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.
Across this series the argument has been that Sylfirm X is underpowered for depressed acne scars, as set out in the opinion, the comparison and why patients see no results. That verdict concerns depth alone, because Sylfirm X remains one of the better devices for the concerns it was designed around. Sound judgement is not a matter of ranking a machine as good or bad. It is a matter of matching a device to the problem it was built to treat. The sections below set out where Sylfirm X performs strongly and where those strengths stop. Of the patients who consult me about Sylfirm X, a substantial share are asking about pigment, redness or pores rather than scar depth, and for that group the answer is favourable.
Where Sylfirm X excels
Its defining feature is a dual-wave system, in particular a pulsed mode targeting pigment and vessels with precision at low energy. That combination makes it a strong option across several concerns, each requiring precise energy at a low dose rather than bulk thermal power.
- Melasma responds poorly to aggressive heat and is easily worsened by it, so the controlled, lower-energy approach of Sylfirm X suits it well. This is one of the few indications for which I actively recommend the device, though what patients obtain is substantial reduction rather than clearance, and recurrence is common.
- Post-inflammatory hyperpigmentation, the brown marks left after acne, responds to the pigment-targeting mode of the device, with improvement accumulating over a course of sessions rather than appearing after a single treatment.
- Redness and rosacea improve where the pulsed mode settles persistent facial redness, over a course of sessions rather than after one.
- Pores and fine lines respond to lower-energy, superficial stimulation, which is the appropriate dose for these concerns rather than an underdose.
- Overall skin quality, tone and smoothness improve with minimal downtime, which makes the device suited to periodic maintenance.
Why those strengths do not reach deep scars
The same restraint that makes Sylfirm X safe for melasma is what limits it for atrophic scars. Its 16 W maximum is well matched to superficial pigment work and to vascular targets lying near the surface. Depressed scars sit deep in the dermis and need the higher output of Infini (~50 W) and Secret RF (25 W). A device optimised for the first task is not optimised for the second, which is a specialisation rather than a defect. Sylfirm X is well suited to pigment, redness and pores, which is a different job from correcting scar depth.
When acne is active, a different priority
Many patients seeking texture improvement still present with active acne. Where the acne is not yet stable, non-insulated Secret RF is preferred, because it settles oil-gland activity while treating texture, and where control is poor, AGNES is added the same day. That goal differs from the one Sylfirm X was built for, since it is a pigment-and-vessel device rather than an acne-control or deep-scar device. The commonest sequencing error I see in a previous plan is scar treatment begun before the acne is stable.
Useful add-ons, PDRN and biostimulators
Whatever device is used, results depend on adjuncts, and selecting them accurately is much of the expertise. PDRN, Rejuran, reduces downtime and potentiates results, and may be given alongside microneedle RF. Biostimulators are matched to the problem, with Ellanse for volume loss, Juvelook for ice pick and boxcar scars, Sculptra or Lenisna for rolling scars, and RE20 for very mild scarring. Sylfirm X is not the component of the plan that performs this structural work. In my experience the adjunct choice separates two plans built on the same device more reliably than the settings do.
The evidence for where Sylfirm X genuinely belongs
The strengths of Sylfirm X can be grounded in evidence as readily as its limits. Its principal indications, melasma, pigmentation and redness, are where lower-energy precise treatment is preferred, and the skin-of-colour literature supports cautious energy and pigment-focused strategies (skin-of-colour optimisation). PDRN, often paired with such treatments, has documented anti-melanogenic effects and improves facial hyperpigmentation (PDRN anti-melanogenesis). For pores and surface quality, lower-energy collagen stimulation is the appropriate dose rather than a limitation. These studies report group averages across treated cohorts rather than what any individual face will achieve.
The evidence shifts to higher-energy tools where the target is deep atrophic scarring, supported by the fractional CO2 (monotherapy series) and fractional RF microneedling (systematic review) literature. That is the line this series draws, with Sylfirm X on the pigment-and-pores side of it and higher-power devices on the deep-scar side.
What the research shows
Matched to the right concern, lower-energy devices are well supported by the published evidence. For pigment, even healing-focused agents such as PDRN have anti-melanogenic effects and improve facial hyperpigmentation (PDRN anti-melanogenesis), and the skin-of-colour literature holds that gentler approaches are safer for pigment-prone skin (skin-of-colour optimisation). For deeper scars the evidence sits instead with higher-energy modalities such as fractional CO2 (monotherapy series) and fractional RF microneedling (systematic review). The difference is one of energy rather than frequency, and additional sessions of a lower-energy device do not convert it into a deep-scar treatment.
