Are lasers like Fractional CO2 the best acne scar treatments?
Did you know that a combination of Laser and Micro-surgical treatments works best?
Find out which treatment consistently BEATS Lasers in terms of Results.
Common questions that I get from patients who have tried scar treatments include:
“Why didn’t Lasers remove my scars completely?”
“How do I decide which treatments I need?”
Before you invest in another Acne Scar treatment, please read this.
Lasers ALONE cannot cure acne scars.
Edge Fractional CO2: Great Laser but it does have its limits!
The purpose of this article is to share
on the best practices for Acne Scar treatments in Singapore to help you to save time, pain and money.
How can I Remove Acne Scars Effectively?
The traditional method of acne scar treatment is to do Fractional Ablative Lasers like Fractional CO2/ Erbium lasers – repeatedly.
However, many patients are still left with a lot of untreated scars.
What I am about to share with you will help you to decide:
- What acne scar treatments you need
- Who is the best acne scar doctor for you
3 New Ways to Treat Acne Scars
1. Think Beyond Lasers
- Lasers are not the only effective acne scar removal treatment.
- Instead, Lasers are just one of many tools in an acne scar specialist’s arsenal.
- Other effective acne scar treatments are Manual techniques (Subcision, Punch excision), Microneedling Radiofrequency, Chemical Peels and Regenerative treatments.
2. Regenerative Treatments Lead the Way
- Previously under-used, regenerative treatments are now very popular.
- Regenerative treatments shorten recovery time by up to 50% and improve scar healing significantly.
3. Subcision + Filler – The All-in-One Acne Scar Solution
- Subcision + Filler can “break down scars” and “stimulate healing” in a single treatment.
- Results are immediate
- Long-term acne scar improvements from Subcision are as good as Lasers.
Let’s dive right in…
What exactly is a scar?
Acne scars are fibrous tissues that are formed in response to skin injury.
These fibrous tissues consist of disorganised and abnormal collagen fibres.
Hence, scars don’t look like normal skin.
Acne scars are most commonly due to severe acne known as cystic acne.
What are the Different Types of Acne Scars?
Acne alone can cause up to SEVEN types of scars.
The most common are: atrophic scars, hypertrophic scars and keloids.
Atrophic scars are further divided into 3 types: ice-pick scars, rolling scars and box-scar scars.
Why Lasers Cannot Cure Acne Scars Completely
Acne scar resurfacing lasers operate based on a simple principle: “controlled break down/damage” of scars to stimulate production of new skin – which hopefully would be normal.
Herein lies the problem…
Scarred Skin Doesn’t Heal As Well As Normal Skin
Scarred skin is ALREADY damaged. Damaged tissues, by definition, CANNOT repair themselves well.
Inflicting controlled injury to these scars repeatedly is a futile effort.
Instead, we should look into other acne scar treatment techniques that improve skin healing.
Regenerative Acne Scar Treatments – Forefront of Scar Treatments in Singapore
Top acne scar doctors use regenerative technologies to ENHANCE healing of the scar.
Lasers alone aren’t effective against this type of scarring.
Lasers COMBINED with Regenerative acne scar treatments will have up to 50% shortened recovery time and improved final scar healing results.
The benefits of these regenerative treatments extend beyond scar healing – it has skin anti-aging effects too.
Common Regenerative Acne Scar Treatments in Singapore
- PDRN – Rejuran Healer, Rejuran S
- Calcium hydroxyapatite – Radiesse
- Cytokines and Growth factors – AnteAge MD
- Hyaluronic Acid Fillers – Juvederm, Restylane, Belotero, Stylage
- Platelet Rich Plasma – not available in Singapore
These regenerative compounds can be delivered into your skin after a micro-surgical procedure called Subcision.
Subcision + Filler
The All-in-One Acne Scar Treatment
Subcision + Filler is the most versatile treatment for tethered acne scars that are “stuck down” to underlying muscles.
In one session, subcision breaks down old scars and can deliver healing compounds such as PDRN (Rejuran) to your scar.
Essentially, you have scar remodelling (controlled break down) and regeneration (healing) all in 1 treatment.
I am a firm believer of Subcision + Filler treatment for Acne Scars as this treatment delivers both immediate and long-term results that are permanent.
DermaSculpt® Micro-Cannula Subcision
There are more than 5 methods to perform subcision.
As the official trainer of DermaSculpt micro-cannula, I specialise in subcision with blunt micro-cannula because this method of subcision has the shortest recovery time, least bruising and least swelling.
“Dr Justin, Subcision seems effective. But is subcision BETTER than Lasers?”
Subcision vs Lasers
Subcision – treats DEEPER scars than lasers
Lasers treat scars that are skin-deep. Subcision can treat deeper scars that lie BENEATH your skin.
