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Acne scars or acne marks? Start here.
Acne scars are permanent changes in skin texture — indentations or raised lumps that do not resolve on their own. Acne marks are flat discolouration left after a breakout, with no change in texture. Provided the area stays protected from the sun and no new inflammatory lesions form there, most marks fade within three to six months, though brown marks take longer than red marks — especially in deeper skin tones. Scars require structural treatment; marks respond to lasers targeting blood vessels or pigment.
Which one you have determines whether treatment is necessary at all, so it is worth establishing before anything else.
"Red acne scars" — post-inflammatory erythema (PIE)
Flat red or pink marks left after a breakout are often called red acne scars. Clinically they are post-inflammatory erythema: dilated blood vessels close to the surface, not damaged structure. The skin stays level to the touch.
PIE is more noticeable on lighter skin and after inflamed lesions. Because the problem is vascular rather than structural, it responds to vascular laser (Vbeam) rather than to resurfacing.
"Brown acne marks" — post-inflammatory hyperpigmentation (PIH)
Flat brown or grey-brown marks are post-inflammatory hyperpigmentation: excess pigment deposited while the skin heals. Again, the surface is level.
PIH is the most common form of post-acne discolouration in Singapore, and it tends to last longer than red marks — often for more than six months, particularly if the area is not protected from the sun. Daily sunscreen can have as much influence on how quickly PIH fades as any in-clinic treatment. If it is slow to resolve, pigment-directed treatment can be considered once the acne itself is stable.
How Scars Form: The Role of Collagen
When an acne cyst or nodule becomes inflamed, it can penetrate deep into the skin, damaging the dermis (the second layer of skin). The skin attempts to repair this damage by producing new collagen fibers.
Atrophic scars (depressed scars)
If the body produces too little collagen during healing, a depression or pit forms.
Raised Scars
If the body produces too much collagen, a raised or lumpy scar forms.
Atrophic Scars
Raised Scars
Ice Pick Scar
Rolling Scar
Boxcar Scar
Keloid Scar
Types of Acne Scars
1. Ice Pick Scars (Deep Pits)
Often considered the most stubborn scar type, Ice Pick scars appear as deep, narrow punctures that extend into the lower layers of the skin (dermis), resembling small holes made by an ice pick. Because they are too deep for standard resurfacing to reach the bottom, they are typically treated with TCA Cross to chemically reconstruct the scar base, followed by CO2 Fractional Laser to smooth the surface.
2. Rolling Scars (Wavy Texture)
If your skin has an uneven, rolling, or wave-like texture, you likely have Rolling Scars. These are caused by fibrous bands of tissue that pull the skin surface down towards the subcutaneous layer ("tethering"). Since the problem lies beneath the surface, Subcision is the standard treatment to physically cut these bands,combined with PN injection to support repair and remodelling of the released tissue.
3. Boxcar Scars (Sharp Craters)
Boxcar scars are round or oval depressions characterized by steep, sharp vertical edges, giving the skin a "pitted" or crater-like appearance. Unlike ice pick scars, they are wider at the surface. Shallow boxcar scars respond well to Laser Resurfacing (CO2), while deeper ones may require Microneedling or Subcision to elevate the depressed skin.
4. Hypertrophic Scars (Raised, Within the Original Lesion)
Hypertrophic scars are firm, raised areas that form when the skin produces too much collagen while healing. They stay within the boundary of the acne lesion that caused them. Many flatten gradually over months or years, though this is slow and unpredictable. They are managed rather than resurfaced — aggressive resurfacing can worsen a raised scar.
5. Keloid Scars (Raised, Extending Beyond the Original Lesion)
Keloids need a different approach from the depressed scars above, and often ongoing management rather than a fixed course of sessions. We cover this in more detail on our page on keloid scar treatment in Singapore.
Most people have more than one type
Mixed scarring is the norm, not the exception. A single cheek commonly contains rolling scars across the outer surface, a cluster of ice pick scars near the nose, and boxcar scars where individual lesions were most inflamed — sometimes with brown or red marks over the same area.
This is why identifying one scar type is only the first step. Each type responds to a different mechanism: tethered scars need to be released, narrow scars need to be treated individually, and shallow texture needs resurfacing. A course built around a single treatment will improve whichever type it suits and leave the rest unchanged.
What matters next is the order in which they are done.
Why acne scars need different treatments — and why order matters
Dr Silver Chua on why different scar types need different treatments, and why the order they're treated in matters.
