1. What is Acne, and how do Acne Scars form? 

Acne and acne scars are the most common skin conditions as acne can affect all age groups, especially teenagers. It is usually caused by dead skin cells or oil getting plugged around hair follicles and pores. Once the plugged pore swells with inflammation, it causes a tear in the surrounding wall and acne results.

As a solitary lesion, this skin condition may disappear on its own after a few hours or a few days. However, severe cases of acne are another matter, as it tends to have many outbreaks, with blackheads and whiteheads appearing on the forehead, chest, upper back, and shoulders. The demographic affected the most are those in their teenage years, but we have seen many adult-onset acne cases too.

Depending on the degree of seriousness of the acne condition, blackheads or whiteheads or both can appear at the same time, and anyone who has this condition knows how distressing it can be. In serious cases, over-the-counter topical acne treatment cannot help much most of the time. So, you either have to wait it out, which can take years, or visit a skin doctor to see what can be done. Even though acne is temporary inflammation, the scars left that were caused by acne can be permanent.

 

What Causes Hypertrophic and Depressed Acne Scars?

The scars are usually the result of an inflamed lesion like a papule, cyst, or pustule. The inflammation starts when excess oil, dead skin, and bacteria accumulate. The original papule or cyst then swells and eventually the follicle wall breaks, spilling its contents.

Lesions that happen near the skin surface heal more easily. Still, deeper level inflamed lesions cause a lot more damage to the dermis as acne occurring at the deeper level can take longer to heal as opposed to those happening near the surface.

To resolve the skin damage, the body automatically produces new collagen to repair the damage caused by acne to the skin. The repaired skin is never as smooth as before the damage as Scar tissue, although composed of the same protein (collagen) as the tissue that it replaces, the fibre composition of the protein is different. This is because instead of a random basketweave formation of the collagen fibres found in normal tissue, in fibrosis the collagen cross-links and forms a pronounced alignment in a single direction.

There are two types of scars, depending on the number of repair tissues formed by our skin’s reaction. When the body replaces too much-lost skin tissue, we end up with a raised scar known as a hypertrophic scar or keloid (in the worst cases). The opposite can also happen when the body does not replace enough lost skin tissue resulting in atrophic scars which look like craters on the skin surface.

 

What Causes Dark-coloured Acne Scars?

Sometimes, dark scars happen after a bad outbreak. These are not classified as scars on a technical level, but discolouration of the skin. When a pimple or acne is inflamed, it means that the skin has laid down blood vessels to mount an immune response to the bacteria attack on the skin. This increased vascularity can change skin colour, texture, or tone. Also, the inflamed lesion will cause increased activity in the surrounding melanocytes resulting in hyperpigmentation.

Hence, dark red or brown marks can appear on popped or un-popped acne, especially those occurring in the deeper layers. These may eventually fade away in a matter of months, but some may need laser treatments to lighten the coloured marks.

Singapore aesthetic doctors put a lot of effort into acne and acne scar treatments. As far as scars are concerned, rolling scars, box scars, and ice pick scars are the most common. Effective treatments can be a combination of TCA cross chemical peels, dermal fillers, Salmon DNA Injection, Hyaluronic Acid Injections, Clear & Smooth Laser, and Fractional Fractional Resurfacing Laser. These treatments work by stimulating collagen production, which will heal and lighten scars. The only catch is that most of these treatments are not a one-off procedure; it usually takes a short course of 6 to 10 sessions to achieve optimum results. The Clear & Smooth Laser is a Fractional Erbium glass Laser.

 

TYPES OF ACNE SCARS

Under atrophic acne scars, there are three types, namely:

●   Ice pick scars:  The depression is very deep, with a tiny opening at the surface

●   Box scars: The scars are rectangular with steep and defined edges.

●   Rolling scars: The scars are broad depressions with rounded, sloping edges.

Acne scars can also be elevated with hypertrophic or keloid formations if the scarring is severe. The scars can also appear as enlarged pores.

 

2. HOW TO PREVENT ACNE SCARS

 

If you want to prevent acne scars, the best way is to break out less. 

A lifestyle change is the best way to start:

● Diet – food and drinks high in sugar and dairy should be avoided if possible.

