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Dr. Tan Hui Yun: Why your acne scar treatment is not working for you
Insecure. Unsuccessful. Shy. As research1 suggests, these are the attributes we tend to give to those with acne scar issues. While this might seem harsh and even cruel, acne scars do have a profoundly negative impact among sufferers.
Further, many opt for the wrong type of acne scar treatment that exacerbates their condition or causes too much discomfort. One common example in Singapore is the fractional CO2 laser.
Allow me to explain what to look out for when seeking acne scar treatments in Singapore, why CO2 lasers may not be optimal for you, and whether active acne and scars can be treated concurrently.
Do I have normal post-acne marks or acne scars?
Do not confuse your post-acne mark with an acne scar. Here are a few key differences to take note of:
| Characteristic | Post-acne marks | Acne scars |
|---|---|---|
| Colour | They usually appear red at first and may fade off to a brown colour. | New acne scars are red or brown, whereas old scars are flesh or white coloured. |
| Texture | Flat. | Raised or depressed compared to the rest of the skin. |
| Damage to skin | They don’t indicate any long-term damage to your skin or permanent loss of collagen | They indicate damaged or overgrown tissue. |
| Permanence | Spots from bad pimples can take 6-12 months to fade on their own. | Acne scars do not fade away and are difficult (although very possible) to remove. |
Can my acne marks or scars completely go away with treatment?
Yes, with the right acne scar treatment, you can get rid of them or see visible improvement – even in the most severe of acne scars.
Case in point: I had an adolescent patient who suffered from acne conglobata, the most severe form of facial acne whereby acne cysts become confluent and cause ‘tunnels’ under the skin.
He was monitored closely for many months and treated almost weekly with lasers, injections and medication adjustments to get his condition under control. Today, he does not have many residual scars despite the severity of his acne.
In general:
- Most individuals can completely clear their acne marks within 3-6 months, as long as their acne is well controlled.
- Certain acne scars (eg. depressed and raised acne scars) almost fully heal (80-90%) over a period of 6-18 months. You should be suspicious if anyone promises you 100% clearance of raised and depressed acne scars in less than 3 sessions of treatment with no downtime!
What acne scar treatment in Singapore is best for me?
Not all acne scars are made equal. Here are the different types of acne scars, and how best to treat them:
| Acne scar type | Treatment modalities |
|---|---|
| Acne marks | They respond well to pigment and vascular lasers. |
| Rolling and shallow boxcar scars | Rolling and shallow boxcar scars respond well to a combination of resurfacing lasers like the Pico or CO2 lasers, subcision, and injectable treatments like Profhilo, Rejuran or fillers. |
| Deep boxcar scars | Deep boxcar scars require additional TCA cross treatments before they become responsive to the aforementioned treatments. |
| Icepick scars | Like deep boxcar scars, they do not respond to conventional lasers alone and require TCA cross treatments as well as more treatment sessions in general. |
| Hypertrophic scars | These respond well to steroid injections, botulinum toxin injections and vascular lasers. |
Is laser treatment suitable for Asian skin?
While CO2 lasers were often used to treat acne scarring in the past, I’ve found that it causes too much discomfort and downtime compared to newer technologies like the Pico Laser, which has usurped it in terms of popularity and effectiveness.
Further, it’s been found that ablative CO2 lasers produce only mild to moderate improvement with high postinflammatory rate on Asian skin2. Weighing this risk-to-reward ratio, I personally do not think CO2 lasers are worth it, especially when there are safer and more effective options out there.
I had a female patient in her late 20s who suffered from severe atrophic acne scarring. Before seeing me, she tried many painful procedures like CO2 lasers and PRP injections, all with unsatisfactory results, as they were not suitable for her many icepick and deep box scars.Due to the severity and variation of scarring, I treated her with a combination of TCA cross, subcision, Pico laser, and Profhilo injections. The most satisfactory outcome was her improved mood, as she had a history of depression and had been emotionally affected by her scarring. The patient got engaged shortly after her treatments.
What should I look out for in my acne scar treatment?
Do not believe in any particular hyped up treatment that you might come across on the Internet, as the success of your treatment ultimately boils down to the experience and skill of your doctor. As such, your chosen aesthetician should:
- Be clinically accredited and well-reviewed
- Be well-known for using scientifically-backed methods
- Display a keen understanding of your issues and concerns
- Offer a tailored approach and treatment plan
- Have access to and knowledge of modern solutions
I also do not recommend doing non-medical facials if you have acne scars. Inexperienced therapists can cause post-extraction breakouts or even worsen existing scars by over-extracting. They might also use non-compatible products that might also aggravate breakouts and lead to more scarring.
Can active acne and acne scars be treated at the same time?
Yes! In fact, when treating acne scars, it is crucial to treat acne concurrently and promptly. Your doctor may prescribe you topical products as the first step of your treatment. These contain ingredients that both help to control acne and speed up scar clearance.
Laser treatments are another option for treating active acne and scars, and may be added to a patient’s treatment plan if it is suitable for their budget, expectations, and acne severity.
Don’t wait to treat your acne scars
The earlier you start treating your scars, the better the final outcome. While most acne scars are still salvageable while they are red, they become permanent once they turn white or flesh coloured.
Moreover, as you age, your skin will lose its collagen and elasticity, and your acne scars will become more visible. As such, scar treatments may need to be repeated down the road to catch up with this collagen loss. New treatments may also need to be considered later on to tackle skin laxity stemming from loss of deep tissue support.
Remember, skincare is a journey. This is why it is important that you work with a doctor whom you believe will serve you well in the long run.
Do you have any questions for me? Feel free to drop me a message at 8822 3039 or info@harmonyaesthetics.sg and I’ll be more than happy to help!
About Dr. Tan Hui Yun
With 15 years of clinical experience under her belt, Dr Tan Hui Yun, who has a background in family medicine, never fails to go the extra mile in her role as an aesthetician. She takes immense pride in addressing her patients’ surface and underlying concerns for long-term confidence, beauty, and life satisfaction.
References
- Dréno, B., Tan, J., Kang, S., Rueda, M.-J., Torres Lozada, V., Bettoli, V., & Layton, A. M. (2016). How People with Facial Acne Scars are Perceived in Society: an Online Survey. Dermatology and Therapy, 6(2), 207–218. https://doi.org/10.1007/s13555-016-0113-x
- https://onlinelibrary.wiley.com/doi/abs/10.1002/lsm.20974