Understanding Acne Scars and Marks in Singapore

Acne can leave behind more than just temporary blemishes — for some individuals, it results in lasting scars or discolouration that affects both skin texture and tone. At our clinic in Singapore, we often see patients confused about whether they are dealing with acne scars, red marks, or pigmentation. Each condition requires a different treatment approach.

This page aims to explain the difference between acne scars and marks, how they form, and how to recognise which type you may have. A proper understanding is the first step toward choosing the right treatment for smoother, clearer skin.

What Are Acne Scars?

Acne scars are permanent textural changes that develop when severe or inflamed acne damages the deeper layers of the skin. Unlike acne marks or pigmentation, scars are the result of structural injury to the skin’s collagen framework during the healing process.

When the skin attempts to repair itself after inflammation or cystic breakouts, it may either produce too little or too much collagen. This imbalance leads to the formation of depressed or raised scars.

Common Characteristics of Acne Scars:

  • Visible changes in skin texture — such as pits, indentations, or uneven skin surface
  • Do not fade with time — unlike pigmentation, scars typically persist without intervention
  • More common after severe, nodular, or cystic acne

Because acne scars affect skin structure, they often require targeted medical treatments such as subcision, laser resurfacing, or collagen-stimulating injectables to visibly improve.

How Do Acne Scars Form?

Acne scars develop when severe or inflammatory acne—such as nodules and cysts—causes deep damage to the skin and underlying collagen structures.

During the healing process, the body attempts to repair this damage. However, if the collagen produced is either insufficient or excessive, it results in an uneven skin texture. This imbalance leads to either depressed scars (from collagen loss) or raised scars (from excess collagen).

The risk of scarring increases with:

  • Prolonged or untreated inflammatory acne
  • Frequent picking or squeezing of pimples
  • Delayed healing or recurrent breakouts in the same area

Because acne scars represent a structural change in the skin, they typically do not improve with over-the-counter skincare alone. Targeted medical treatments are required to stimulate collagen remodelling and restore smoother skin.

Acne scar formation

What Are Acne Marks?

Acne marks refer to flat discolorations left behind after active acne has healed. Unlike acne scars, these marks do not involve structural skin damage and are more superficial in nature. They are common in patients who experience repeated inflammation or who tend to pick at their acne lesions.

There are two main types of acne marks seen in clinical practice:

Post-Inflammatory Erythema (PIE)

PIE presents as persistent pink or red patches that remain after inflamed acne clears. It is caused by damage to the skin’s superficial blood vessels during inflammation. PIE is especially common in individuals with fair to medium skin tones.

Key features:

  • Flat red or pink marks
  • No skin indentation
  • Typically worsened by sun exposure or trauma

Effective treatment options include vascular lasers such as Pro Yellow Laser or Gold Toning, which target underlying blood vessels to reduce redness and promote faster healing.

Post-Inflammatory Hyperpigmentation (PIH)

PIH appears as brown or greyish spots and is caused by an overproduction of melanin in response to skin inflammation. It is more common in medium to darker skin tones.

Key features:

  • Brown, dark, or purplish discoloration
  • Flat appearance with no change in texture
  • Often takes several months to fade without treatment

Treatment options include brightening serums (e.g. Vitamin C, arbutin, niacinamide) and pigmentation lasers like Pico Laser to accelerate clearance.

Are Acne Marks Permanent?

While acne marks can be frustrating, they are not permanent. With appropriate sun protection and doctor-guided treatments, most acne marks fade over time. However, early intervention often leads to faster and more complete resolution—particularly for patients prone to pigmentation issues after inflammation.

Types of Acne Scars

Acne scars can be broadly categorised into atrophic (depressed) and hypertrophic (raised) scars. Identifying the type of acne scar is essential for selecting the most appropriate treatment, as each responds differently to lasers, subcision, or collagen-stimulating procedures.

Atrophic Acne Scars (Depressed Scars)

These scars are the most common and result from a loss of collagen during the healing phase of severe acne.

a. Ice Pick Scars

  • Appearance: Deep, narrow, and sharp indentations that resemble small holes or punctures
  • Cause: Severe inflammation that extends into the deeper dermis
  • Commonly found: Cheeks and upper cheeks
  • Treatment options: Subcision, Polynucleotide Scar Injections, CO2 Fractional laser

b. Boxcar Scars

  • Appearance: Broad, rectangular or U-shaped depressions with well-defined edges
  • Cause: Collagen loss following inflammatory acne
  • Commonly found: Cheeks and temples
  • Treatment options: Subcision, CO2 fractional laser, Polynucleotide Scar Injections

c. Rolling Scars

  • Appearance: Wide, shallow depressions with soft edges that create a wavy skin texture
  • Cause: Fibrous bands pulling the skin downwards
  • Commonly found: Lower cheeks and jawline
  • Best treatment options: Subcision, collagen-stimulating injectables, fractional resurfacing

Hypertrophic and Keloid Scars (Raised Scars)

These are less common and occur when the body produces too much collagen during wound healing.

