Written by Dr Gerard Ee | Medically reviewed by Dr Gerard Ee | Expert opinion by Dr Gerard Ee
Dr Gerard Ee is an aesthetic doctor and the founder and medical director of The Clifford Clinic, which he established 14 years ago. He has treated acne scars for 16 years and more than 2,000 acne-scar patients and is one of Singapore’s longest-standing users of the Infini RF microneedling system (16 years). He holds a Diploma in Dermatology (Cardiff) and is a Member of the Royal College of Surgeons (MRCS). More on Dr Gerard Ee.
Acne scars are among the most common skin concerns treated in Singapore, and among the most misunderstood. Many patients arrive after months of creams, serums and at-home devices with little to show for it. The explanation is consistent: a true acne scar is a structural change deep within the skin, and topical products cannot reach that depth. This guide explains what acne scars are, which treatments genuinely work, how they are combined, and the realistic results and costs in Singapore. The aim is to make the reasoning behind each treatment clear enough to support an informed decision. Dr Gerard Ee has treated more than two thousand patients for acne scars over sixteen years, including public figures such as actor Mark Lee, whose ongoing skin journey was featured by CNA.
What an acne scar actually is
Acne scarring begins with inflammation. When a pore becomes clogged and inflamed, particularly in cystic or nodular acne that reaches deep into the skin, the immune response damages the surrounding tissue and the collagen scaffold that gives skin its structure. As the wound heals, the body remodels collagen. When it produces too little, the skin sinks inward into a depressed, or atrophic, scar. When it produces too much, a raised hypertrophic or keloid scar forms. In both cases, the change sits well below the surface, which is precisely why topical products that act on the upper layers cannot reverse it.
This singular fact recontextualizes the issue. In cases where scars are true depressions or elevations, the pertinent inquiry shifts from selecting an appropriate cream to the means of recreating collagen at the precise depth. Given that this remodelling constitutes a biological process, it necessitates a duration, a consideration that is crucial to acknowledge, as impatience often contributes to perceptions of suboptimal treatment outcomes.
Scars or marks: the distinction that saves money
Prior to considering any treatment, the initial step is to determine the presence or absence of a scar. A significant proportion of what patients identify as scarring are, in fact, post-acne marks: flat discolorations with preserved skin texture. Brown or tan marks are classified as post-inflammatory hyperpigmentation (PIH), which is more prevalent in individuals with darker skin tones. Pink or red marks are identified as post-inflammatory erythema (PIE). The primary characteristic of both is their temporary nature. As only the pigmentation is affected, these marks typically fade over a period of weeks to months, with accelerated healing observed upon application of sun protection.
A true scar, by contrast, is a change in texture: a dip, a raised area or an uneven surface. It does not fade on its own. The simplest way to tell the two apart at home is to stretch the skin gently or shine a light across it from the side. If the colour flattens and the surface stays smooth, it is a mark. If a shadow-casting dip or bump remains, it is a scar. Settling this distinction at the outset is important, because treating fading marks with expensive resurfacing wastes money, while dismissing real scars as marks wastes months. A dedicated guide covers acne scars versus pigmentation in detail.
The types of acne scars, and why the type matters
Approximately eight or nine in ten acne scars are atrophic, meaning they sit below the surrounding skin. They take three recognisable forms, and most patients have a mixture of all three. Because the proportions determine the treatment plan, it is worth learning to recognise them.
Ice pick scars
Narrow, deep, V-shaped scars that resemble fine punctures. They extend deep into the dermis, making them the hardest to treat and generally unresponsive to broad resurfacing or microneedling. They require a targeted approach, such as TCA CROSS or Juvelook, placed directly into the scar.
Boxcar scars
Round or oval depressions with sharp, defined edges, often across the cheeks and temples. These respond well to resurfacing, to energy-based collagen remodelling, and to certain biostimulators.
Rolling scars
Broad, sloping depressions caused by fibrous bands that tether the skin to deeper tissue, producing a wavy, undulating surface. The essential point is that they are tethered: until the bands are released with subcision, resurfacing alone will not lift them. A full breakdown is set out in the types of acne scars explained.