The KINS Approach to Acne Scars
At KINS, acne scarring is assessed by a doctor who treats more than 150 patients with acne and acne scarring each month. Scars form differently in every patient, so we look at what is actually there before deciding what to use — and how much of it.
01
Treating the acne comes before treating the scars
If you are still breaking out, we treat that first. New breakouts during a course of scar treatment leave new scars alongside the ones being treated, and inflamed skin is more likely to be left with brown marks. Where breakouts are mild and settled, the two can overlap.
02
The right intensity for your skin, not the maximum
Stronger settings don't reliably mean better results. Skin that marks easily needs gentler laser settings and longer gaps between sessions — pushing past what your skin can recover from can leave brown marks that outlast the scars. We check how your skin responded before treating again, not after.
03
The best treatment for your scars may not be the best for you
The treatment most likely to work on your scar type isn't always the one you can accommodate. If a laser needs five days of visible recovery and you can't take five days, a gentler option with little downtime is a legitimate choice — more sessions, longer overall, and we'll say so upfront.
Dr. Silver Chua
Medical Director and Consultant
04
We recommend, then decide together
From lasers to injections, each option has its own downtime, cost and limits. We tell you which of your scar types it addresses, which it doesn't, and what we'd do in your position. We'll also tell you when more sessions are unlikely to add meaningful change.
What each treatment does
Each of these addresses a different aspect of scarring. Most plans use one or two of them. Which ones apply to you — and how many — depends on your scar types and on the four things above.
Treating the scar structure
For rolling scars held down by fibrous bands. A fine needle releases the bands so the scar base is no longer pulled down, and a polynucleotide injection is given in the same procedure to support repair and remodelling of the tissue as it heals.
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Tethered rolling scars
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Downtime 3–5 days
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Local anaesthesia
First trial: $299
TCA CROSS
For ice pick scars. A high-concentration acid is applied point by point into each scar channel, prompting collagen to form from within so the channel narrows. Surrounding skin is untouched, and it is suitable across skin tones. Often followed by fractional CO2 laser to smooth the surface.
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Ice pick scars
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Scabs 3-7 days
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All skin tones
Resurfacing texture
For boxcar edges and established texture, and as the resurfacing step after point treatments such as TCA CROSS. Thousands of micro-channels are created into the dermis, removing damaged tissue and prompting collagen remodelling in the skin between them, so the surface levels out as it heals.
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Boxcar
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Overall texture
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Downtime 3–5 days
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Typically 3 sessions
First trial: $288
Fine needles create controlled micro-channels in the skin, prompting the natural repair response and new collagen formation in the treated area. Used for milder, shallower scarring and for overall texture, and often combined with a biostimulator to support remodelling afterwards.
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Mild scarring
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Texture
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Downtime 2–3 days
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3-6 sessions
First trial: $168
Flattening raised scars
For hypertrophic and keloid scars, which are reduced rather than resurfaced. Softens the tissue and eases itch or tenderness. Where the scar is red or thickened, vascular laser is used alongside the injections. Keloids need ongoing review rather than a fixed course — see keloid scar treatment in Singapore.
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Raised scars
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Minimal downtime
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Every 4–6 weeks
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Multiple sessions
First trial: $300
Treating redness and pigment
For post-inflammatory erythema — the flat red marks left after a breakout. Targets haemoglobin in the dilated vessels responsible for the redness, without affecting surrounding tissue. We use a pulsed dye laser system for this. Also used on raised scars that are red or thickened, alongside steroid injection.
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Red marks (PIE)
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Raised scars
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Minimal downtime
First trial: $299
For post-inflammatory hyperpigmentation — the flat brown marks left after a breakout. A dual-wavelength Nd:YAG system targets excess pigment at different depths, with wavelength and mode selected according to how deep the pigment sits and how readily your skin marks.
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Brown marks (PIH)
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Minimal downtime
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Adjusted to skin tone
First trial: $188
Supporting recovery and prevention
Polynucleotide (PN) treatments, such as Rejuran, are injectable therapies derived from salmon DNA. They are used to improve the physiological environment of the skin, focusing on hydration and repair at the cellular level.
How It Works
Unlike fillers that simply add volume, PN treatments work by delivering biological building blocks to the dermis. This helps to repair damaged DNA and reduce inflammation. When used in combination with laser treatments, PN supports the skin’s natural regenerative capacity, thickening the dermis and improving elasticity from within.
