Acne scars are permanent textural changes on the skin that are left even after acne has subsided.
There are two types of acne scars, namely – Atrophic scars and Hypertrophic scars. Atrophic scars consist of flat, shallow depressions that heal below the top layer of skin. These scars are commonly caused by severe cystic acne. These include ice pick, boxcar and rolling scars. Hypertrophic scars are a thickened, wide, often raised scar that develops where the skin is injured. Scars are common during the skin healing process, but a hypertrophic scar is a result of abnormal healing response to a trauma or injury.
Hypertrophic scars are raised acne lesions of scar tissue on the skin and are a result of the overgrowth of fibrous tissue in the region where the acne lesion had developed. Hypertrophic and keloid scars are more common in areas such as the jawline, chest, back, and shoulders. People with darker skin colour are more likely to develop this type of scarring.
Yes, getting acne scars are preventable. Getting pimples does not necessarily mean you will have a scar. Whilst most acne leaves behind dark spots, they usually disappear on its own in 3 to 6 months. Permanent scars typically occur when there is improper care given to the pimples such as pickling or popping them. Having a good skincare regime prevents breakouts and treating a small inflamed scar early will prevent progression into cystic, nodular acne that causes acne scarring.
Although it sounds like a dead-end, there are various types of treatments we offer at Nuffield to help your skin resurface as much as possible. Each acne scar needs to be treated differently. Below shows a table of the treatments we offer and the scars they treat.
| TCA Cross | FractionalRadiofrequency | Fractional Pico | Co2 Laser | ScarSubcision | Rejuran Scar | Micro-needlingFacial | |
| Ice pick scars | ✓✓✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |
| Boxcar scars | ✓✓✓ | ✓✓ | ✓✓✓ | ✓✓✓ | ✓✓ | ✓✓ | |
| Rolling scars | ✓✓✓ | ✓✓ | ✓✓✓ | ✓✓✓ | ✓✓ | ✓✓ | |
| Keloid scars | ✓ |
TCA cross
TCA stands for Trichloroacetic Acid. There are many types of TCA chemical peels available, but TCA cross is different. TCA cross is a specific procedure for only icepick scars where a high concentration of TCA is placed directly into each scar with a pointed object, like a tooth-pick. This erodes the surrounding scar tissue, allowing remodelling of the scarring tissue.
After the initial redness fades from your skin, you’ll notice that scabs form over the area. Over the next three days, the treated area will start to shed. This process may occur for the next 5 to 7 days. Then, the skin will start healing after which visible improvements can be seen usually after a series of 3 treatments.
After doing this treatment, you should use a gentle cleanser to clean your face, regularly apply moisturiser and sunscreen to hydrate and protect your skin. Not every scar is suitable for TCA cross procedure and scars can worsen with TCA cross if misused. There are also risks of forming hyperpigmentation or hypopigmentation. You must consult your doctor to discuss your treatment options.
Fractional Radiofrequency is a scar treatment that combines the use of radiofrequency technology and micro-needling. Fractional Radiofrequency delivers radiofrequency energy to the tips of the needles where it is translated to heat. Controlled thermal damage can ablate and coagulate the dermis at designated depths, kickstarting scar remodelling and collagen production. Together with that, we also use micro-needling.
By mechanical destruction of the scarring tissue as the micro needles puncture through the target area, they create micro-injury deep into the dermis. However, the results vary greatly depending on the micro-needling technology used.
During the process, you might feel a slight prickling sensation followed by a warm feeling as the needles pass over your skin. The treatment usually lasts 30 to 60 minutes.
At Nuffield, we chose Morpheus 8 with its updated technology. Morpheus 8 is safe for deeper-skinned patients as its insulated ultra-fine needles are driven into the dermis with well-motorised machines. These features ensure minimal damage to the skin surface possible, lowering the risk of developing post-inflammatory hyperpigmentations and minimising downtime of the treatment. A reputable fractional radiofrequency device provides sufficient power to drive the needles to the desired depth and the accompanying microneedles are well-made, so they remain sharp throughout the procedure.
Laser treatment treats scars by inducing controlled damage to the top 1-2mm of the skin, allowing scar remodelling.
All CO2 lasers have a long wavelength of 10,600 nm, heavily absorbed by water targeting scar tissue deeper into the dermis, remodelling the scarring tissue. The laser, one of the longest wavelengths, targets the scarred areas and generates healthy tissue to regenerate through collagen production. It absorbs the surrounding hydration in the skin, kills the old collagen to stimulate new collagen production encouraging scar remodelling.
Fully ablative Co2 laser is the go-to for scar resurfacing treatment. However, fractional CO2 lasers are more commonly used in Asia. When the energy is fractionated, it breaks up the laser energy into thousands of tiny beams to treat only a fraction of the skin in the area, leaving columns of healthy skin to help the healing process. Fractional CO2 laser reduces downtime and its associated risks of PIH.