Subcision – immediate & long-lasting results
The results for Subcision + Filler are immediate and permanent.
Compared to Subcision, the results of Lasers are slower because collagen production takes weeks.
If your acne scar doctor doesn’t offer Subcision + Filler, please find out why.
I believe that Subcision is a “must-have” treatment in every acne scar treatment plan.
Did you know that Subcision can also be used to diagnose how deep your scars are?
During Subcision, I am able to assess the depth of acne scars with greater accuracy.
This allows me to focus my scar treatments at the specific depth that needs improvement.
How Deep are Acne Scars? – Why is Understanding Scar Depth Important?
Apart from the basic scar type (ice-pick, box-scar, rolling), understanding the DEPTH of your scars is the next most important factor to ensure good results.
Although both patients have rolling and box-scar acne scars, you can see that these 2 patients differ in scar depth.
As a result, the treatment strategies for both patients are different.
Scars Are NOT Just Skin Deep – Common Misconception
It is a common misconception amongst patients and doctors that scars are merely skin deep.
To assess how deep is your scar, you need to make expressions (smile and talk).
Scars that worsen when you make expressions are BEYOND skin deep.
These scars are attached to your muscles below (up to 4mm deep) – that is why the depressions/ “dents” worsen when you smile or talk.
Your acne scar doctor also needs to FEEL your scar to assess depth.
How Do I Treat Scars That Are Beyond Skin Deep?
If your scars extend BELOW your skin, Lasers are NOT going to improve your scars effectively.
This is because Lasers can only deliver energy skin-deep (up to 1.5mm deep).
For scars that lie below the skin (more than 1.5mm deep), you need MicroNeedling Radiofrequency.
Certain Micro-Needling Radiofrequency devices can treat up to 5.0mm.
MicroNeedling Radiofrequency – Best Treatment for Deep Acne Scars
Micro-Needling Fractional Radiofrequency goes by the brands – INFINI, Intracel, Intensif, Secret RF, Profound RF.
Technically not a Laser, Micro-Needling Radiofrequency is a non-laser energy device that is a proven acne scar treatment used world-wide.
It is proven by more than 15 research publications to be effective for deep acne scars.
Difference between MicroNeedling Radiofrequency & Fractional Lasers – DEPTH
Micro-needling Fractional Radiofrequency delivers ablative energy up to 5.0mm.
Fractional Lasers (Fractional CO2 and Erbium lasers) can only reach 1.5mm deep (skin deep).
I use Micro-Needling Radiofrequency for deep acne scars (beyond 1.5mm) that I cannot reach with Fractional CO2 Lasers.
Often times, I use both treatments together for better scar improvements.
Apart from treating deep acne scars, Micro-needling Radiofrequency is also safer for darker skin types as compared to traditional Fractional CO2/ Erbium lasers.
“Dr Justin, are there other types of Fractional Lasers?”
Yes. Apart from Fractional Ablative Lasers, there is another sub-type called Fractional Non-Ablative Lasers.
Fractional Ablative Lasers vs Fractional Non-ablative Lasers
Fractional Ablative Lasers like Fractional CO2/ Erbium are the gold standard for Skin resurfacing Lasers. They treat the epidermis and dermis.
Fractional Non-ablative lasers like Erbium
Although Fractional Non-Ablative lasers have less downtime, they are not as effective as Fractional CO2 Lasers.
As a result-oriented doctor, I prefer treatments that deliver more effective results like Fractional Ablative Lasers (Fractional CO2).
“I’ve heard of MicroNeedling Radiofrequency. Which is the best Microneedling Radiofrequency?
Insulated MicroNeedling Radiofrequency – The Latest Generation of MicroNeedling Radiofrequency
INFINI by Lutronic is the World’s First Insulated Microneedling Fractional Radiofrequency.
The key success factor for INFINI is the insulation of the micro-needles that deliver the RF energy, unlike other
The Safest Micro-Needling Fractional Radiofrequency
Insulation of the micro-needles means that there is minimal damage to the upper layers of the skin, known as the epidermis.
This minimises the risk of post-infllammatory hyper-pigmentation (darkening of skin).
Insulated needles which spare the upper part of the skin also gives faster recovery as compared to Fractional CO2/ Erbium.
Recovery time is typically 1-2 days as compared to 2-4 days for Fractional CO2/Erbium.
(One exception is Edge One Fractional CO2 that only has 2 days downtime due to the Edge Pulse technology that minimises charring of surrounding skin.)
So far all the treatments discussed are useful for treating large areas of acne scars.
What about individual spots or ice-pick scars that are notoriously difficult to treat?