There are also raised hypertrophic and keloid scars, which represent an excess of collagen rather than a deficit and are more common on the jawline, chest and back. They are noted here mainly to mark a limitation: the resurfacing and microneedling treatments that improve depressed scars cannot improve a keloid, which is a separate problem requiring a different approach.
Why one machine is never the answer
Since a typical facial scar comprises various types at different depths, no single device can effectively address all of them. For instance, a laser designed to smooth a boxcar scar will not impact a tether beneath a rolling scar, and a needle used to release a tether does not reconstruct the base of an ice pick scar.
This underscores the necessity of layered treatment plans and highlights the importance of caution when selecting a clinic that employs the same machine for all scar types. Aligning the mechanism of treatment—such as release for tethers, collagen stimulation for volume, resurfacing for superficial corrections, and reconstruction for deep pits—with the specific mechanism of the scar is essential in achieving successful outcomes and avoiding disappointment.
The step most people skip: treating the acne first
The initial concern in any patient with scars is to confirm whether the acne is truly under control, as numerous individuals experience persistent breakouts despite believing their acne has resolved. This issue holds greater significance than most might anticipate. Treating scars on skin prone to acne can exacerbate the condition, and each new breakout presents a risk of forming a new scar. From my clinical perspective, focusing on improving skin texture while the acne remains active is analogous to constructing on unstable ground.
This is also where device choice begins. Among the energy treatments, non-insulated microneedle radiofrequency (Secret RF) is genuinely safe for acne-prone skin because its needles pass through and calm the oil glands while improving texture. Where acne control is poor, it can be combined with AGNES RF, which targets the oil glands directly. A common pattern is recurrent acne of several years’ standing that is assumed to be settling but never quite does and addressing that root cause is decisive. The combination of AGNES and Secret RF is designed for exactly this situation: it brings the acne under control while resurfacing the rough texture that accompanies it. Only once the acne is settled does attention turn to remodelling the deeper scars. For patients whose acne treatment has repeatedly fallen short, it may be useful to know why your AGNES acne treatment did not work.
RF microneedling: Infini and Secret RF
Radiofrequency (RF) microneedling is one of the core tools for depressed scars. Fine needles deliver RF energy directly into the dermis, heating it in a controlled way to trigger new collagen, which then remodels over the following months to lift scars from below. Because the heat is delivered through needles rather than across the surface, RF microneedling is generally safer in pigmented and Asian skin than older fully ablative lasers, a meaningful advantage in Singapore.
The two systems used most in scar work are not interchangeable. Infini uses insulated needles, which concentrate energy at the needle tip deep in the dermis while sparing the surface. This allows high energy to be placed exactly where a deep scar needs it, with a strong safety margin, and is the reason it is generally preferred in darker skin. Secret RF uses non-insulated needles that deliver energy along the whole shaft. This is gentler on the deep dermis but carries the advantage of passing through and calming the oil gland, which suits acne-prone skin. For depressed scars, the maximum power a device can deliver matters, and the regulatory figures are clear: Infini reaches up to around 50 W (FDA 510(k) K121481) and Secret RF is cleared to 25 W (FDA 510(k) K170325). A full comparison is set out in Infini vs Secret RF.
Subcision: releasing what pulls scars down
For rolling scars, subcision is often the single most effective step, and it is one that resurfacing-only plans miss entirely. Using a fine needle or a blunt cannula, the practitioner passes beneath the tethered scar and divides the fibrous bands anchoring it down. Once released, the skin lifts and the controlled injury stimulates fresh collagen to fill the space. Subcision is rarely used in isolation, since it pairs naturally with RF and with biostimulators. In this practice, hyaluronic acid fillers are generally avoided for scars in favour of biostimulators that build the skin’s own collagen. There is more detail in the guide to subcision and biostimulators for rolling scars and the subcision for acne scars page.
