S3 Resurfacing Lift — Acne Scar Laser Protocol

What the S3 Resurfacing Lift is, and how a CO2 laser treats acne scars

The S3 Resurfacing Lift is Dr Sin Yong's protocol for deeper acne scars on the DEKA SmartXide Tetra Pro, a fractional CO2 laser. Its 10,600 nm light is absorbed by water, so it vaporises microscopic columns of skin and leaves untreated bridges between them. The surface heals from those bridges while the dermis remodels collagen, and the heat around each column drives the tightening response CO2 is known for.

Acne scars are architectural defects, not surface marks, and ice-pick, boxcar and rolling scars sit at different depths, often side by side. So the protocol varies depth and density across one treatment field.

What S3 stands for: Stack, Scan, Sculpt

• Stack: the depth and heat of each pulse, set to reach the base of a deep scar without excess injury to the tissue beside it.
• Scan: the pattern, density and spacing of the columns, balancing coverage against healing and the risk of post-inflammatory hyperpigmentation in Asian skin.
• Sculpt: the spot geometry, used to blend scar edges into the surrounding skin.

Point shots go into individual scar pits first, then fractional passes cover the skin around them. The Tetra Pro's Pulse Shape Design lets the doctor set how each pulse rises, dwells and tails off, and its FRACTIONAL and ULTRA modes allow ablation depth and density to be calibrated for each scar type and skin tone. The device is described on CO2 laser Singapore: the DEKA Tetra Pro.

Fractional, fully ablative and non-ablative: the terms

Fractional describes how a laser delivers its energy, in microscopic columns, not which laser it is.

Scar removal beyond acne scars

Not every scar Dr Sin Yong is asked to look at comes from acne. Surgical scars, scars left by an injury and chickenpox scars are assessed in the same consultation, on the same principle: the scar is examined before any laser is chosen, because each kind sits at a different depth and behaves differently in the skin.

• Surgical scars: how long ago the operation was and whether the scar is still red and maturing, its width, whether it sits flat, depressed or raised, and the tension across it. A raised scar or a keloid is a different problem, set out under keloids and hypertrophic scars; timing is covered in when to treat a surgical scar.
• Injury scars: the shape and edges left by a cut or graze, whether the scar is tethered to the tissue beneath, and any darker or lighter pigment within it or around it.
• Chickenpox scars: usually round, depressed and scattered, often on the forehead, temples and cheeks. Their depth and the sharpness of their edges are read the way boxcar and ice-pick acne scars are.

The S3 settings are then chosen for the scar rather than taken from a fixed programme. A punched-out or deep chickenpox scar may take point shots into its base before fractional passes over the skin around it; a flat surgical or injury scar with an uneven surface is blended into the surrounding skin with fractional passes and spot geometry; density is set lower on darker skin and on thinner skin. Where a scar is tethered, subcision is considered as part of 4D Scar Reconstruction. Where a lighter laser fits better, the FSX Laser is discussed instead. A young, red or raised scar may be given time or a different treatment first, and some scars are referred on.

Which acne scars suit the S3 Resurfacing Lift, and who should wait

S3 suits depressed scars too deep for a lighter laser, on skin where acne is quiet, in people who accept gradual change and a recovery with crusting and sun avoidance. It is a poor fit for raised scars, active acne or hopes of complete erasure.

Back acne scars can be treated with the same protocol, though the plan for the back may differ from the face. To sort your own scars, try the acne scar type checker or read acne scar types: ice-pick, boxcar and rolling.

Related guide: Rolling scars

Acne scar laser options compared: S3, FSX Laser and what is used alongside them

Which tool leads depends on scar depth and tethering, and most faces need more than one. The lasers alone, including picosecond, are compared on acne scar laser treatment.

Erbium laser or CO2 laser for acne scars?

Both are ablative. An erbium laser (Er:YAG, 2,940 nm) is absorbed by water more strongly, so it vaporises cleanly with a thin zone of heat and less remodelling. CO2 leaves a wider band of heat, which suits deeper scar edges where that collagen response is wanted, with settings that respect pigment risk. Neither releases a tethered rolling scar. Erbium glass is a different, non-ablative wavelength, used in the FSX Laser.

More comparisons: S3 vs Secret RF, subcision vs laser, Tixel vs CO2 vs RF microneedling and Fraxel vs CO2 vs Tetra Pro. The Luminescence Laser is a lighter option for shallower scars and melasma, and pico laser with the S3 Resurfacing Lift covers brown marks between scars.

Where S3 sits in 4D Scar Reconstruction

4D Scar Reconstruction is the framework Dr Sin Yong uses S3 within. It addresses four dimensions of scar architecture (surface texture, dermal depth, subcutaneous tethering and volumetric deficit) with four tools:

• Subcision releases tethering first, so the scar floor is free to rise before laser energy is applied.
• The S3 Resurfacing Lift works on depth and texture: the scar floor, its edges and the skin around it.
• TCA CROSS treats ice-pick tracts too narrow for a laser alone.
• Calcium hydroxylapatite filler, placed after subcision, supports a volume deficit; see subcision with filler.

The order and spacing follow the scar map, and each step is reviewed before the next is timed.

What the S3 Resurfacing Lift cannot do

S3 remodels the floor and edges of a scar. It does not erase the scar, and it does not reach every part of one. When scars plateau after several laser sessions, one part was usually left untreated: a tether still pulling, a tract too narrow to resurface, or pigment between the scars.

