Chemical peeling/TCA CROSS Technique

Scars brought about by acne can be ice pick, rolling and box type scars.  Several scars are formed over the years of repeated inflammation process caused by acne.

Chemical peel in the form of TCA (trichloroacetic acid) is a treatment regimen that would slough off the superficial layers of our skin and stimulate collagen production. Commonly called as TCA CROSS technique for deep scars, this utilizes high concentration of TCA applied locally on the pitted scars.

After the treatment, frosting or a whitish appearance can be seen on top of the scars. Few days later there will be scabs formation which will fall off in 1-2 weeks’ time.

Automated Micro needling Therapy

This collagen induction therapy utilizes the skin’s self-healing mechanisms.  Micro-needles are used to stimulate the proliferation of new cells, e.g. fibroblasts to transform into collagen and elastin fibers. The task of fibroblasts is to migrate to the point of intrusion for wound closure. The pricking channels, caused by the micro-needles, close very quickly and no tissue lesion can be detected, and none has to be repaired. The transformation for wound repair cells (e.g. fibroblasts and others) is an automatic process. Their final mission is to transform into collagen fibers. They integrate into the existing collagen formation in the upper dermis. This new fiber formation – in terms of many hundred percent – thickens the skin and fills former atrophic scars. As single needle prick is not worth mentioning. But if thousands of microscopic small needle-pricks are set, the induced collagen formation becomes confluent and forms a new collagen layer. This body reaction is called neo-collagenesis.

The procedure would require a topical anesthesia for 45 minutes, and then the procedure would last from 15 to 30 minutes. To maximize result, additional topical medications are being applied during the procedure.  Temporary redness is an expected outcome which will disappear in a few days and eventually you will notice gradual improvement of your scars. Repeat treatment session can be done every 3 to 4 weeks.

Fractional CO2 Laser

Smart Fractional CO2 Laser is a smart choice for those who want to get rid of many unwanted skin conditions like acne scars. It has a wavelength in the mid-infrared at 10,600 nm, CO2 laser energy is well-absorbed in water. As skin contains a very high water percentage, this makes the CO2 laser ideal for precise and safe treatment.

The Smart fractional CO2 laser creates tiny columns of heat that penetrate to a certain level of the skin, creating cellular damage which eventually leads to collagen formation.

 Technological advances in CO2 laser construction have meant smaller spot sizes and greater precision for laser surgery, and more flexibility in tip sizes and protocols for fractional CO2 laser treatment.

This laser has many settings and depth penetration that can be adjusted depending on the patient’s reason of treatment. Shapes of laser beam can also be adjusted, say for example you have a chicken pox scar that is circular, the laser beam shape and depth can also be customized according to that.

What to expect during the treatment ?

The treatment is a tolerable experience. Gone are the days when CO2 laser heals longer and are painful to do. The technology behind the Smart Fractional laser is advanced that treatment and healing is fast and tolerable. There is even a low pain mode setting for this technology, where numbing cream is not necessary, however if we use the usual setting, the numbing cream can be justify for 30 to 45minutes before we start the treatment.

You may feel itching or stinging sensation for 12 to 72 hours. Then 5 to 7 days after laser your skin will become dry and peel off.

Afraid of the downtime?

You can still proceed with your daily activities as long as you put sunscreen every 4 hours.

Dos and don’ts:

  1.  Discontinue any whitening products 3 days before treatment.
  2. Avoid sun exposure. Use a sunscreen every 4 hours after treatment.
  3. Use a mild cleanser or mild soap all throughout.
  4. Hot shower or steam bath should also be avoided.

An average of 4-5 sessions, done monthly is necessary to maximize results.

TCA cross

TCA CROSS is one of the targeted treatment approaches for acne scars. It uses high concentration of Trichloroacetic acid to promote skin coagulation and collagen production.

This is best for ice pick and boxcar type of acne scars.

 Tiny droplets of the solution is applied to the scar until white frosting is observed. Scabs are then formed which will resolved in 10 to 14 days.

Treatment is fast, Repeat session can be done in  4-6 weeks.


Subcision is a procedure used to treat acne scarring, specifically rolling type of depressed acne scars. These scars are caused when fibrotic strands that pull the skin downwards, creating the superficial indentations.

During the procedure, individual scars will be treated using a tiny, hypodermic needle that will be inserted into the skin. The needle will be moved back and forth in a fanning pattern as the sharp edges of the needle will be used to cut away at the fibrotic scar tissue. These cuts effectively release the fibrotic strands of the scar from the underlying tissue. This release elevates the previously depressed skin and will continue to improve as the wound healing cascade will stimulate further collagen production.

 If many scars need to be treated, treatment will be divided into multiple session.

After the treatment, there will be swelling and bruises, which will improve it 3-7days.

Fillers Injection

Dermal fillers can be used to treat depressed acne scars. Dermal fillers will help to raise the indentations and volume loss caused by acne, creating a smoother appearance. Certain acne scars, such as rolling scars and some less defined boxcar scars can be effectively treated with dermal fillers.

 Rolling scars, which are wave like depressions in the skin, as well as some boxcar scars, which are circular and deep indentations, can both be treated with fillers with great improvement. Hyaluronic acid fillers like  Restylane are commonly used in this application.

Treatment with dermal fillers will begin by thoroughly cleansing the skin and determining which scars will be filled. The amount of filler used will vary and depend on the number of scars being treated and the severity of the scars.  A needle will then be inserted underneath the scarred area and the filler deposited until all scars have been treated.

Punch Excision or Elevation

Punch excision or elevation uses a simple surgical technique either to remove the depressed scar or to elevate the scar parallel to the normal skin. This uses a tool  that looks like a pencil with a tiny hole at the tip.

Healing may takes 1-2 weeks and new skin growth will replace the old scar making it less visible.