Lasers: fractional CO2 and Pico MLA
Fractional CO2 laser is often described as the gold standard for resurfacing, and for boxcar scars and general surface texture it earns that reputation. It creates microscopic columns of controlled injury that prompt the skin to rebuild with fresh collagen. It is powerful but it is a course of treatment, not a one-off cure, and in darker skin it is used cautiously and at lower energy to avoid pigmentation. A dedicated article covers CO2 laser for acne scars.
Pico MLA is a complementary laser: a picosecond device fitted with a microlens array that concentrates the beam into many tiny high-energy points just beneath the surface. It is effective for refining enlarged pores, smoothing fine surface irregularity and evening out pigment, with minimal downtime. Its limits matter equally: because it works at and just below the surface, it is not effective for tethered rolling scars or deep ice pick scars. It is best used as a surface-and-pigment complement within a plan, rather than a treatment for depressed scars in its own right.
TCA CROSS and reconstruction for ice pick scars
Deep ice pick scars follow a different logic. Rather than resurfacing around them, TCA CROSS applies a high-strength acid precisely into the scar to stimulate collagen and rebuild the narrow pit from its base. Juvelook placed into the scar does the same and is, in Dr Gerard Ee’s clinical experience, a safer and more effective alternative to TCA CROSS for boxcar and ice pick scars. These targeted techniques are what improve ice pick scars that lasers and microneedling leave largely untouched, and they illustrate why scar type has to drive treatment choice.
Biostimulators and PDRN: rebuilding and repairing
Where volume and collagen support are needed, biostimulators are best chosen by scar type rather than using one product for everything. Ellanse suits significant volume loss, Juvelook suits ice pick and boxcar scars, Sculptra or Lenisna suit scars that are mostly rolling with loose skin, and RE20 suits very mild scarring. PDRN (Rejuran) is a useful addition across the board: it improves healing, reduces downtime, and potentiates results, and it can be performed alongside microneedle RF. One practical detail is worth noting: Sculptra is best placed with a cannula, and passing that cannula beneath a scar produces a subcision effect at the same time as stimulating collagen, so the delivery does double duty.
Putting it together: how a six-month plan looks
In practice, modalities are rotated over roughly six months rather than one being repeated. A representative plan might combine subcision for tethered scars, a rotation of Infini and Secret RF, a couple of fractional CO2 sessions, Pico MLA for pores and pigment, and PDRN to support healing, with a biostimulator added where the scar type calls for it. A typical sequence begins with subcision and Secret RF together, then fractional CO2 about a month later once the skin has settled. Sessions are spaced four to six weeks apart, because that interval lets each session’s collagen mature before the next stimulus. Crowding treatments together simply under-doses each one. The principle behind layering is set out in combination therapy for atrophic scars.
Acne scars and darker skin
For Fitzpatrick IV to VI skin, the overriding priority is avoiding post-inflammatory hyperpigmentation while still delivering enough energy to remodel collagen. Deeper skin has more active pigment cells that respond to heat and inflammation, so an approach that is unremarkable in lighter skin can leave lasting marks. The usual backbone in these patients is insulated Infini, because the insulation protects the surface. Fractional CO2 is used at lower energy, PDRN supports healing, and sun protection is rigorous. Importantly, a tendency to keloids is not by itself a barrier to treating atrophic scars. The full version is in acne scars on dark skin.
What results are realistic
Realistic expectations are part of achieving a good result. True scars can be significantly improved but are rarely erased completely. A rotation of modalities without injectables typically delivers around twenty to thirty per cent improvement over six months, with more when biostimulators and PDRN are added. Most visible change appears over three to six months as new collagen matures. There is no single best-responder patient. Consistent results come from accurate diagnosis, treating the root cause, supporting the skin with good skincare, and giving the process time. In my experience, the acne scar journey is slow but genuinely rewarding, and with patience the skin can become markedly smoother over time.