Myths we hear in clinic

• “A laser alone treats every acne scar type.” Scars sit at different depths, and some need subcision, TCA CROSS or volume support as well.
• “Darker skin can never have fractional CO2.” It is not excluded, but pigment risk is higher, so the settings and sun protection are planned around it.

Risks and side effects of CO2 laser for acne scars

Fractional CO2 makes a wound on purpose, so redness, swelling, pinpoint bleeding and oozing, then crusting and a sandpaper-like feel, are part of healing. Subcision adds bruising, and TCA CROSS leaves a small crust on each treated scar. The risks that matter are:

• Post-inflammatory hyperpigmentation: darkening, more likely in Asian skin, often appearing after the surface has closed and looks clean.
• Prolonged redness and, less often, lightening of the skin.
• Infection, acne-like eruptions or a cold sore flare on freshly resurfaced skin.
• New scarring, which is rare.

Scar mapping, settings chosen per scar and skin type, antiviral cover where cold sores have occurred, undisturbed healing and strict sun protection lower these risks but do not remove them. A patch that darkens is reviewed and managed, not treated over with more laser. Darker skin is covered on fractional CO2 laser in Asian skin.

When to contact the clinic

Contact the clinic the same day for thick, yellow or oozing crusts; pain, heat or redness that increases or spreads; blisters or a cold sore in the treated area; skin that darkens or a firm, raised scar forming; or fever. See what to do if something feels wrong after a treatment.

What to expect: before, on the day and recovery

The first visit is a consultation, separate from the laser. Dr Sin Yong maps the scars, checks tethering by stretching the skin and takes a medical history. You leave with a written plan that includes the option of no treatment.

Before you book

• Declare isotretinoin, photosensitising medicines and any recent laser, peel or microneedling.
• Mention pregnancy, breastfeeding, keloids and cold sores; antiviral tablets are usually prescribed where cold sores have occurred.
• Avoid sun and tanning, and pause retinoids and acids if advised.
• Bring photographs of your scars and records of earlier treatment.

On the day

After cleansing, anaesthetic is applied: topical for most areas, local where deeper work is planned. Dr Sin Yong then delivers the laser himself, point shots first and fractional passes after, with depth and density set per scar and skin type; in Fitzpatrick III to V skin, density is the setting pulled back most. An ointment goes on, and you leave with written aftercare. More on what to expect at a CO2 laser visit.

Recovery, stage by stage

The sequence below describes phases, not a timetable: how quickly each passes depends on the settings used, the area and the person, and is discussed at consultation.

1. Immediately afterThe treated skin is red, swollen and warm, with pinpoint oozing; a healing phase is expected rather than walking out unchanged.
2. The first eveningGentle cleansing and a bland occlusive moisturiser; antiviral cover if prescribed; sleep with the head raised to limit swelling.
3. The following daysFine scabbing and peeling form as the microscopic channels close; scabs are left to separate on their own, never picked.
4. As the skin settlesPinkness fades gradually; active skincare such as retinoids and acids stays paused until the surface has healed, with strict sun protection.
5. Follow-upA review manages any early redness or pigment change promptly, and further resurfacing is timed only once the skin has settled.

Make-up waits until the skin has closed over, and the review is timed to when darkening would appear. See CO2 laser aftercare, CO2 laser downtime and acne scar treatment downtime.

How Dr Sin Yong approaches the S3 Resurfacing Lift on the Tetra Pro

He starts with the scars, not the device: each pattern is photographed and mapped, tethering is checked, and skin type and any history of darkening are noted before a plan is written. Every step, from the assessment to holding the laser, is done by him personally.

In plain words, depth decides the laser, and a tethered scar is released before it is resurfaced. In darker skin he treats settings published for lighter skin as a starting point, not an answer, and calibrates the protocol to limit heat spreading into the surrounding tissue.

“The method is matched to the scar, not the scar to the method.”

Dr Sin YongOn acne scar morphology

DEKA and NeoAsia issued him a Key Opinion Leader certificate on the SmartXide Tetra Pro in October 2025, the month he co-presented his S3 Resurfacing protocol with Dr Davin Lim at a DEKA Tetra Pro physician session in Singapore and volunteered as the live demonstration patient. He is first author of a clinical paper on his S3 Resurfacing protocol on the Tetra Pro for acne scarring, currently in preparation, with Irene Fusco and Laura Pieri of DEKA's clinical research team as co-authors. In October 2026, at the DEKA Academy in Florence, he spent a day on the Tetra Pro comparing his depth and density choices with the faculty's, and met the research team to work through the manuscript.

The Orchard Road practice is a designated DEKA Centre of Excellence. That describes the site, not an outcome; the settings chosen for your skin matter more than the badge.

What decides the cost of CO2 laser for acne scars

Fees are not published, and a figure given before the scars are examined would not describe your face. The fee follows the written plan:

• The scars: which types are present, how deep they sit and how many there are.
• The area: a zone on the cheeks, the full face or the back.
• The plan: S3 alone, or with subcision, TCA CROSS or CaHA filler.
• The settings: the passes and depths used, and the consumables.
• Staging: a course with healing between visits, each step reviewed before the next.
• Who performs it: Dr Sin Yong assesses and treats personally.

Compare quotes like for like: scar types, methods, area, and the review and aftercare included. The consultation also decides whether laser is advised at all. See acne scar treatment cost: the fee factors and how fees are quoted.