Precision Acne Scar Treatments
1. TCA CROSS Deep Chemical Peel for Ice-Pick Scars
TCA CROSS is a specialised chemical peel where specific spots of ice-pick and deep scars are treated using high concentration TCA to break down scar tissue.
I use a range of TCA Cross concentrations from 50% to 100% depending on the severity of the ice-pick acne scars.
2. Punch Excision – Permanent Removal of Scars
During the procedure a dermatologist or plastic surgeon uses a small, cookie cutter-like tool to puncture the top layer of the skin in order to physically extract the scar.
Punch Excision is used to remove scars that cannot be fixed using Lasers, Microneedling Radiofrequency, Subcision or TCA CROSS.
The 360º Acne Scar Treatment – Precise & Personalised
I believe in Precise and Personalised treatment for each and every scar.
With a full suite of more than 8 Acne Scar treatments, I use a customised combination of the latest lasers and technology to ensure that each scar will have the most optimal treatment.
I commonly combine up to 3 types of treatments in 1 session for faster and more effective acne scar removal results.
How Much Improvement Can I Expect for My Acne Scar?
On average, acne scars can be improved close to 90% with this program.
Each program takes between 3-12 months to complete, depending on the severity of acne scars and your skin type.
Patient Case #1:
32 year old asian male executive with generalised acne scarring who is keen on improving skin texture.
Not keen for downtime of more than 2-3 days. He is an active weekend athlete who has ongoing sun exposure over the weekends.
He also has an important meeting in 1 weeks’ time.
This was the custom plan I prescribed him:
Considering his busy schedule, I used a combination of 3 or more types of treatments in 1 clinic visit and prioritised treatments with less downtime for his first session so that he is fully recovered for his important meeting.
Patient Case #2:
29 year old female with rolling scars and box car scars, keen to improve skin within 4 months for her wedding.
Not keen for down-time of more than 2-3 days.
For this lady, I came up with the following treatment plan:
As she is most concerned about recovery time, I selected treatments with less downtime while ensuring that she gets her desired results by her wedding.
Your Acne Scars REQUIRE Customised Treatment
While both patients have acne scars, you can see that their treatment plans are COMPLETELY different!
“But Dr Justin, if this 360º approach is so effective, why isn’t it more widely practised?”
Although many acne scar experts in Singapore are adopting this approach
1. Time-consuming process
The 360º Approach to Acne Scar is time-consuming – from consultation all the way to treatment and recovery.
Detailed consultation to understand your goals, lifestyle and preferences.
Meticulous photography, manual mapping of each scar and treatment planning.
Scars need to be felt instead of just seen. Scar assessments require manual palpation of the scars to determine how deep the scars are.
Lasers are also faster to perform than subcision – except 1. I take more than 3x longer for subcision as compared to a Fractional CO2/Erbium Laser.
INFINI Fractional Micro-Needling is the only other energy based device that takes as long as subcision – this is because multiple passes at different depths are needed.
The regenerative healing compounds like Rejuran are also injected in micro-droplets by hand.
2. Limited types of lasers/technology
Most clinics only have 1-2 types of Lasers.
An Acne Scar clinic has to be well-equipped with the latest acne scar lasers, peels and fillers.
Such technology is expensive and most clinics won’t have the full range unless they specialise in treating acne scars.
3. Acne Scar Expertise
Your final results are dependent on the “Doctor” and not on the “Device”.
Lasers are tools. You need an expert acne scar doctor to use the best tools optimally to give you the best results.
This treatment approach requires in-depth knowledge of the strength and weaknesses of each type of treatment.
As you can see now, apart from there being so many different types of acne scars, there are just as many treatment approaches!
For more about acne scar treatments, you can read my article on DoctorXDentist, where I’m a featured expert too.
Sozo’s Acne Scar Treatment Price List
|360° Acne Scar Treatment Program||Combination of the most suitable treatments||All||Ask Now|
|Lutronic Fractional PicoPlus||Fractional Non-ablative Laser||Shallow Rolling, Atrophic scars||From $450|
|INFINI Fractional RF||Microneedling Radiofrequency||Deep Rolling, Atrophic scars||From $850|
|EndyMed Nano-Fractional Radiofrequency||Nanofractional Radiofrequency||Shallow Rolling scars||From $500|
|EdgeOne Fractional CO2||Fractional Ablative Laser||Shallow Rolling, Boxcar scars||From $450|
|Subcision + Filler||Mechanical Breakdown of scars||All Scars||From $400|
|TCA Cross||Chemical Breakdown of Scars||Deep Ice pick, Boxcar||From $300|
|Enerjet 2.0||Jet Pressure Subcision||All Scars||From $800|
|Injectable Collagen Stimulator||All Scars||From $500|