● Learn to manage stress effectively, do whatever you can to avoid getting stressed out, as this is known to trigger acne outbreaks.

● Make sure that skincare products and cosmetics you use are well suited for your skin type. Keep the skin clean, never go to bed without cleaning off makeup.

● Wear light makeup and base makeup sparingly, do not try to use foundation or concealers to cover up acne and pimples. Make sure cosmetic applicators and brushes are cleaned fortnightly.

 

Most important tip: Do NOT squeeze or pop your pimples yourself! It is incredibly tempting to do so, but please do not pop your pimples as the infection might spread, and the injury might cause worse scarring.

 

If you can see that your acne might be turning into a scar, or you have family members with acne scars, see your doctor or skin specialist as soon as possible to get started on the appropriate treatment.

Finding help for the removal of acne and acne scars can be frustrating.

Usually, patients try many methods from over the counter topical medications, Chinese herbs, DIY home treatments, spa facials or underpowered beauty lasers. Unfortunately; these attempts are ineffective most of the time. It is waste your time, money and effort on such treatments that do not work, or worse, aggravate the acne condition. Fresh scars are also easier to treat than matured scars. Remember that the skin takes time to regenerate, so do not expect astounding results with acne scar treatments. Plan early!! When the wedding is three months ahead, start much earlier.

 

DOCTOR’S TREATMENTS

Take note that the causes of acne come mainly in three ways:

1. Acne bacteria

2. Sebum excretion in large quantities due to hormonal imbalance

3. Clogged pores

Treatments have to target the above three factors to combat acne and acne scars effectively.

The skin produces the sebum that is a natural oil that keeps the skin moisturized and protected, but overproduction can cause the pores clogged. The clog is a mixture of oil, bacteria, and dirt from the environment, resulting in the formation of comedones (whiteheads and blackheads).

Treatment with antibiotics, oral isotretinoin and topical creams can be used to avoid acne scars, provided the acne (usually pustular acne or cystic) are detected early and treated accordingly.

Treatments By Doctors 

Brightening Laser / Acne Red Mark Laser Laser

Brightening Laser / Acne Red Mark Laser laser effectively treats acne caused by P.acne bacteria by extinguishing these bacteria, and at the same time reduces redness and soreness caused by inflammation. The Brightening Laser / Acne Red Mark Laser laser also shrink sebaceous glands that produce sebum (oil), externally, it also makes the pore size shrink.

The FDA and HSA Singapore have approved the use of Brightening Laser / Acne Red Mark Laser lasers as a method of treatment against vascular and benign pigmented lesions. The technology is based on advanced copper bromide laser technology, that can address a wide array of skin conditions like vascular lesions, acne, melasma, and others. It also promotes skin rejuvenation leading to brighter and smoother skin. It also works well to lighten dark eye circles and reduction of redness for acne-prone skins. The yellow light also promotes collagen growth and reduces small red blood vessels—thus resulting in an overall tightening, firming and rejuvenating effect on the skin.

 

Carbon Laser (Fractional Fractional Resurfacing Laser)

The Fractional Fractional Resurfacing Laser is the most common method of treatment in Singapore and works best for most types of atrophic acne scarring. Depending on the strength of the setting, this treatment has downtime between 5 – 10 days. It will be useful to discuss with your skin doctor what is the best strength of laser for you, as well as how much downtime you can accept. Please understand that Fractional Resurfacing Lasers do leave ‘ constructive injury” on the skin, it is precisely that process that jumpstarts the healing and rejuvenating process.

 

Laser Rejuvenation ND YAG Laser

Laser Rejuvenation is the most popular treatment in our clinic arsenal. It has a great capacity to safely improve any type of skin concerns with no downtime. The magic within this Laser Rejuvenation Nd:YAG laser is a beam of energy delivered deep into the skin, energising the cells bringing on a radiant glow. This treatment blurs out imperfections, making it one of the most popular pick me up for pre-events.

Salmon DNA Injection

Scars are caused by acne because of inflammation, and the result is misformed scar tissues under the skin. The tissue itself is made up of collagen fibres, but because of the abnormality of the healing process, the fibres were arranged randomly. Finally, the skin is pulled inwards, thus pitted scars are formed. Most clinics offer this treatment, an innovative version of the popular Korean Salmon DNA-derived Healer Version for scars. This treatment can help restore and regenerate new skin cells to treat mature acne scarring. The S Version induces collagen and fibroblast production, can be combined with scar subcisions to raise deep scars and expedite healing. Results from this combined therapy can be quite fast with noticeable results.

