If you chanced on this post with the question "How to get rid of acne scars?", you're not alone. It's one of the most common skin problems that patients send in an enquiry on DxD for.
Dealing with acne in your youth is bad enough, but the scars it leaves behind can be a real nightmare.
Don't waste your time and money on treatments that don't work. Before coming to see me, it’s not uncommon for patients to try completely ineffective methods, from DIY home treatments to beauty spa facials and underpowered lasers.
I decided to write this comprehensive guide to increase awareness about your best options when it comes to treating acne scars in Singapore, based on my personal experience over the years.
Bear with me as it's a long read (1830 words in total), but I promise to tell you everything you need to know about getting rid of those pesky scars.
First things first, is it an acne scar?
You may have an acne mark (not permanent), instead of an acne scar (permanent). My patients often mistake dark acne marks for acne scars. It's important to distinguish between the two.
Acne marks are also known as post-inflammatory hyperpigmentation (PIH). These dark coloured spots are left behind when a pimple goes away, and can be red or brown coloured. They generally disappear on their own within 3 - 6 months. You can expedite the process with a diligent treatment of topical retinoid cream and sunscreen.
Acne scars are permanent depressions or elevation on the skin. They can result from cystic acne (big, red and tender pimples) or inflamed pustular acne (whitish pus-filled pimples), especially if you pick/pop them!
What kind of acne scar do you have?
Atrophic acne scars appear as depressions in the skin. The 3 main categories of atrophic scars are:
- Ice pick scars: Deeper than they are wide, with a narrow opening.
- Boxcar scars: Broad, rectangular depressions with steep, defined edges.
- Rolling scars: Broad depressions that have rounded, sloping edges.
Acne scars can also be elevated. This includes raised hypertrophic scars and keloid acne scars. Acne scarring may also appear as very enlarged pores.
Is acne scarring preventable?
The million dollar question my patients often ask. In a nutshell, the answer is yes. If scarring acne (usually cystic or pustular acne) is stopped early in its tracks with aggressive treatment, you can avoid acne scars completely. This usually involves treatment with oral isotretinoin and topical creams.
(Also read: A concise guide to acne treatment in Singapore)
If you think your acne might be starting to scar, or you have family members with acne scars, see your doctor or dermatologist ASAP to get started on the appropriate treatment.
Who should you find in Singapore for acne scar treatment?
In Singapore, dermatologists and doctors with an interest in skin can help with acne scar treatment. It's useful to seek the opinion of a few doctors. In particular, you should find out:
- How much experience he has with acne scar treatment
- Number of treatments required
- Realistic expectations of outcomes and improvement - ask him to show you a couple of before and after photos of patients he has treated
How much does acne scar treatment in Singapore cost?
This depends on the type and extent of scarring you have, and nature of treatment required.
To illustrate: For severe and extensive acne scars, your doctor may suggest 3 - 5 x sessions of laser resurfacing, 1 x subcision and 1 x non-ablative laser at a total cost of $4000.
To give you a sense of the average price range:
- Mild to moderate acne scar treatment in Singapore costs: $1800 - $3000
- Severe acne scar treatment in Singapore costs: $2800 - $5000
How much improvement can I expect after acne scar treatment?
In my experience, most patients can expect an average improvement of 50 - 70% after treatment. For the majority of cases, patients see a 70 - 80% improvement in acne scars.
The law of diminishing returns applies - eg. after achieving 90%, it's much more more difficult to attain another 5 - 10% of scar improvement.
The first few treatments often result in the greatest improvements.
The amount of improvement also depends on:
- the type and extent of acne scarring you have
- your skin type and skin response to treatment.
For example, dark-skinned patients with atrophic scars may only see improvements of 50%, while patients with ice-pick scars or shallow box-car scars can see improvements of up to 80%.
What's the best acne scar treatment in Singapore?
The best acne scar treatments available in Singapore are:
- Laser treatment eg. fractional CO2 laser
- Radiofrequency (RF) microneedling eg. Venus Viva and INFINI
- Chemical peels eg. TCA CROSS
- Punch excision/grafting
- Dermal fillers eg. Restylane and Juvederm
(Also read: FAQ about acne scar treatment in Singapore)
The treatment recommended by your doctor depends on:
- the type and extent of acne scarring you have
- the amount of downtime after treatment you're willing to accept
Which acne scar treatment should I pick?
To obtain the best results, you need a tailored approach to target your combination of acne scar with the ideal treatments.
- Ice pick scars and narrow boxcar scars respond well to TCA CROSS.
- Rolling scars and craters can be effectively treated with fractional lasers and RF microneedling. Punch grafting and dermal fillers are also good options.
- Tethered and anchored scars are best treated with subscision.
Confused? I would be too, in your shoes. You should therefore let your doctor advise you on the right acne scar treatments.
My role is just to give you an overview of all the effective treatments, so that you have all the information you need in discussions with your doctor.