What acne scar treatment costs in Singapore
Cost depends on the treatments and the number of sessions, so any figure is a guide rather than a quote. Individual treatments can be accessible; a single fractional CO2 session can start at S$390, while a six-month custom scar package combining Infini, Secret RF, fractional CO2 and Pico MLA is around S$4,000. Two common mistakes are worth avoiding: chasing the lowest price and assuming that repeating the most expensive machine many times gives the best result. Neither is true. Spending more is not the most cost-effective route to better skin. The right combination, properly spaced, is. A detailed breakdown of the cost of acne scar treatment in Singapore is available.
The most common mistakes
Two patterns account for most disappointed patients seeking a second opinion. The first is an underpowered or weak microneedle RF machine used on deep scars, producing little or no result. The second is repeated monthly treatment that delivers very little while costing a great deal over many sessions. Both stem from the same root issues: too little energy delivered and too little time for the body to build collagen between sessions. A third pattern is treating scars while the acne is still active, which simply produces new scars. None of these outcomes reflects anything unreasonable on the patient’s part, but all three are avoidable with the right plan. The candid six things your doctor isn’t telling you expands on this.
Choosing where to be treated
When evaluating a clinic, look for a doctor who assesses the specific scar types in person and owns a range of technologies rather than one machine used for everything. It is reasonable to ask what the maximum power of the RF device is and how far apart sessions are spaced. A confident, specific answer is a good sign. Be wary of pressure to buy large packages up front, a push toward weekly or monthly visits, or promises of total scar removal. Honesty about limitations (that RF cannot fix keloids or temple scars, and that results are gradual) is a reliable marker of a trustworthy clinic.
A treatment philosophy, in short
The approach that consistently works is to treat the root cause first and then rebuild texture gradually, choosing each tool for the job it does best, rather than chasing a fast result by stacking machines or buying the most expensive package. Spending more is not the same as achieving better results. Combined with skincare that calms the oil gland and supports collagen, this steady, staged approach ages and looks better than aggressive over-treatment.
How many sessions are needed, and how often
There is no fixed number, as outcomes depend on the depth and mix of scars, skin tone, and how the skin responds. Acne scar treatment is almost always a course rather than a single visit. As a rough guide, many patients follow a six-month programme of treatments spaced four to six weeks apart, after which the plan is reviewed and further sessions or maintenance considered. Treating more frequently is counterproductive: sessions that are too close together do not give the body time to build collagen, and trying to do too much in one sitting under-doses each individual treatment. Fewer, properly-dosed treatments at sensible intervals consistently outperform a crowded, intensive schedule.
Tracking progress the right way also helps. Improvement from collagen remodelling is gradual and easy to miss day to day, so results are best assessed over three to six months with consistent, well-lit photographs rather than in the bathroom mirror. Patients who understand this rhythm tend to stay the course and achieve the best outcomes.
Aftercare: protecting the result
Effective results are achieved through a collaborative effort between clinical treatment and at-home care. Sun protection plays a significant role, as ultraviolet light can darken scars, particularly after acne has been controlled, and it is especially pertinent in resurfacing treatments and for individuals with pigment-prone or darker skin. A notable deviation from conventional guidelines is observed: during active acne, the use of heavy sunscreens may, based on clinical experience, congest the skin and provoke additional breakouts, ultimately leading to more scars. Therefore, during the active phase of acne, it is advisable to focus on controlling the condition and, where sun protection is truly necessary, to opt for light, non-comedogenic alternatives or protective clothing such as hats and shaded areas. Once the acne is under control, the importance of sun protection increases substantially and is highly recommended. Additionally, implementing a gentle, non-irritating skincare routine that supports the skin barrier and manages oil and inflammation can facilitate both healing and the underlying acne issues. While not complicated, these measures are crucial in safeguarding the significant investment of time and resources involved in treatment.
What the research shows
Acne scarring is common: studies report that most acne patients develop some scarring and around half have clinically relevant scars, with severity, duration of inflammation and family history among the main risk factors (pathogenesis review, prevalence and risk factors). The main treatments are well supported. Ablative fractional CO2 laser is a gold-standard resurfacing option with meta-analytic support for improving atrophic scars (CO2 meta-analysis, monotherapy series), and fractional radiofrequency microneedling has a growing evidence base as an effective, well-tolerated treatment (systematic review).
