Acne Scar Treatment

Acne Scars

The most important step in acne scar treatment is to ensure that acne has been treated completely. It is important to ensure prevent the development of further acne scars. Because we are a dermatologist-led clinic, we can treat acne very effectively with high long-term cure rates. Please see our page on acne treatment.

There are numerous treatments for acne scars, and typically, combinations of treatments are necessary to achieve the best result. The choice of acne scar treatment is determined by the type and extent of scarring, your preference, side effects, and cost. Acne scar treatment is not a ‘one-size fits all’ approach.

What causes acne scars?

Acne scarring is caused by abnormal wound healing due to inflammation as a result of acne. This results in an abnormal balance of collagen synthesis and the degradation of the extracellular matrix.

The different types of acne scars

Acne scars can be classified into two main types of scars.

• Atrophic scars are the most common and they develop from loss of collagen in the dermis. This loss creates a depression in the skin. There are three sub-categories to describe atrophic scars:
  • Ice pick scars are narrow (< 2 mm), deep, and sharply demarcated.
  • Rolling scars are wide (4-5 mm), shallow, and undulate on the surface of the skin due to a fibrous attachment to the subcutaneous tissues.
  • Boxcar scars are wide with sharply demarcated borders. They can be either superficial or deep.
• Hypertrophic scars or keloid scars, are less common and result from an abnormal overproduction of collagen. They are typically firm and raised. These scars can also cause irritation and discomfort.

How to remove acne scars effectively?

The first thing we will ascertain is what your concerns are about your scars and what your desired outcome is.

Scar treatments are initially targeted towards deep scars and redness (erythema). This is usually followed by procedures to enhance collagen remodelling, such as laser treatments to even out the skin surface. Any stubborn scars are then treated with fillers or fractional laser treatments.

Acne treatment for redness and erythema

The treatment of erythema (redness) is very important, as it can make scars more obvious. Fortunately, the treatment of erythema with vascular lasers can be very effective.¹Alster TS, McMeekin TO. Improvement of facial acne scars by the 585 nm flashlamp-pumped pulsed dye laser. J Am Acad Dermatol. 1996 Jul;35(1):79-81. doi: 10.1016/S0190-9622(96)90501-0

Deep acne scar treatment

Deep acne scars can be resistant to simpler treatment methods and require special considerations. Some of the options include:

• CROSS (Chemical Reconstruction of Skin Scars) technique, particularly for ice-pick scars.
• Subcision can be used to release rolling scars, which are typically abnormally tethered to deeper structures. This allows the formation of new, healthy collagen underneath the scar.
• Punch excision and punch elevation are performed to elevate the scar to the level of the surrounding skin. This is normally then stitched in place.

Collagen remodelling for acne scar treatment

Collagen remodelling is subsequently undertaken to encourage increased production of healthy collagen under scars. There are several options to encourage collagen remodelling:

Non-ablative fractional resurfacing (NAFR)

NAFR is well tolerated, has few side effects, and requires short recovery periods of about one to three days. NAFR typically requires four to six treatments at monthly intervals. NAFR can provide similar results to ablative laser while having minimal downtime. Studies have shown that 90% of people report improvement with NAFR.²Alster TS, Tanzi EL, Lazarus M. The use of fractional laser photothermolysis for the treatment of atrophic scars. Dermatol Surg. 2007 Mar;33(3):295-9. doi: 10.1111/j.1524-4725.2007.33059.x^,3Lee HS, Lee JH, Ahn GY, Lee DH, Shin JW, Kim DH, Chung JH. Fractional photothermolysis for the treatment of acne scars: a report of 27 Korean patients. J Dermatolog Treat. 2008;19(1):45-9. doi: 10.1080/09546630701691244

Ablative laser resurfacing

Traditionally, ablative laser resurfacing is the most effective treatment. However, it is invasive and not well tolerated by everyone. Recovery can take about 7-14 days. ⁴Ong MW, Bashir SJ. Fractional laser resurfacing for acne scars: a review. Br J Dermatol. 2012 Jun;166(6):1160-9. doi: 10.1111/j.1365-2133.2012.10870.x^,5Cho SB, Lee SJ, Cho S, Oh SH, Chung WS, Kang JM, Kim YK, Kim DH. Non-ablative 1550-nm erbium-glass and ablative 10 600-nm carbon dioxide fractional lasers for acne scars: a randomized split-face study with blinded response evaluation. J Eur Acad Dermatol Venereol. 2010 Aug;24(8):921-5. doi: 10.1111/j.1468-3083.2009.03551.x