However, CO2 lasers are aggressive treatments associated with risk of post-inflammatory hyperpigmentation (PIH). With the development in laser technology, the use of fractional pico lasers in the treatment of scars is becoming increasingly popular.
Fractional pico laser uses ultra-short picosecond pulses of laser light to reach deeper into the skin’s sub-layers to create micro-cavities in the skin. It creates bubbles under the skin to activate the Laser-Induced Optical Breakdown (LION) effect of breaking down the scarring tissue under the skin. Depending on the intensity of the treatment, mild petechiae can result as the microcavities are created under the skin. This proves to be a safer treatment for darker skin type patients as the thermal effects on the superficial layer of the skin are minimal and the skin is intact. In the treatment of acne scars, a higher setting of Fractional Pico laser may result in scabs forming.
Not all pico lasers are the same. At Nuffield, we trust our Fotona StarWalker PQX to aid us in this treatment. PQX has specifications for a short pulse width of 300ps and a high peak power of 2.7GW. This means it rapidly delivers powerful power beams allowing the treatment to be safer and more effective.
At the time of treatment, the laser will be slightly warm and have tingling sensations. After treatment, your face may have a little redness which will subside in a few hours. Pico laser does not have any downtime and regular activities can be carried out as usual.
Rejuran is derived from Salmon DNA, very compatible with our human DNA. Fragments of DNA, Polynucleotides, not only fill the space of the depressed scar, the main effect is to improve tissue regeneration, resulting in natural tissue regeneration. It helps in cell repair with growth factors stimulations and increased angiogenesis (improved blood circulation) resulting in collagen production and scar remodelling leading to a smoother skin texture. It is useful in healing all atrophic scars.
Since it is more concentrated and denser in texture than injectable Rejurans, Rejuran S is designed to treat atrophic acne scars. It serves as a filler to fill up depressed scars, with properties to repair the skin.
Although the fillers are temporary, they will stimulate collagen production, which fades your acne scars permanently session by session.
During post-treatment, there will be a downtime of 2-3 days and injection marks may be visible. You may also notice multiple even bumps on your face, which is expected during the healing process. Improvements in the skin can be gradually seen over the four weeks after treatments. Rejuran is commonly paired with subcision for maximum benefit.
Acne scars are sometimes depressed because the fibrous, non-elastic scarring tissue causes tethering of the skin. Scar subcision is a method that involves the insertion of a needle that mechanically releases the non-elastic skin that causes its pitted appearance.
While breaking the non-elastic skin, blood vessels are disrupted during the treatment, which causes blood to accumulate in the treated area. The blood is useful to prevent short-term reattachment of the scars. The use of rejuran scar simultaneously will serve as an additional boost in collagen-building within the targeted space, where it is injected. During the healing process, connective tissues and collagen synthesis remodels the matrix and allows the atrophic scar to rise and appear shallower.
This treatment works well with scars that are broader and shallower (rolling and boxcar scars). This treatment is also slightly invasive and may be painful likened to a snapping feeling. Numbing cream may be applied to help with any discomfort that may result from the injection.
Subcision required a 5 to 7-day downtime where bruising is expected. However, after a week, visible improvements can be seen.
Micro-needling facial treatments improve scarring appearance by breaking down the scarring tissue mechanically with each puncture.
With the use of Dermapen and its patented microneedling technology, you can be assured that the needles are single-use with a microchip that ‘expires’. The needles are finely made and driven into the skin with a powerful motorised mechanism, ensuring that treatment is delivered to the desired depth with minimal downtime seen on the skin surface. It is a collagen induction therapy which works by creating tiny injuries with needles across the scar to help form pockets of healing with making new collagen-rich tissue. This helps to resurface the skin and reduce a scar’s depth.
Some side effects of this treatment are minor skin irritation and redness immediately following the procedure for the first few days. This is your body’s natural response to the damage made to your skin. As this treatment does not deliver any energy, the risk of burns to the skin is eliminated. This treatment is best suited for patients who prefer a treatment less intensive with less downtime.
At Nuffield, we care about serving with medical-grade machines. Each individual is carefully evaluated and a customised treatment plan is discussed. As aggressive treatments are required to treat acne, they are not without its risk. A treatment plan must be designed based on the type of scars you have, your skin type to deliver effective treatments with minimal risk.
In this article, we covered the types of acne scars and the various treatments for acne scars we provide. Acne scars require time and maintenance to reach the desired goals. Everyone takes their own pace to recover from treatments.
However, you should note that to obtain satisfying visible outcomes, a combination of acne treatments must be done to optimise the results.
Using products at home may not be the best solution to eradicate acne scars. Receiving these treatments may better help give you the results you are looking for. It is thus important to make an informed decision on the types of treatment you require.
