What Most Doctors Don’t Tell You About Acne Scar Treatments

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Scars are the biggest nemesis to flawless skin. While skin problems like pigmentation and prominent blood vessels can be concealed with make-up, scars are not. They often require thick make-up which leads to cakey and unnatural looking skin.

I have a personal interest in treating acne and acne scars, having battled acne during my teenage years. My active lifestyle as an athlete contributed to worsening of the condition as well as dull skin.

As a physician, common questions that I get from patients who have tried scar treatments include:

“Why didn’t the Fractional CO2 Laser remove my scars completely?”

“How do I decide which treatment I need?”

“I need to work, is there a way to reduce recovery time?”

My Fractional CO2 of choice, the Edge.

Honestly, Fractional CO2 is the gold standard laser for acne scars.

However, a lot of patients who tried it are still dissatisfied with their scars. The reason is simply that Fractional CO2 treatments do NOT treat EVERY type of scar.

If your doctor insists on treating your entire face using ONLY Fractional CO2 lasers… please, ask them “WHY!?”

Different Scars. Different Treatments.

Facial scars are most commonly due to Acne. Other causes include herpes zosters, surgery or injury. Acne alone can cause up to SEVEN types of scars. It takes an extremely trained doctor to be able to identify exactly which type a patient has.

Each type of scar requires a PRECISE and specific treatment. For example, Fractional CO2 does NOT treat ice-pick (deep and shallow pit) scars at all.

Lasers aren’t effective at all against this type of scarring.

No two patients have the exact same type and severity of scarring. However, acne scars, no matter how old or severe can be improved.

My personal opinion as a doctor is that acne scar treatments require a bespoke plan based on skin type, scar type, lifestyle and cost concerns. I call this a 360 Scar Treatment approach.

What is a 360 Scar Treatment approach?

This approach is based on the concept of Precision and Personalised treatment for each and every scar.

I use lasers, chemical peels, subcision and fillers to ensure that each scar will have an optimal treatment.

Subcision
TCA Cross for Ice Pick Scars

On average, acne scars can be improved by at least 70% 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:

Scar Type Treatment Sessions
Ice pick scars TCA peel 2-3
Subcision + Filler 2-3
Rolling scars Infini RF 2-3
PicoPlus Triple Depth 2-3
Boxcar scars Fractional CO2 2-3
Sublative 2-3

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:

A 29-year-old female with rolling scars and boxcar scars, keen to improve skin within 4 months for her wedding. Not keen for the downtime of more than 2-3 days.

For this lady, I came up with the following treatment plan:

Scar Type Treatment Sessions
Rolling scars Infini RF 2-3
PicoPlus Triple Depth 2-3
Rejuran Healer 1-2
Boxcar scars Fractional CO2 2-3
Sublative 1-2

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.

Performing the new Lutronic Pico Plus laser

While both patients have acne scars, you can see that their treatment plans are COMPLETELY DIFFERENT!

“But Dr Justin, if this 360 approach is so effective, why isn’t it more widely practised?”

There are 4 main reasons as to why you’d rarely see this.

1. Time-consuming

A personalised approach requires detailed consultation to understand the patient’s goals, lifestyle and preferences.

In addition, you need meticulous photography, manual mapping of each scar and treatment planning.

2. Limited types of laser machines

A clinic has to be well-equipped with the latest lasers, peels and fillers. Such supplies are expensive and most clinics won’t have the full range.

3. Expertise

A 360 Scar treatment requires meticulous diagnosis and precise treatments that target each scar individually.

It also requires in-depth knowledge of the strength and weaknesses of each treatment modality.

4. Post-treatment Recovery – The Missing Factor

Undergoing treatments for scars without good post-treatment recovery is akin to exercising without getting sufficient rest. I use a combination of Recovery serums and Phototherapy to enhance recovery and to minimise side-effects of the treatments.

As you can see now, apart from there being so many different types of acne scars, there are just as many treatment approaches! It takes a lot of time and patience to customise an effective program for each individual.

However, in my opinion as a doctor, this is the best way of delivering results for acne scars and the 360-approach should be more widely practiced.

Having questions on Acne Scar Treatments in Singapore? Ask me using the form right below or click on the floating WhatsApp icon on the bottom right.

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