How to get rid of acne scars
1. Laser treatments
(not actual laser representation - I just thought this looked cool)
Laser treatments can be helpful for both acne scars and acne marks (post-inflammatory hyperpigmentation).
Pulse-dye lasers are useful in reducing the redness associated with acne marks/PIH, and have minimal downtime.
Fractional C02 laser is extremely effective for treating most kinds of atrophic acne scar, and has a downtime of 5 - 10 days. It's by far one of the most common acne scar treatments in Singapore, because it works.
(Also read: Fractional Laser Experience: A Doctor Tells All)
Laser treatment for acne scars takes considerable expertise to perform well. Experienced doctors know how to adjust the power setting of the laser according to the depth of acne scarring, and the part of face being worked on.
Laser treatment cost in Singapore: Pulse-dye laser costs $250 - $400/session. Fractional laser costs $500 - $1000/session. Both require 2 - 3 sessions for the best results.
2. Radiofrequency microneedling
Radiofrequency (RF) microneedling treatments, such as the Venus Viva and INFINI system use small needles to deliver heat energy to the skin. This stimulates collagen production and acne scar remodelling.
RF microneedling is ideal for rolling, atrophic, mixed, and tethered scars. Healing time is quicker than lasers - often within 48 hours. There's also less chance of hyperpigmentation. Improvements are expected up to 6 months post-treatment.
Radiofrequency microneedling cost in Singapore: Infini costs about $1000 - $2500/session in Singapore. 1 - 2 sessions are normally recommended.
3. Chemical peels
Many doctors don't like chemical peels because results can be unpredictable. Some types of acne scarring require a deeper peel, while certain parts of the face also absorb the chemical peel more than others. This makes calibration of a chemical peel extremely tricky - get it wrong, and it's ineffective at best, and disastrous at worst!
In my practise, I like to use a hybrid technique called TCA CROSS. This involves using a toothpick or needle to place TCA solution into deep acne scars, one at a time. The TCA solution stimulates collagen production, which levels out deep acne scars.
Time-consuming? You bet it is, but ice pick scars respond very well to this method. One treatment generally improves the scar by 30 - 40%. The deeper and narrower the scar, the better the results.
Chemical peel cost in Singapore: TCA CROSS costs roughly $130/session, and $350 for 3 sessions. 2 - 3 sessions are usually required for the best results.
4. Subscision of scars
Acne scars are sometimes depressed due to fibrous scar tissue that pull down the surface of your skin. In this situation, all the lasers and chemical peels in the world will have limited effect, as your skin surface is "tethered down" by these scar tissue.
With subcision, a small needle is used to release the fibrous scar tissue beneath the scar. As the area heals, the new collagen also helps to push the base of the acne scar up.
Scar subscision works best for shallow scars with a broad base, rather than on ice pick scars. You'll usually see small improvements in your acne scars after each treatment. The downside to subscision is the bruise that's left right after the procedure, which can last for 1 - 2 weeks.
Subscision cost in Singapore: Typical prices are around $100 - $300/session, for up to 5 sites. Optimum results may require 1 - 4 sessions.
5. Punch excision/grafting
Punch excision involves using a tiny hole-punch like device to cut out the acne scar. The wound is then sutured close, with the stitch removed within a week. It's best suited for icepick scars that have a narrow opening, but are deep.
In punch grafting, after the scar is excised, a small piece of skin is taken from another site on the body (often from behind the ear). The piece of skin removed is then placed into the hole where the acne scar once was. Both sites are then sutured closed, or held in place with surgical tape and allowed to heal on its own.
Punch excision cost in Singapore: $200 - $350/session, depending on the number of sites.
6. Dermal fillers: Restylane and Juvederm
Fillers such as Restylane and Juvederm fillers are used to elevate shallow, broad-based acne scars. They are less commonly used in Singapore as the results are temporary, requiring repeat treatment every 6 - 8 months.
Bellafill is the first FDA-approved dermal filler for permanently correcting moderate to severe acne scars. It's unfortunately not available in Singapore yet at the time of writing.
Dermal fillers cost in Singapore: Restylane and Juvederm costs about $500 - $850/syringe. 2 syringes are typically used per session, which costs $1300.
To sum up, treating acne scars is a complex field. I often see patients come into my practise requesting for one particular acne scar treatment that they had researched extensively.
It's important to bear in mind however that acne scar treatment is not a one size fits all. The best outcomes usually result from a combination of different methods, individualised to your skin type and scar.
There are no set rules for achieving a perfect result, but there are certainly poor techniques that ensure suboptimal results. Always consider seeking the opinion of multiple doctors before proceeding with any treatment.
If you are curious about how each procedure is carried out, the following 15 minutes long video covers all the acne scar treatments I've described:
Dr Irenaeus Liu Han Ping is an aesthetic doctor at the Centre for Cosmetic Rejuvenation & Surgery. As a previous surgical trainee, he enjoys using his hands to help people. Outside of work, he enjoys golf and spending time with his two children.