Condition > Acne Scars

Acne Scars – Causes, Treatment & Recommended Removal Method

What Causes Pimple Scars?

Pimple scars, acne scars, pock marks or acne marks are usually caused by inflamed lesions and enlarged pores that leave a break in the follicle wall. As the body attempts to heal itself by forming new collagen fibers to replace the lost tissue that has been destroyed, it doesn’t usually end up as smooth and flawless as before. As the wound heals, the body can sometimes produce either too much or too little collagen, creating raised tissue or an indentation on the skin’s surface. Many patients are concerned if these pock marks can be removed. Unfortunately, most of them do not fade over time, but acne scars do go away when treated properly.

A patient typically went through many treatments and home remedies for acne scar removal before seeing a doctor. There are several treatments for those suffering from pimple scars. Some treatments are more effective at getting rid of specific types of acne scars. Suitable treatment options may vary slightly depending on the type of scarring that acne has caused. There are three types of acne scars:

acne scar before and after treatment and removal

Atrophic scars 

These are small indentations in the skin. They occur when the skin does not produce sufficient fibroblasts during the healing process. As fibroblasts are cells that play a crucial role in wound healing and the synthesis of collagen. Atrophic scars are usually the results after acne, chicken pox, and indented scars. The indentation can form into one of three types of acne scars:

#1 Ice Pick Scars

This type of scar extends into the dermis and looks as if it was pierced by an ice pick. Some ice pick scars may resemble large, enlarged pores but most are small, thin, deep holes in the skin. The ice pick scar is the result of an infection caused by a cyst or another deep inflamed blemish that makes its way to the surface. Long, column-like scars are left behind due to the destruction of skin tissue.

#2 Boxcar scars

A boxcar scar is a round or oval depression that has steep vertical sides, resembling chicken pox scars. Unlike ice-pick scars, boxcar scars cause the skin to appear uneven and pitted. The skin over this area is left without support when collagen is destroyed by an inflammatory breakout. The extent of tissue loss can determine the severity of boxcar scars. It frequently occurs on the cheeks and temples, and have a rather wide cross-section measuring between 1.5 to 4mm in diameter.

#3 Rolling Scars

This type of scarring causes rolling or wave-like depressions across otherwise normal-looking skin. Boxcar scars have sharp edges, while rolling scars have uneven and craggy skin. The formation of rolling scars is caused by fibrous bands of tissue developing between the skin and the subcutaneous tissue beneath. As these bands pull the epidermis from within, they bind it to deeper structures of the skin, creating the rolling appearance.

Treating Acne Scars

Scarring after acne occurs frequently. It is an unwanted reminder of a painful and bothersome condition. When left alone, as you grow older, they will turn into more obvious and severe acne scars. However, acne scars do not have to be permanent, as recent advances in laser and ablative radiofrequency technology have allowed us to offer effective treatments in minimizing unsightly scar damage to the skin after acne.

Acne Scars Treatment with Today's Medical Technology - Dr Kenneth Thean

Topical scar removal creams may help but medical grade treatments are generally more effective in treating pitted scars. There are several types of treatment that can help reduce acne scars or acne marks and improve the overall skin quality

  • Ablative Laser Treatment

    Laser treatment helps to lighten acne scars as it smooths away the top layer of the skin. Some of the common lasers used for acne scarring are erbium YAG (er:YAG) lasers, fractional carbon dioxide (CO2) lasers and other resurfacing lasers which can also reduce the pores and aid in skin renewal to reveal a healthier skin. However, it is not suitable for patients who are still suffering from acne breakouts or has darker skin tone of Fitzpatrick skin phototypes IV-VI. Asian skin in particular may develop a higher rate of (80%) post-inflammatory hyperpigmentation (PIH) in ablative laser treatment than non-ablative fractional resurfacing. 
  • Non-Ablative Lasers

    Non ablative lasers such as picosecond lasers help to stimulate new and healthier collagen production which encourage new cell growth to replace damaged, scarred tissue. This treatment not only helps to smoothen acne scarring, it can also help to reduce the appearance of enlarged pores and treat post acne marks.
  • Medical Peels

