routine can prevent the development of severe acne and the scars that can follow.
Essential skincare practices include:
- Gentle cleansing. Use mild cleansers to remove impurities without stripping the skin of natural oils, which can worsen irritation.
- Consistent use of sunscreen. Protect the skin from UV damage, which can exacerbate scar pigmentation and hinder healing.
- Avoid picking at spots. Squeezing or picking at your pimples can deepen inflammation and increase the risk of scarring.
- Maintain a healthy diet. A balanced diet rich in vitamins and minerals can support skin health and reduce acne outbreaks.
Why Choose Dr Justin Boey for Acne Scar Removal Treatments?
At Sozo Aesthetic Clinic, we offer US FDA-approved laser treatments and technology to provide effective results.
Specialist
Beyond mere laser treatments, successful acne scar treatment requires the correct treatment strategy and acne scar technical expertise.
Conclusion
Understanding acne scar types, causes, and treatment helps individuals make informed decisions about managing and treating them.
Sozo Aesthetic Clinic’s Dr. Justin Boey emphasises the importance of consulting with a reputable healthcare professional to determine the most suitable treatment plan for individual needs. By exploring various treatment options, you can find effective solutions to reduce the appearance of acne scars and improve your overall skin tone and health.
If you are struggling with acne scars, consider speaking with an aesthetic practitioner to discuss your options for acne scar treatments. Taking proactive steps to address acne scars can help restore confidence and achieve healthier skin.