Laser-Assisted Drug Delivery

Creating micro-channels in the skin with laser or microneedling, followed by applying growth factors and bioremodellers has shown impressive results in studies published to date⁶Pawar M, Singh M. Microneedling with autologous platelet-rich plasma versus microneedling with topical insulin in the treatment of postacne atrophic scars: A simultaneous split-face comparative study. J Am Acad Dermatol. 2021;84(3):810-811. doi:10.1016/j.jaad.2020.05.152^,7Wang JV, Ugonabo N, Geronemus RG. Fractional Ablative Laser-Assisted Delivery of Topical Poly-l-lactic Acid: A 2.5-Year Safety Review. Dermatol Surg. 2022;48(2):258-259. doi: 10.1097/DSS.0000000000003333^,8Steuer AB, Bajaj S, Wang JV, Geronemus RG. Safety and Effectiveness of Fractional Ablative CO 2 Laser-Assisted Delivery of Topical Poly- l -Lactic Acid for Rhytides and Scars. Dermatol Surg. 2024;50(4):400-402. doi:10.1097/DSS.0000000000004072.

The skin acts as a barrier to the environment which limits the absorption of topical products. Laser-assisted drug delivery (LADD) is a relatively new technique to assist with the delivery of growth factors into the skin. Temporarily disrupting the skin barrier with laser enhances transdermal delivery⁹Ng WHS, Smith SD. Laser-Assisted Drug Delivery: A Systematic Review of Safety and Adverse Events. Pharmaceutics. 2022;14(12):2738. Published 2022 Dec 7. doi:10.3390/pharmaceutics14122738^,10Wenande E, Anderson RR, Haedersdal M. Fundamentals of fractional laser-assisted drug delivery: An in-depth guide to experimental methodology and data interpretation. Adv Drug Deliv Rev. 2020;153:169-184. doi:10.1016/j.addr.2019.10.003.

Chemical peels

Superficial chemical peels in combination with microneedling has similar efficacy to deep peels but, with shorter recovery times, reduced toxicity, and scarring.¹¹Leheta TM, Abdel Hay RM, El Garem YF. Deep peeling using phenol versus percutaneous collagen induction combined with trichloroacetic acid 20% in atrophic post-acne scars; a randomized controlled trial. J Dermatolog Treat. 2014 Apr;25(2):130-6. doi: 10.3109/09546634.2012.674192^,12Garg S, Baveja S. Combination therapy in the management of atrophic acne scars. J Cutan Aesthet Surg. 2014 Jan;7(1):18-23. doi: 10.4103/0974-2077.129964

Microneedling

Microneedling is an alternative, effective treatment that has a short recovery time and a low risk of causing pigmentation.¹³Mujahid N, Shareef F, Maymone MBC, Vashi NA. Microneedling as a Treatment for Acne Scarring: A Systematic Review. Dermatol Surg. 2020 Jan;46(1):86-92. doi: 10.1097/DSS.0000000000002020

Radiofrequency treatment

Radiofrequency treatment can also induce remodelling effectively.¹⁴Rongsaard N, Rummaneethorn P. Comparison of a fractional bipolar radiofrequency device and a fractional erbium-doped glass 1,550-nm device for the treatment of atrophic acne scars: a randomized split-face clinical study. Dermatol Surg. 2014 Jan;40(1):14-21. doi: 10.1111/dsu.12372

Dermal filler

Sometimes, stubborn atrophic (depressed) scars need a little help with dermal fillers to elevate the depression to the skin’s surface. This is particularly useful for rolling scars.

What to expect with acne scar treatment?

An experienced healthcare provider will conduct your first appointment as a consultation. The first thing they will ascertain is what your skin concerns are and what your desired outcome is. Next, they will undertake a comprehensive assessment of your skin and provide their expert recommendations regarding treatment. Then they will develop a treatment plan tailored to your skin.

Our optimal goal is to help you achieve long-term results and not have to keep coming back for appointments.

Acne Scar Treatment with Anue

We believe our clients deserve access to expert administration of evidence-based acne scar treatments. That is why we offer our services by our trusted team, supervised by renowned specialist dermatologist, Dr. David Lim.

By using refined techniques, qualified professionals, and high-quality products, we aim to make you look and feel your best. Our acne scar treatments are safe and effective at helping you achieve your goals.