    Medical / Chemical Peels can also help to improve the appearance of acne scars by using chemical solution to remove the outer layer of the skin. However, this would require strong acids such as TCA or phenol peels to help reduce deep acne scarring. This type of strong acid is only suitable for fair-skin individuals and are usually not recommended for darker skin tone of Fitzpatrick skin prototypes IV-VI. As stronger chemical peels may cause depigmentation or stimulate post-inflammatory hyperpigmentation (PIH) which may results in an uneven skin tone. 
  • Dermal Filler

    Dermal filler is one of the ways on how to clear acne scars. Although fillers can help to plump the skin by using collagen to smoothen out depressed scars and even out skin tone, it is usually a temporary solution and may require to be injected every few months to maintain the results. 
  • Puro Treatment for Acne Scars

    Puro is a customisable FDA cleared solution for acne scars treatment that uses 160 micro pins to safely deliver heat via NanoFractional RF™ through the skin’s surface. The pins create tiny micro-dermal channels in the skin while conveying heat to the deeper layer of the skin, which then trigger the skin's wound healing response. This process stimulates collagen production to increase cellular turnover and improve skin barrier's resilience to treat  skin damage, brighten the skin, reduce hyperpigmentation, lighten the appearance of acne scars and minimize the pores. This treatment is suitable for all skin types and has a much lower risk of PIH especially for darker skin tone. Additionally, this treatment is more comfortable than ablative lasers and results in smoother, healthier skin with minimal downtime.
  • Intensif RF Microneedling Treatment for Acne Scars

    This therapy is good for depressed scars that lie more than 1.5mm deep below the skin, microneedling helps. It is a procedure that uses a small, handheld, needle-studded roller containing multiple fine needles to puncture the top layer of your skin. How this works is that it encourages peeling it triggers the production of collagen and elastin as the skin tries to heal, leaving skin with a smoother appearance. Results can be seen within six to 12 weeks after treatment. This is a popular treatment because the results are better, there are also fewer risk of side effects, minimal downtime and are much suitable for darker skin tone. 

Acne Scar Removal in Singapore – Why We Don’t Use CO2 Lasers

In the past, treatment for acne scars or acne marks were CO2 fractional resurfacing lasers. CO2 fractional lasers treat scars by gradually removing a few microns from the upper layer of the skin. This resurfacing treatment is more suitable for Caucasian skin as compared to Asian skin. If used on Asian skin, complications of hyperpigmentation and burns often occur, resulting in multiple treatments. Results when using this treatment for deeper scars is unsatisfactory, because more complications arise, as well as longer downtime for patients.

So here are some of the results why Dr Kenneth Thean and Dr Chiam Chiak Teng recommend a different approach when it comes to pimple scar removal in Singapore. Instead of using the CO2 laser, I prefer to use the safer Erbrium Yag lasers, and ablative radiofrequency technology; these are more suitable for use on Asian skin.

We can now quite easily target the scar to almost the full thickness of the skin. The 500 micron ablative depth, can treat the deep scar tissue that pulls the skin surface down. Dermal lasers are also used to stimulate the growth of the skin's collagen. This triple-action of deep fractional skin resurfacing, which releases the tethering scar fibers and rebuilds the skin’s collagen matrix, means the skin is restored to its natural position, resulting in much smoother skin. Other treatments such as Chemical Peels can also reduce scarring appearance.

Significant improvement is achieved after just one treatment. With the reduction in the risk of complications, multiple treatment sessions can be carried out safely. We can thus achieve a considerably smoother skin surface safely and effectively.

Frequently Asked Questions on Acne Scars & Acne Marks

1. There are many treatments in the market to treat pimple scars or acne marks, which one do I choose from?

The type of acne marks treatment is usually recommended by the doctor after careful assessment of the patient's skin condition and the acne scar type(s). Depending on the severity of the scars and marks, the doctor may use a combination of lasers and other energy devices or injectables to achieve optimal results. 

2. Will it be painful?

Some of the acne marks treatment may have a slight tingling sensations during the session, however it is also dependent of individual's threshold. While other treatments can be comfortable as numbing cream will be applied to reduce any pain or discomfort for patients during the treatment. 

3. How many treatments do I need and how long will I see visible results?

It varies on individual's skin condition, scar type(s) as well as the treatments recommended by the doctor. A consultation is required in order to provide an accurate assessment and treatment plan for our patients.