Three Stages · In Order · CityLink Mall
Acne, the marks it leaves and the scars it can cause are three stages of one process, and they are treated in that order. This page shows how to tell which stage you are at, what carries on through all three, and how isotretinoin affects the timing of scar work, as Dr Sin Yong plans it.
Every inflamed spot can leave something behind once it settles. Sometimes it is only colour: a red mark from dilated capillaries, or a brown or grey one from melanin. Sometimes the dermis itself has changed, leaving a dip, or a band of tissue pulling the surface down. Colour fades on its own timetable; structure does not. Scars come from deep inflammation and from picking while acne is active, not from marks left alone too long.
So the work runs in sequence, each stage making the next one easier:
Types
Two quick checks sort most marks. Press a clear glass slide or ruler on the mark: red that fades under pressure is post-inflammatory erythema (PIE), while brown or grey that stays is post-inflammatory hyperpigmentation (PIH). Then stretch the skin gently and run a fingertip across it. Flat colour cannot be felt; a scar can, and one that flattens as the skin is pulled is tethered from below.
At the consultation, Dr SY grades the acne, sorts marks with the glass, maps scars under stretch and side lighting, and asks about isotretinoin, past or present. The scar types themselves are set out on acne scar types.
The Decision
Each new inflamed spot is a potential new mark and a potential new scar, so nothing structural starts while acne is still forming. Acne is first graded as comedonal, papulopustular or nodulocystic, since the plan differs for each, and look-alikes are excluded, such as Malassezia folliculitis, which does not respond to acne treatment. Medical treatment comes first; see acne treatment. From the first day, you protect the skin from the sun, repair the barrier and stop picking.
When to wait. Resurfacing, needling and subcision are held back until no new spots are forming. Laser for red or brown marks also waits for breakouts to settle, because each new spot leaves a new mark and inflamed skin pigments more readily.
When not to wait. A plan for red or brown marks does not have to be finished before scar work begins. Acne control does.
When to refer. Acne that stays severe or unstable despite standard treatment may need referral to a dermatologist before a scar plan is made. Why the order within the scar stage matters is explained in acne scar treatment order.
At Atelier
At Atelier, the options follow the stage:
Some things run through every stage. Pigment control carries on through each resurfacing visit, because resurfacing inflames the skin and inflammation makes pigment. In Fitzpatrick III to V skin, brown marks often outlast the acne that caused them. Atelier's CO2 laser is a DEKA platform; Dr Sin Yong holds a Key Opinion Leader appointment with DEKA. Three common mistakes are brightening serums on red marks, harsh exfoliation on brown ones, and repeated surface laser on dents held down from beneath.
Timing
Isotretinoin is a prescription-only medicine used for severe or scarring acne, under a doctor's monitoring. Taking it affects when resurfacing and subcision can be done, but it does not rule scar treatment out.
Older teaching was to wait many months after the last dose before resurfacing. More recent analyses of the evidence have found too little to justify that delay for several procedures, fractional lasers among them. Fully ablative laser and mechanical dermabrasion are still not advised during treatment.
Each decision weighs the method and its depth, your skin type, how well the acne is controlled and the dose you take. Isotretinoin is never stopped or changed to suit a laser date. It must not be taken in pregnancy; see acne in pregnancy.
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