Acne scars are the biggest concern that patients have when they first experience a breakout.

Causing significant emotional distress and a loss of self-esteem – it has been reported that 11% of men and 14% of women will experience acne scars at any point of time.

Unfortunately, it is hard to predict if you will fall into this statistic until it actually happens, and by then – only early aggressive treatment can help to improve its appearance.

Acne scars form due to the skin’s natural healing process after acne inflammation occurs. Categorized into atrophic, hypertrophic, or keloid scars – atrophic scars are further broken down into rolling, icepick and boxcar scars.

Here is a summary of their characteristics:

Rolling: Wide, undulating scars that forms a “M” shape. Represents 15% – 25% of all acne scars

Icepick: Narrow, deep scars that form a “V” shape. Represents 60% – 70% of all acne scars

Boxcar: Round, oval scars with well-defined edges that forms a “U” shape. Represents 20% – 30% of all acne scars.

Since each scar type differs in its shape, depth, and size – treating them should involve different modalities. The problem is that many patients have multiple scar types – and they require a more comprehensive treatment plan involving a combination of treatment modalities in order to optimize results.

Why using a single treatment modality doesn’t always work

Essentially, acne scars form due to the destruction and imbalanced deposition of collagen in the skin, which is why majority of treatments are aimed to help remodel collagen in order to rejuvenate and smooth out the skin.

Today, acne scar removal treatment can include, surgical techniques, ablative and non-ablative laser resurfacing, chemical peels, microdermabrasion, and dermal fillers.

Each method comes with their own set of benefits, mechanisms, and side effects – providing varying degrees of efficacy in treating mild to severe acne scars and types.

There has been a comprehensive review of 36 relevant articles showing the effectiveness of each treatment type. While they are all effective in their own way, there is no one treatment that has been shown to be universally productive in treating all scar types.

 Ultimately, the goal of any acne scars treatment is to give the skin a more flawless appearance and to minimize any side effects and recurrence. In order to address the different elements of acne scars – employing the appropriate selection of more than one treatment modality is the only way to treat different layers of the skin.

Evidence supporting combination therapy

When talking about combination therapy, it doesn’t always mean the use of two treatment modalities in the same session. In fact, there has been plenty of studies showing a triple combination therapy as extremely effective way in treating atrophic scars.

A 2014 study conducted with 50 patients using a combination therapy of subcision, micro-needling, and 15% TCA peels revealed acne grade improvements and a high level of patient satisfaction.

Another 2015 study featuring 42 patients also showed a greater improvement in acne scars when the fractional CO2 laser was combined with punch elevation techniques as compared to just using laser treatment alone.

A 2017 study also studies the effects of combining the fractional CO2 laser with subcision in the treatment of atrophic scars. Results showed a higher average recovery rate and patient satisfaction using the combination approach.

In addition, the evidence suggests that the adherence to acne scar treatments increases with the use of combination therapy, largely due to greater improvements experience by patients.

The biggest benefit of combination therapy is the synergy that is obtained which translates to quicker results, lower incidence of potential side effects, and potential cost-savings.

Since most patients face a combination of atrophic, hypertrophic and keloid scars, as well as active lesions – the most impressive outcomes often are achieved when lasers are combined with another modality such as surgical techniques or chemical peels.

Possible treatment combinations

There are plenty of combinations that doctors can leverage on to customize a solid and effective plan for their patients, including:

• Microneedling + Chemical Peels
• Fractional Laser + Dermal Fillers
• Micro-needling + Dermal Fillers
• TCA Cross + Fractional Laser
• Subcision + Chemical Peels + Fractional Laser 

Subcision acne scars treatment is often the first step for many patients to help elevate the scar tissue, followed by laser resurfacing to help stimulate collagen production to encourage further remodeling and rejuvenation.

Since many of these treatments involve stimulating collagen production – it is often a gradual process that can take up to 3 – 6 months to see the full results. For those who want to see immediate results, dermal fillers are a good option for addressing volume loss as seen in rolling and boxcar scars.

The key point to note here is that additional improvements can be attained by combining several of these treatments together.

Combination therapy

At the end of the day, your diagnosis and pre-treatment assessment is just as essential as the execution of the treatment itself.

Because of the nature and complexity of scarring, investing in any single therapy is no longer relevant and feasible.

Treating acne scars takes a lot of patience, skill, and a wide breadth of knowledge and experience in treating all skin and scar types. Depending on your personal needs, goals, and tolerance for any side effects and recovery time – our doctors have over 18 years of experience treating even the toughest cases and can help you to achieve a more confident you!

At our clinic, we offer all the treatments mentioned, including fillers such as the popular Ellansé and Rejuran – which contains vital polynucleotides that helps to boost the skin’s healing process and improve skin regeneration by as much as 20%!

We also offer Infini RF – the best solution for very deep acne scars as it is able to reach up to 3.5mm deep below the skin’s surface.

Together with TCA Cross, deep chemical peels, and subcision – paired with over 18 years of experience and expertise in acne laser treatment and acne spot treatment in Singapore – our clinic has a wide variety of different treatments, unique protocols, and a range of dermatologist-prescribed skincare and oral medications and creams that has enabled us to treat a wide range of patients with different needs.

Seeing great results often starts with early treatment. Contact us to know more about our acne scar removal cost and book a consultation with us today!