This treatment series is a popular aesthetic treatment because of the biological molecule polynucleotide which repairs the skin and reduces inflammation.

The viscosity allows it to plump up depressions on the skin and allow for the development of what is essentially a scaffolding for which collagen can build upon to restore the scaring. However, not all patients are suitable for this treatment because it all depends on the patient’s skin type and scar type.

 

Chemical Peels 

Chemical peeling is a painless procedure that removes the dead skin and bacteria that accumulated on the skin. You can expect a smoother and glowing complexion from the first treatment. Chemical peels work well for acne-prone skins and acne scars, as it clarifies sebum and kills bacteria. The acid treatment peels away the top layer of the skin for rejuvenation, tightens pores for a smoother look and reduce the chances of inflammation.

After the chemical peel process or preferably on all 365 days in sunny Singapore, patients are advised to wear sunscreen every day, preferably the” broad-spectrum” type with SPF 50. A good sunscreen allows protection against UVA and UVB rays, limit exposure to the sun, especially at peak hours of 11 am to 3 pm.

The best Acne treatments are usually a combination of treatments / it is a program, not a single treatment.

The efficacy of the acne scar treatment depends on the amount of scarring and skin type of the patient. The success of an acne treatment programme depends on the diligence of the patient.

Aftercare/ Home Care after Treatment

Cyspera Cysteamine

What is Cyspera Cysteamine cream?
Cyspera contains 5% of Cysteamine is used in the treatment of hyperpigmentation conditions such as melasma, new and matured acne scars. It gives evenness to skin tone, and serves as a great home care product to compliment all the doctor’s treatment.
Cyspera with cysteamine hydrochloride is a metabolite of L-cysteine and an all-natural cellular element. L-cysteamine prevents melanin synthesis. It also reduces skin pigment by restraining the production of tyrosinase and peroxidase.
Cysteamine is safe to use on all skin types for acne scars and various other parts of the body including lips, underarms, nipples and inner thighs
The depigmenting result of Cyspera becomes visible after 4weeks of application. Optimal outcomes are achieved after 8 to 12 weeks of application.

Besides the in-clinic treatments, good home care is also necessary. Medical grade skincare is usually simple in packaging with less marketing, unlike the commercial brands. Still, it has all the essential ingredients in the correct strength to ensure the continuity of the recovery process of acne scars.

 

COSTS OF TREATMENT

How much does acne scar treatment in Singapore cost?

The cost of the treatments depends on the severity of the acne scar condition. More specifically, the type of scarring and the treatments that are required.

Severe and extensive acne scars may require a treatment programme consisting of several sessions of laser resurfacing, subcisions, non-ablative lasers, injections and medical facials. A course will take up to 6 months to complete; the patient also needs to understand that obvious results are not immediate but gradual over time.

 

How much improvement can I expect after acne scar treatment?

The average improvement rate is 60% – 80% that can be expected by most patients after receiving a course of treatment. The rate of improvement depends on:

· The extend of acne scarring and skin type of the patient.

· How well the skin responds to the treatment.

Patients with dark skin who also have ice-pick scars /atrophic scars can expect to see a 50% improvement, and those with shallow box scars can expect up to 80% improvement.

Fractional Laser treatments are effective in dealing with textural acne scars.

Vascular lasers are better options for red acne marks and post-inflammatory hyperpigmentation, and this comes with ultra-minimal downtime.

Laser treatments cost in Singapore are roughly rated in the following:

● Vascular laser costs $500- $600 per session.

● Fractional laser costs $500 – $1000 per session.

● Both require 2 – 3 sessions to get the best outcome.

 

When looking for a doctor, they should have the following qualities:

● Detail-oriented – The doctor must be great in identifying the types of scar at the appropriate treatment, and prescribe a suitable programme.

● He or she has a good understanding of the effects of laser treatments, in a combination of other treatments on individual skin.

● Is experienced in treating acne scars, across different age group and ethnicity.