  • Appearance: Firm, raised nodules or ridges above the skin surface
  • Cause: Excessive collagen response
  • Commonly found: Jawline, chest, back, and shoulders
  • Best treatment options: Steroid injections, intralesional treatments, laser resurfacing
Types of Acne Scars

Accurate diagnosis of the scar type is crucial in developing an effective, customised treatment plan. Many patients have a combination of scar types and may benefit from a multimodal approach using lasers, injectables, and subcision techniques.

Available Acne Scar Treatments in Singapore

At our clinic, we offer a customised, multi-modal approach to acne scar treatment. Each treatment plan is tailored to your specific scar type, skin condition, and recovery preferences. The most effective results are often achieved through a combination of different techniques.

Fractional CO2 Laser Resurfacing

This laser treatment delivers controlled heat to the deeper layers of the skin, triggering collagen remodelling and skin renewal. It is particularly effective for boxcar and rolling scars, helping to smooth skin texture and reduce scar depth over time.

  • Stimulates collagen production
  • Improves skin tone and texture
  • Moderate downtime depending on treatment intensity
Co2 Laser

Subcision for Acne Scars

Subcision is a minor surgical procedure used to release the fibrous bands tethering depressed scars to the deeper tissue. It is especially useful for rolling scars, which are caused by skin being pulled downward.

  • Physically lifts depressed scars
  • Often combined with collagen-stimulating injectables for enhanced results
  • Minimal downtime with mild bruising or swelling
Subcision

Collagen-Stimulating Microinjections

These injectable treatments help rebuild the skin’s support structure by promoting natural collagen synthesis. They are commonly used in combination with subcision or laser treatments to improve overall scar depth and skin elasticity.

We offer a range of collagen-stimulating injectables, including scar-targeted polynucleotide treatments and hybrid injectables with skin-rejuvenating effects, depending on your scar type and treatment goals.

Key benefits:

  • Enhances skin healing from within
  • Provides gradual, natural improvement over several sessions
  • Suitable for ice pick and atrophic scars

Treatment Options for Acne Marks (PIE and PIH)

Acne marks are flat discolourations that remain on the skin after active acne has healed. They are different from acne scars in that they do not involve textural changes to the skin but can still cause significant cosmetic concern. The two most common types of acne marks are Post-Inflammatory Erythema (PIE) and Post-Inflammatory Hyperpigmentation (PIH).

Red Acne Marks (Post-Inflammatory Erythema – PIE)

PIE refers to persistent red or pink marks that appear after inflamed acne lesions, particularly cystic or nodular breakouts. These marks are caused by damaged and dilated blood vessels near the skin surface that remain even after inflammation resolves.

At our clinic, we commonly treat PIE using the Pro Yellow Laser, a vascular laser that penetrates the skin to safely break down these dilated blood vessels.

Key benefits:

  • Reduces the appearance of red acne marks by targeting superficial blood vessels
  • Accelerates fading of PIE that may otherwise persist for months
  • Gentle and safe for fair to medium skin tones

Early treatment of PIE can help prevent the red marks from becoming long-lasting or evolving into post-inflammatory pigmentation, especially in patients prone to persistent redness.

Acne Laser Doctor

Brown Acne Marks (Post-Inflammatory Hyperpigmentation – PIH)

PIH occurs when inflammation from acne triggers the skin’s pigment-producing cells (melanocytes) to overproduce melanin. This excess melanin is deposited in the skin during the healing phase, leading to lingering brown, grey, or dark spots.

PIH is more common in medium to darker skin tones and can be stubborn, often lasting for many months without treatment.

We treat PIH with a combination of pigment-lightening topical creams and pigment-specific laser treatments such as the Pico Laser.

Key benefits:

  • Breaks down melanin safely with minimal risk of rebound pigmentation
  • Helps fade stubborn brown marks left behind after acne clears
  • Safe for Asian skin types with minimal downtime

For optimal results, strict sun protection and a personalised treatment plan are essential, as PIH can worsen with sun exposure or irritation.

Spectra Laser

Frequently Asked Questions (FAQ)

How Do I Choose the Best Clinic for Acne Scar and Mark Treatments in Singapore?

Choosing the right clinic is key to achieving safe, visible results. Here are a few factors to consider:

Patient results and reviews: Look for before-and-after photos and testimonials that reflect consistent, natural-looking outcomes.

Experience in acne scar management: Look for clinics led by doctors who specialise in treating different scar types — including boxcar, ice pick, rolling scars, and pigmentation issues like PIE and PIH.

Range of treatment options: A reputable clinic should offer a combination of evidence-based treatments such as CO2 laser, subcision, and collagen-stimulating injectables.

Personalised consultation: Each patient’s skin and scar pattern is different. The best clinics take time to assess your skin thoroughly and design a customised plan.

Doctor-led care: Ensure treatments are performed or supervised by qualified medical doctors, not technicians.

Ready to Start Your Acne Scar Treatment Journey?

Acne scars and marks can be effectively treated with the right combination of medical expertise and evidence-based therapies. At our clinic, all treatment plans are tailored to your unique skin condition, scar type, and goals — with doctor-led care at every step.

📍 Whether you’re struggling with deep acne scars, persistent red marks (PIE), or stubborn pigmentation (PIH), we’re here to help.

Book a consultation to get started with a personalised assessment.

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