What is an acne scar?

An acne scar is a permanent depression or elevation on the skin after injury to your skin due to acne.

Acne scars are commonly a result of cystic acne (big and red pimples) or inflamed pustular acne (pus-filled pimples), especially if you squeeze or pop them!

Atrophic acne scars appear as depressions in the skin.

The 3 main categories of atrophic scars are:

1 Ice pick scars: Deeper than they are wide, with a narrow opening.

2 Boxcar scars: Broad, rectangular depressions with steep, defined edges.

3 Rolling scars: Broad depressions that have rounded, sloping edges.

Elevated acne scars are known as hypertrophic scars and keloid acne scars.

Acne Scars vs Post-Acne Marks: What’s the Difference?

You may have an acne mark (not permanent), instead of an acne scar (permanent).

Patients often mistake dark acne marks for acne scars. It's important to distinguish between the two.

These ice pick scars are likely to be permanent, without any further treatment.

These dark coloured post-acne marks/ spots are can be red (post-inflammatory erythema) or brown (post-inflammatory hyperpigmentation).

They generally disappear on their own within 3 to 6 months. You can expedite the process with a diligent treatment of topical retinoid cream, sunscreen, and pico laser treatments.

Is acne scarring preventable?

Yes!

If scarring acne (usually cystic or pustular acne) is stopped early with aggressive treatment, you can even avoid acne scars completely.

Acne treatment involves oral isotretinoin, topical creams, and laser treatments.

Treat acne early and aggressively, because acne scarring is harder to treat and costlier to treat as well.

How much improvement can I expect after acne scar treatment?

In my experience with acne scar treatments in Singapore, most patients can expect an average improvement of 70% after treatment. For the majority of cases, patients see a 70 - 80% improvement in acne scars.

The first few treatments often result in the most noticeable improvements.

The law of diminishing returns applies - eg. after achieving 80%, it's much more difficult to attain another 5 - 10% of scar improvement.

The amount of improvement also depends on:

• the type and severity 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 shallow box-car scars can see improvements of up to 85%.

What are the most effective acne scar treatments?

Acne scar treatments that have imprpoved the appearance of scars for many patients I've met are:

1 Laser treatment eg. fractional CO2 laser

2 Radiofrequency (RF) microneedling eg. INFINI

3 Chemical peels eg. TCA CROSS

4 Subcision

5 Punch excision/grafting

6 Dermal fillers eg. Juvederm, Restylane, Rejuran Healer, and Stylage

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

What’s the cost of acne scar treatment in Singapore?

This depends on the type and extent of scarring you have, and the nature of treatment required.

After surveying more than 50+ clinics that offer acne scar treatments, here's the average price range of acne scar removal in Singapore:

• Mild to moderate acne scar treatment in Singapore costs: $1800 - $3500
• Severe acne scar treatment in Singapore costs: $2800 - $8000

Effective acne scar treatments usually require lasers and minor skin surgery procedures.

This has to be performed by a trained medical doctor in a clinic.

AESTHETIC PROCEDURE

TREATMENT NAMES

COST IN SINGAPORE

Fractional C02 lasers

DEKA Smartxide

“DOT”

Lumenis Ultrapulse

Fraxel Repair

Edge CO2

Lutronic eCO2

Mixto SX

$400 - $1000/session

3-6 sessions required

Fractional erbium lasers

Fraxel Dual

Pixel Pro

Mosaic by Lutronic

Cutera Pearl

Sciton Profractional

$400 - $800/session

2-5 sessions required

Fractional micro-needling Radio-frequency Laser

Lutronic Infini

Intracel

EndyMed Intensif

$900 - $1500/session

2-3 sessions required

Fractional Picosecond Laser

PicoPlus

PicoSure

Picoway

Discovery

$600 - $1200/ session

2-5 sessions are required

Chemical peels

TCA Cross

$150 - $500/ session

2-3 sessions are required

Punch Biopsy

$500 - $2000/ session depending on severity and area of scars

Subcision (+/- filler)

$400 - $1000/ session

Filler costs are usually separate. From $500 onwards.

Pneumatic subcision

Enerjet 2.0

Airjet

$800 - $1500/session

2-5 sessions

Corticosteroid injection

$250 - $1000/ session

2-3 sessions

What factors affect the total cost of acne scar treatments?

Effective removal of acne scars requires several sessions of treatments. This is why the total cost of treatment can range from $3000 - $10,000.

1. Area, type, and severity of acne scars

Deeper scarring that affects a larger area of the face would require a more intensive treatment with multiple sessions. This translates to higher total cost.

For example, shallow acne scars affecting a tiny area of the cheeks may only require 1 session of subcision, and 1 session of Edge Fractional CO2 laser. That will not cost more than $800.

However, deep acne scars affecting the full face and neck may require more than 6-10 sessions of different types of treatments. This can bring the cost closer to $10,000.

2. Type and Brand of Lasers:

The price is often determined by the “brand” of the laser.

Lasers range from $50,000 to $300,000 for top lasers.

3. Doctor’s experience and expertise:

Laser technology is important because it is a valuable tool that enable your doctor to deliver results.

However, the experience of your doctor in treating acne scars matters just as much, if not more.

An expert acne scar specialist can advise on the most suitable treatments (usually a combination) for you so that you do not waste unnecessary money on treatments that are inappropriate for your scar type and skin type.

4. Post-laser Care:

Post-laser recovery creams, antibiotics, and sunblock are essentials for good recovery and to minimise complications.

Expert tip: Ask for any hidden costs! Find out if your post-laser recovery creams and sunblock are included in the treatment price.

Medically authored by Dr Justin Boey, last updated 1 Jan 2019.