The evidence for gentle, low-energy devices
Where lower-energy devices belong, the published evidence is consistently supportive of them. A picosecond laser with intense pulsed light reduced atrophic scarring and post-inflammatory erythema, cutting ECCA scores by 28% over three sessions (picosecond plus IPL study), and picosecond lasers cause fewer adverse effects than ablative resurfacing (picosecond versus CO2 trial). For pigment, redness and pores, a profile of modest gain with few adverse effects is the one required. A 28% reduction over three sessions is meaningful and also partial, which is the scale of change to describe to a patient rather than an expectation of clearance.
The same studies reinforce the dividing line between the two categories of device. Where the target is deep atrophic scarring, lower-energy devices trade some efficacy for safety, which is why higher-energy and often combined treatment is used for depressed scars. That trade is acceptable when the concern is pigment and unacceptable when it is depth.
Melasma and why gentle energy suits it
Melasma is a chronic, relapsing pigmentary disorder driven by hormonal influences, ultraviolet and visible light and heat, in which melanocytes are persistently overactive and a vascular component is often present. The condition is readily worsened, since aggressive heat or inflammation can provoke a rebound that leaves the pigmentation darker than before. The preferred approach is therefore controlled, lower-energy, pigment-directed treatment rather than forceful resurfacing. The pulsed mode of Sylfirm X is well matched to that requirement, which is why melasma is one of its strongest indications. Because the disorder relapses, the accurate account is substantial reduction rather than clearance, with recurrence common, and in my experience the patients given that account at the outset are the ones who hold their result.
How Sylfirm X targets pigment and vessels
The pulsed mode delivers energy that selectively affects pigment-laden cells and abnormal blood vessels while limiting thermal spread into surrounding tissue. That selectivity addresses both the pigmentary and the vascular components contributing to melasma and to post-inflammatory hyperpigmentation. Precision rather than raw power is the real advantage of the device, and the same quality is both unnecessary and insufficient for deep structural remodelling. I cannot establish at a first consultation how much of a patient’s melasma is pigmentary and how much is vascular, and that proportion is one reason outcomes vary.
Redness, rosacea and post-inflammatory erythema
Persistent facial redness, whether from rosacea or the post-inflammatory erythema left after acne, arises from dilated and reactive superficial blood vessels. The vascular targeting of Sylfirm X may settle that redness over a course of gentle sessions, which makes it reasonable for sensitive or easily flushing skin. As with pigment, the emphasis falls on repeated, controlled treatment rather than a single aggressive session. The redness is described as persistent for a reason, so a course may reduce and control it rather than remove it, and outcomes vary.
Enlarged pores and skin quality
Enlarged pores result from a combination of excess oil, loss of skin firmness and cumulative sun damage. Lower-energy dermal stimulation produces a modest tightening that reduces their appearance and improves overall texture and tone, with minimal downtime. Because the treatment is restrained, it lends itself to periodic maintenance, and improvements in general skin quality are a common secondary benefit. The improvement in pore appearance is modest by design, and a pore visible under close inspection before treatment will usually remain visible afterwards. Of the patients who consult me about pore size, the ones who report satisfaction came expecting refinement rather than removal.
Why aggressive treatment can worsen melasma
Restraint matters more with pigment than with almost any other concern treated by an energy device. Melasma in particular is heat-sensitive, and over-aggressive lasers or resurfacing can trigger rebound pigmentation that leaves the condition worse than at the outset. A controlled device that treats pigment without excessive heat is therefore not a compromise but the safer and more effective choice. Judged against that requirement, the lower-energy design of Sylfirm X is a feature rather than a limitation.
Combining Sylfirm X with topicals and PDRN
The best pigment results rarely follow from a device used alone. They follow from combining treatment with diligent sun protection and topicals such as tranexamic acid, azelaic acid and retinoids, which reduce melanin production. PDRN may support healing and has documented anti-melanogenic effects, which makes it a reasonable companion. A multimodal and patient plan built around these measures produces durable improvement in melasma and post-inflammatory pigmentation. A device booked without the topical and photoprotective half of the plan is the arrangement most likely to produce a result that fades between sessions.
What results and session plans to expect
For its core indications, Sylfirm X produces gradual improvement over a course of sessions spaced weeks apart, usually followed by periodic maintenance rather than a single definitive treatment. That controlled trajectory suits pigment and vascular concerns, and it is particularly valuable in the pigment-prone Asian skin common in Singapore, where a lower-energy approach reduces the risk of provoking further pigmentation. Maintenance is part of the design rather than a sign that the first course underperformed, and pigment reduced by a course may return where treatment stops entirely.