The literature also supports combination treatment. Pairing PDRN such as Rejuran with fractional CO2 laser supports healing and shortens recovery, since PDRN promotes fibroblast activity and collagen synthesis (PDRN scar prevention). Subcision paired with TCA CROSS is a recognised, cost-effective approach for atrophic scars (subcision plus CROSS), and collagen-stimulating poly-lactic acid delivered with fractional CO2 has shown high rates of scar improvement (PLLA plus CO2). None of this replaces an individual assessment, but it is the evidence base on which a sound plan is built.
The bottom line
Acne scars are highly treatable, but the approach matters. Settle the acne first, identify the scar types accurately, match each to the right tool, combine them in sequence, space sessions sensibly, and allow collagen the months it needs. Approached this way, smoother, more even skin is a realistic goal for almost everyone. For more detail on any one element, start with what causes acne scars, the types of acne scars, or RF microneedling: Infini vs Secret RF.
Frequently Asked Questions
Which acne scar treatment is most effective?
No single treatment suits everyone. The strongest results come from combining modalities, RF microneedling (Infini or Secret RF), subcision, fractional CO2, Pico MLA and biostimulators, matched to the specific scar types, rather than repeating one device.
How much does acne scar treatment cost in Singapore?
Individual sessions can be accessible; a single fractional CO2 session can start from as low as S$390, while a six-month custom scar package combining Infini, Secret RF, fractional CO2 and Pico MLA is around S$4,000.
Can acne scars be completely removed?
Rarely to perfection. True scars can be significantly improved, often around twenty to thirty per cent over six months with energy-based treatment, more with biostimulators, but realistic, gradual improvement is the honest goal.
How long does acne scar treatment take to work?
Collagen remodelling is slow. Most patients need several sessions spaced four to six weeks apart, with much of the visible improvement appearing over three to six months.
Do I need to treat my acne before my scars?
Yes. Treating scars while acne is active can flare the acne and create new scars. The acne is stabilised first, often with non-insulated Secret RF and sometimes AGNES RF, before focusing on scar remodelling.
Is acne scar treatment safe for dark skin?
Yes, with the right choices. Insulated Infini is generally safest because it spares the surface, fractional CO2 is used at lower energy, and sun protection is essential. A keloid tendency does not by itself rule out treating atrophic scars.
Key references
- Acne Scarring, Pathogenesis, Evaluation, and Treatment Options. PubMed.
- CO2 versus Er:YAG fractional laser for atrophic acne scars: meta-analysis and systematic review. PubMed.
- Fractional radiofrequency microneedling as monotherapy in acne scars: systematic review (16 studies, 481 patients). PubMed.
- PDRN (polydeoxyribonucleotide) for scar prevention and enhanced wound healing. PubMed.
- Subcision plus 50% TCA CROSS for atrophic acne scars: a cost-effective therapy. PubMed.
- Atrophic scars treated with fractional CO2 laser facilitating topical poly-L-lactic acid. PubMed.
Device specifications & sources
- S. FDA 510(k) Summary K213612 (SYLFIRM X, ViOL Co., Ltd.): Output power Max 16 W at 50 Ω. 2 MHz. Bi-polar RF.
- S. FDA 510(k) Summary K170325 (Secret RF, Ilooda Co., Ltd.): Max power Max 25 W at 500 Ω. 2 MHz. Needle depth 0.5-3.5 mm.
- S. FDA 510(k) K121481 (INFINI, Lutronic Inc.): insulated RF microneedling system, 49-pin handpiece, maximum RF generator output approximately 50 W.
Written, medically reviewed and expert opinion by Dr Gerard Ee, aesthetic doctor and Founder & Medical Director of The Clifford Clinic. This article reflects my clinical experience treating acne scars in Singapore and is intended for general education, not medical advice. Treatment suitability, results, downtime and cost vary from person to person. Please arrange a consultation for advice specific to your skin.
