Acne scar treatment:
what to expect, from grading to the review

What happens at the first acne scar visit?

The first visit is a medical consultation. It commits you to nothing, and no package is sold on the day. Dr Sin Yong does the whole examination himself and grades six things before any plan is written.

A pressing-glass test separates red marks from pigment and from true scars. Standardised photographs are taken for your medical record and are not published. Before the visit, declare all medicines, including isotretinoin and blood thinners, avoid sun and tanning, pause strong retinoids and acids as advised, and bring records of any earlier laser, peel or microneedling.

What happens at the release and support stages?

The course runs in a set order, and most methods are carried out under local or topical anaesthetic.

Release: subcision

A tethered or rolling scar is pulled down by fibrous bands from below, and energy alone does not cut them. In subcision, a fine needle is passed through a small puncture beside the scar under local anaesthetic, and the bands beneath it are divided. There are no stitches. Bruising where subcision has been done is the expected after-effect. Where a released scar has a volume deficit, calcium hydroxylapatite (CaHA) may be placed in the released space.

Support: TCA CROSS

A narrow ice-pick tract, deeper than it is wide, is treated at its floor rather than sanded from the top. TCA CROSS places a tiny amount of high-strength trichloroacetic acid into the floor of each tract with a fine applicator, leaving the skin around it alone. It is felt as a brief sting; each treated scar frosts white, forms a small crust and sheds it as it heals. The checklist for the healing that follows is on TCA CROSS aftercare.

Each stage is reviewed against the photographs before the next is timed, and the interval follows healing rather than a calendar.

“You can resurface a tethered scar indefinitely. The tether keeps pulling it down, which is why release comes first in every plan I write.”

Dr Sin YongOn the order of acne scar treatment

What happens at the resurfacing stage?

Resurfacing comes last, once the scars are free to remodel, and depth decides the laser.

• Superficial scars and texture: the FSX Laser, non-ablative wavelengths that heat the dermis and leave the surface intact. Redness follows and settles.
• Deep boxcar and ice-pick scars: the S3 Resurfacing Lift on the DEKA SmartXide Tetra Pro fractional CO2. Point shots go into individual pits first, then fractional passes cross the skin around them, under topical or local anaesthetic. Redness, swelling, pinpoint bleeding and oozing follow, then crusting and peeling that shed on their own.
• Shallow rolling scars and skin quality: RF microneedling on Secret RF, which treats at depth with less surface disruption.

On Fitzpatrick III to V skin the passes are lighter and staged, and sun protection runs through the plan, because post-inflammatory darkening is the main risk. The trade-off between lasers is reflected in the evidence: a 2026 meta-analysis of five comparative studies found fractional CO2 more often produced a marked response than erbium-based fractional lasers, with more pain and a longer recovery. What a fractional CO2 day involves in detail is on what to expect at a CO2 laser visit.

What does aftercare involve, and what needs a call?

What you see after each stage depends on the method: bruising after subcision, a brief sting and small crusts after TCA CROSS, and redness, swelling and pinpoint scabbing after resurfacing. These settle as the skin heals.

• Keep the skin clean and let scabs fall away on their own.
• Avoid heat, heavy exercise and active skincare until advised.
• Stay out of the sun, and restart retinoids when the clinic says.

Contact the clinic the same day for

• Pain that increases instead of settling.
• Spreading redness, warmth or pus.
• Blistering, or a wound that is not healing.
• Marked swelling or a change in skin colour after an injectable.

Recovery by method is on acne scar treatment downtime, and the resurfacing checklist on CO2 laser aftercare.

What happens at each acne scar review?

Every review compares the skin with the standardised photographs from the first visit and the stage before. Dr Sin Yong regrades the scars that remain, checks for darkening or prolonged redness, and decides the next step: another stage of the same method, a different method for scars that have changed type, or nothing further. The number of stages is set from what review shows, not fixed at the outset, and you judge the change under ordinary light alongside him.

The evidence supports this kind of sequence. A 2026 network meta-analysis of 56 randomised trials with 1,488 patients with moderate to severe atrophic scars found that combination treatments generally ranked above single treatments, with fractional CO2 combined with subcision among the most consistent pairings. Trials use different scoring systems, so they guide the choice of method rather than predict the result for one face. What decides the fee is on acne scar treatment cost.