Types of Acne Scars & Marks Pico Fractional Laser Effectively Treat

The American Academy of Dermatology reveals that acne scars often have complex characteristics [1]. Acne scars cause the skin's surface to look uneven and bumpy, are unsightly and make us look older than we are. 

Understanding the type of acne scars you suffer from is crucial as it determines the most suitable treatment for your condition.

Why does acne leave scars? How do acne scars form?

Cystic pimples are inflammatory acne, which involves more white blood cells rushing to the area, and because there are more enzymes in that area, it leads to more destruction. When skin pores are engorged with excess oil, dead skin cells and bacteria will swell, causing the follicle wall to break. The skin then tries to desperately heal itself, but the outcome will not be as smooth as the original skin and results in what is known as Acne Scars. 

There is a major difference between acne scars and marks. Acne scars are deep indentations usually caused by picking at a blemish (though not always). Acne marks may fade away with time, but acne scars take much longer to disappear and can only be erased with laser treatment.

How acne scars form depends on the cause of its scar formation. 

Types of acne scars

There are two types of acne scars — atrophic and hypertrophic scars. 

Atrophic scars are indented or pitted due to a lack of collagen during healing, while hypertrophic scars are raised and thick due to an overproduction of collagen. 

Keloids and Hypertrophic Scars

Appearance: Keloids grow many times the size of the original wound and can continue to grow laterally even after the acne site is healed. 

Severity: Keloid scars are one of the more severe types of acne scars, where the acne scars are raised compared to the indented scars that most acne leaves behind. 

Cause: Keloids are caused due to the overproduction of collagen in the body. As such, the body is unaware that the acne wound has healed and continues its production of collagen, thereby leaving a raised scar, also known as keloids.

Occurrence: While uncommon, some people are more prone to developing keloids. 

Ice Pick Acne Scars

Appearance: Ice pick scars are narrowly pitted-shaped and look like many small and narrow. However, they extend deeper into the skin than other scars, with deep holes that pierce through the skin's surface, with some looking very much like huge open pores. 

Severity: Ice-pick scars are one of the trickiest acne scars to treat. 

Cause: Ice pick scars are usually caused by severe acne, such as cystic acne or deep, inflamed blemishes that occur deep in the pores. As such, the skin tissue is destroyed, leaving a deep and column-like scar known as an ice-pick scar.

Occurrence: Those who pick their acne, usually with sharp objects or squeezing with their hands or fingernails.

Boxcar Acne Scars

Appearance: Boxcar scars, unlike ice-pick scars, are shallower but broader. They have round or oval depressions that give the skin an uneven appearance. Wider than ice pick scars, boxcar scars make the skin bumpy. 

Severity: The severity of boxcar scars depends mainly on the amount of tissue lost during the acne outbreak.

Cause: Boxcar scars are developed when the inflammation of the acne breakout destroys collagen, causing tissue loss. The loss of tissue causes the skin around the area to be vulnerable. Without this support, the pitted appearance on the skin's surface is created. 

Occurrence: Picking or squeezing acne

Rolling Acne Scars

Appearance: Like boxcar scars, rolling scars are also characterised by their shallow indentations on the skin's surface. Having soft and smooth edges, rolling scars are barely noticeable should the skin be stretched. 

Severity: The skin's low pliability makes it challenging to go away on its own

Cause: Rolling scars are caused, usually by a prolonged term of inflammatory acne, where bands of tissue develop in the deeper structures of the skin's surface as well as between the surfaces of the skin. 

Occurrence: Such acne scars are typically more noticeable with age when the skin loses elasticity, creating the trademark 'rolling' effect.

Post-inflammatory Hyperpigmentation (PIH)

Appearance: Appears as tan, brown, or black patches on the skin

Severity: May slightly fade away on its own

Cause: Result of inflamed wounds, which are caused by increased pigment production due to injury or inflammation of the skin.

Occurrence: Darkened spots developed from the areas where the acne or skin trauma (such as picking or squeezing) once occurred.

Treating Acne Scars with Pico Fractional Laser

While dealing with acne can be emotionally and psychologically taxing, coping with the aftermath of acne can prove to be equally distressing. 

Pico Fractional Laser is an FDA-approved picosecond laser that can promote the restoration of smooth and healthy-looking skin. It is a multi-function laser that combines ultra-short picosecond laser and HEXA Laser laser-induced optical breakdown (LIOB) to treat various skin conditions, such as acne, acne scarring, and enlarged pores. It is non-invasive and delivers noticeable and improved results in fewer sessions than other types of acne scar laser.

How does Pico Fractional Laser for Acne Scars work?

Pico Fractional Laser treats acne scarring by creating thermal injury on the targeted area. The injured skin will then trigger the body's natural healing cycle, after which collagen production is stimulated; skin repairing and remodelling will occur.

In treating scars and enlarged pores, the laser penetrates deeper into the skin than just its surface to deliver pulses, which cause tiny globules of air or bubbles. During a patient's recovery stage, collagen fills up the bubbles and raises indentations and depressions of the scars. This results in a smoother appearance.

Depending on your acne scar type, skin condition, and severity of the scarring, Pico Fractional Laser may be done as a solo treatment or combined with the following treatments:

• Chemical Peel

• Steroid Injection

• Facial Fat Grafting

• Subcision

What other types of scars can Pico Fractional Laser treat?

There are different types of scars, but all of them have the same distressing effects. Pico Fractional Laser effectively addresses all kinds of acne scars and other kinds of scars, such as:

• Surgical scars
• Chicken pox scars
• Nail scratches
  

As the appointed trainer for Pico Fractional Laser in Singapore, Dr Ivan Puah has much knowledge and experience behind this efficient acne treatment. He thoroughly understands acne, having attained a Graduate Diploma in Family Dermatology from NUS and over 15 years of experience in laser skin treatments.

As each patient is unique, Dr Ivan Puah will concoct a personal acne scar and acne mark treatment plan for each patient. Tackling acne scars doesn't have to be a disheartening process. Talk to Dr Ivan Puah today.

FAQ on acne scars and Pico Fractional Laser in Singapore

Is Pico Fractional Laser for acne scars permanent?

This treatment improves the skin's appearance for most skin types. Its enhanced capabilities also mean shorter treatment and recovery time. However, as with most (if not all) procedures, the long-term result also depends on your lifestyle and habits. Have a realistic goal in mind and discuss any concerns with our doctor.

Is Pico Fractional Laser for acne scars safe?

The treatment minimises skin damage significantly. Its technology results not only in shorter treatment and recovery time but, more importantly, in increased safety.

Does Pico Fractional Laser for acne scars hurt?

The treatment may cause minimal discomfort, but do raise any concerns that you may have with our doctor during the consultation.

Any side effects of Pico Fractional Laser for acne scars?

Compared to traditional laser treatments, Pico Fractional Laser side effects are much less. You can expect pink or redness on the skin for up to four to five days after treatment, so keeping it moisturised is essential during recovery and shielding your face from the sun.

How many sessions will I need?

The number of sessions will depend on the extent of your condition. In general, it may require anywhere from two to six sessions, which may be repeated every one to four weeks. During the consultation, our doctor will advise you on what is recommended.