Why more than one step may be planned
A depressed acne scar is rarely a single problem. Its base may be tied down, the tissue beneath may be thin, the walls may be steep and the surface may be rough.
No one device reaches all four. So Dr Sin Yong grades each scar first, and the plan follows that grading.
What are the four dimensions of 4D Scar Reconstruction?
| Dimension | The problem | Tool considered |
|---|---|---|
| Tethering | Fibrous bands pull down the base of rolling and tethered scars | Subcision, applied across a zone |
| Volume | Tissue has been lost beneath the scar | Calcium hydroxylapatite (CaHA) filler in the released space |
| Depth | Narrow tracts and individual pits | TCA CROSS for ice-pick tracts, point-shot CO2 for single pits |
| Texture | An uneven surface | Fractional CO2 at 10,600 nm, given as the S3 Resurfacing Lift |
Grading comes before treatment
| What is found | Likely first step |
|---|---|
| Rolling or tethered scars | Release by subcision |
| Ice-pick tracts | TCA CROSS |
| Individual pits | Point-shot CO2 |
| Chickenpox pits with a tethered base | Release, then assessment for the other steps |
| Flat red or brown marks | Redness or pigment care, not this plan |
| Raised, itchy or growing scars | Keloid treatment, not this plan |
Why the order matters
The tools, in plain words
A fine instrument separates the bands under the skin. Most people feel pressure. Read more about rolling scars.
Placed where a released scar lacks support. See calcium hydroxylapatite filler for how this product behaves.
High-strength trichloroacetic acid is placed into each ice-pick tract. It feels like a brief sting.
The DEKA SmartXide Tetra Pro treats narrow columns and leaves untreated skin between them. Settings are calibrated for Fitzpatrick III to V skin. It feels like heat.
A 785 nm picosecond laser is used for pigment. This is kept separate from resurfacing.
FSX Laser may be considered at review if some superficial texture remains.
Who it may suit
This plan is built for depressed acne scars of mixed type, such as rolling, tethered, boxcar and ice-pick scars together. It is most relevant when one treatment has stopped helping. Chickenpox pits with a tethered base may also fit. Depressed scars from surgery or injury are looked at case by case. Dr Sin Yong performs every step himself. Two scars side by side can need different steps, so the plan is set scar by scar and not for the face as a whole. A step is only used if a scar needs it. That is also why this page gives no fixed recipe. It helps to bring records of earlier scar treatment, because a plateau on one method tells the doctor something useful.
Who should wait, or take another route
Active acne, a recent course of oral acne medicine, infection or a cold sore in the area, a fresh tan, pregnancy or breastfeeding.
A tendency to keloids, blood thinners or a bleeding disorder, and allergy to any planned product.
Flat red or brown marks need redness or pigment care. Raised, itchy or growing scars need keloid treatment.
Isolated scars too deep or wide for these methods, scars where width or position is the issue, and any uncertain diagnosis.
What it cannot do
It cannot erase a scar. The realistic aim is a flatter, less visible scar, measured on the Goodman and Baron grading scale. It is not a replacement for a single laser in every case, and it is not a burn or trauma service. It does not treat raised scars, flat marks alone or active acne. Surgical revision is outside this plan and is referred out. No fixed outcome can be promised, because response depends on scar type, depth and tethering. Response can differ from scar to scar. If a scar will not respond to these methods, you should hear that at assessment and not after treatment.
Risks and side effects
Redness, swelling and pinpoint scabbing after resurfacing. Bruising and tenderness after subcision. A small crust on each scar after TCA CROSS. Swelling or bruising at injection sites.
Prolonged redness, pigment change, infection, a cold sore flare, lumps from injected product, or a weaker response than hoped. Pigment change is more likely in darker skin and with sun exposure.
Worsening or lasting pain, spreading redness, warmth or pus, blisters, slow healing, a firm lump or marked swelling. Skin turning white or dusky after an injectable needs urgent assessment by your injector or A&E now. See complication care.
Sessions and recovery
No session count is promised. The course is planned for you and reviewed stage by stage. Procedures use local or topical anaesthesia. After resurfacing, expect redness and oozing, then fine scabbing and peeling, then pinkness that fades as the skin remodels. Avoid heat, heavy exercise and pressing on released areas. Use only the products provided, and protect your skin from the sun throughout. Restart retinoids and acids only when told. Downtime varies with depth and with your skin, so it is discussed at consultation. See CO2 laser aftercare for more. Please plan work and social events around the recovery you discuss with the doctor, since each stage heals differently.
How the fee is set
Fees are not published. The fee depends on the area and number of zones, which steps your scars need, how much filler is used, the staging and any later refinement. You receive a written quote after assessment, before any treatment is decided. See acne scar cost factors and how we quote. Before booking, declare your medicines, including oral acne medicine and blood thinners. Also mention pregnancy or breastfeeding, cold sores and keloids, and avoid sun and tanning.