Benefits & Downtime
Incorporating PN healers is intended to enhance overall skin quality and support faster recovery following laser procedures. It acts as a synergistic treatment to optimize the outcome of scar revision. The downtime is minimal, usually consisting of small bumps or needle marks that subside within 1 to 2 days.
First trial: $600
Microbiome skincare for Acne Scars
The KINS Microbiome Program
The KINS Microbiome Program takes a holistic approach to acne management by focusing on the skin’s resident flora (bacteria). This program is designed to address the underlying factors that contribute to acne and inflammation.
How It Works
We assess the balance of your skin microbiome to identify potential causes of chronic inflammation. Based on this assessment, we provide specialized care and advice aimed at restoring a healthy bacterial balance and strengthening the skin barrier. This approach targets the root environment of the skin rather than just the surface symptoms.
Benefits & Downtime
The goal is to support long-term skin resilience and manage the risk of future breakouts, which is crucial for preventing new scarring. This is a non-invasive management program with no downtime, allowing patients to integrate it easily into their daily routine.
First trial: $46
Your Acne Scar Treatment Journey:
5 Steps
Step 1: Booking & Preparation
To minimize waiting time and ensure a stress-free visit, we operate on a strictly by-appointment basis. After booking, you will receive a secure Pre-Registration Form via email. Filling this out beforehand allows for a smooth check-in process on the day. (Note: Please bring your IC card or Passport for identity verification on your first visit.)
Step 2: Skin Imaging Analysis
Before every consultation we take standardised clinical photographs (approx. 2–3 mins). Scarring photographs poorly under flat lighting — depth only shows under consistent, angled conditions, so we use the same setup each time to make change measurable rather than impressionistic.
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Preparation: Photos are taken on bare skin. We ask that you remove makeup, or our staff can gently assist you with makeup removal at the clinic.
Step 3: In-Depth Consultation
(30 mins)
Understanding the root cause, not just the symptoms. For your first visit, we dedicate approximately 30 minutes to get to know you. The doctor will evaluate your skin condition, medical history, and lifestyle factors (such as sleep, stress, and skincare routine) to understand why the acne is occurring.
Your Bespoke Plan: Based on this holistic diagnosis, we propose a tailored treatment plan—often combining different therapies for the best results. We believe in full transparency:
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Effectiveness: what each option can and cannot change for your scar type?
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Risks: Are there side effects like redness or dryness?
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Cost: We provide a clear explanation of fees. We proceed with treatment only after you are fully informed and comfortable.
Step 4: The Treatment Experience
Gentle care with your doctor by your side. If you wish, you can receive treatment on the same day as your consultation (approx. 30–60 mins). Alternatively, you can book the treatment for a later date if you have other commitments. Your comfort is our priority. The doctor will be with you every step of the way, ensuring pain and anxiety are minimized. If you feel uneasy at any point, please let us know immediately—we are here to support you.
Step 5: After care & Continuous Support
Scar treatment works over months, not weeks. What we look at between sessions is whether the last one changed what we expected it to change — and if it didn't, whether the plan needs adjusting rather than repeating. Sun protection matters throughout: skin treated for scarring marks more easily than untreated skin.
Home support via WhatsApp. If you have questions about aftercare or notice anything unexpected, message us. You don't need to wait for the next visit.
KINS Clinic DOCTOR'S PROFILE
Dermatologist and Chief Medical Advisor
Fellows of the Academy of Medicine, Singapore (FAMS) / Membership of the Royal Colleges of Physicians (MRCP) / Bachelor of Medicine and Bachelor of Surgery (BMBS)
Prior to joining KINS Clinic, Dr. Henry Loh was a co- founding partner of Dermatology Associates, one of the largest private dermatology clinic groups in Singapore. He has also been instrumental in promoting the use of the latest treatments.
Medical Director and Consultant
Post-graduate Diploma in Practical Dermatology (PgDip) / Doctor of Medicine (MD) / Bachelor of Medical Studies (BMed) / Bachelor of Science in Medicine (BSc (Med))
Dr Silver Chua specialises in the medical care of acne, rosacea, and other common skin concerns, complemented by a strong background in aesthetic treatments. She leads the fully integrated care pathway at KINS Clinic—ensuring patients receive cohesive, evidence-based care that bridges both medical and aesthetic needs. Her approach is grounded in safety, with a strong emphasis on achieving naturally balanced, lasting results.
Dr Silver is fluent in both English and Mandarin
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