Where the line is drawn
For all these strengths, the boundary of the device is deep structural scarring. The lower-energy output that makes Sylfirm X precise and restrained for pigment is not suited to remodelling a deep depressed scar, which requires a stronger thermal stimulus in the dermis. Recognising that boundary is what allows the device to be used well, as an excellent choice for pigment, redness and pores and the wrong choice for deep scars. When a patient tells me that a course of Sylfirm X changed nothing, the explanation is usually that the device was being judged on scar depth.
Choosing between Sylfirm X and other pigment treatments
For pigment, redness and pores, Sylfirm X is one of several reasonable options, and the best choice depends on the specific problem. For melasma, controlled lower-energy approaches are preferred, with topical tranexamic acid, azelaic acid and retinoids and strict sun protection remaining the foundation of care. For brown post-inflammatory hyperpigmentation, a picosecond laser may break up pigment with minimal downtime, while chemical peels are used cautiously in darker skin. For red post-inflammatory erythema and rosacea, a pulsed dye laser or intense pulsed light targets the vessels directly and may outperform a microneedle device. For enlarged pores, lower-energy microneedle radiofrequency and picosecond devices are both of use. These are layered more often than set against one another, chosen by the dominant concern and the skin tone. What unites these options is that they are all lower-energy and pigment-directed, which is why none of them is the answer for a deep depressed scar. Patients frequently ask for a named device rather than a named problem, and a request for a particular machine may not always be the most clinically appropriate starting point.
Supporting pigment results with skincare
Whatever device is used, the home routine performs a large share of the work, and neglecting it is the most common reason in-clinic results fade. A regimen built around a topical retinoid with tranexamic acid, azelaic acid, niacinamide and vitamin C steadily reduces melanin production between treatments. Rigorous daily broad-spectrum sun protection is not optional once the acne allows it, and tinted sunscreens with iron oxides add defence against visible light. Avoiding what sets pigment back matters equally, since harsh scrubbing, over-exfoliation, heat and picking all provoke the inflammation that darkens marks. Pigment also fades over months rather than weeks, so patience is itself part of the regimen. This disciplined home care is the part of the plan most within the patient’s own control. In my experience the difference between a result that holds and one that fades is more often the home routine than the device chosen.
The bottom line
The correct choice is the device that fits the problem rather than the one with the loudest marketing. For pigment and skin quality, Sylfirm X is a sound choice. For depressed scars, the priorities are power, the right adjuncts and a combination strategy, explained in why power matters. For planning around an individual skin type, the complete treatment guide is the place to begin. Outcomes vary between patients whichever device is selected, and the assessment that settles the plan is made in person.
Frequently Asked Questions
What is Sylfirm X best for?
Sylfirm X is best suited to melasma, post-inflammatory hyperpigmentation, redness and rosacea, enlarged pores and fine lines. Its dual-wave, lower-energy approach targets pigment and vascular concerns without aggressive heat. It is not suited to deep depressed acne scars, which require a higher-energy device within a combination plan.
Is Sylfirm X good for melasma?
Melasma is one of the strongest indications for Sylfirm X, because the controlled, lower-energy pulsed mode targets pigment without the aggressive heat that often worsens the condition. Melasma is also relapsing, so the realistic expectation is substantial reduction rather than clearance, with recurrence common.
What is best for acne scars if acne is still active?
Non-insulated Secret RF is preferred, sometimes with AGNES on the same day, because it settles oil-gland activity while improving texture. The acne is brought under control before deeper scar remodelling begins.
Does PDRN (Rejuran) help with acne scar treatment?
PDRN reduces downtime and potentiates results, and it pairs with microneedle RF. Biostimulators are then chosen by scar type, with Ellanse for volume, Juvelook for ice pick and boxcar, Sculptra or Lenisna for rolling and RE20 for mild scarring.
Key references
- Anti-melanogenesis properties of polydeoxyribonucleotide (PDRN). PubMed.
- Optimizing fractional CO2 outcomes for pigmented atrophic acne scars in skin of colour. PubMed.
- Fractional CO2 laser resurfacing as monotherapy for atrophic facial acne scars. PubMed.
- Fractional radiofrequency microneedling as monotherapy in acne scars: systematic review. PubMed.
Comparative trials cited
- Feng H, Wu Y, Jiang M, et al. Fractional 1064 nm Nd:YAG picosecond laser combined with intense pulsed light for atrophic acne scars: split-face study. Lasers Surg Med. 2021;53:1356-1363. Journal.
- Yuan Y, He Y, Fang J, et al. Fractionated 1064 nm picosecond laser with holographic optics versus fractional CO2 laser for atrophic acne scars: randomised split-face study. Int J Dermatol. 2025;64:85-91. 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.
