Medically reviewed by Dr Sin Yong · Last reviewed · 7 min read · Jump to questions
Dr Sin Yong · MBBS (NUS) · MRCS (Edin) · MSc Aesthetic Medicine with Distinction (Queen Mary, London) · MSc Practical Dermatology (Cardiff) · International KOL
Scar reconstruction is the treatment of scars by their structure rather than their surface: tethered rolling scars are released by subcision before resurfacing, icepick tracts are treated with TCA CROSS, boxcar scars are rebuilt with fractional CO2 laser, and keloids follow a separate intralesional pathway. Each scar is mapped by type before a sequence is planned.
Most disappointing scar treatments share one mistake: they treat the surface of a scar that is anchored underneath. A rolling acne scar is a normal-looking skin surface tethered down by fibrous bands. A boxcar scar is a punched-out defect with sharp walls. An icepick scar is a deep, narrow tract. A keloid is the opposite problem entirely — scar tissue that has overgrown its boundary. Each of these is a different structure, and each responds to a different tool. Reconstruction begins by naming the structure.
“You can resurface a tethered scar indefinitely. The tether keeps pulling it down.”
— Dr Sin Yong
Fractional lasers rebuild surface texture superbly — but a laser cannot cut a fibrous band. If a scar is tethered, the band re-anchors the surface after every resurfacing pass. That is why tethered rolling scars are released first by subcision, a needle-based technique described in the dermatologic literature since the 1990s, which frees the scar floor so it can rise. Only then does resurfacing have something worth polishing.
Subcision releases tethered and rolling scars from below. TCA CROSS places high-strength trichloroacetic acid precisely into icepick tracts to collapse and rebuild them. Fractional CO2 laser rebuilds walls and surface texture on boxcar scarring. Injectables and biostimulators support atrophic floors. Intralesional therapy flattens keloids and hypertrophic scars — a different pathway for a different disease. Most reconstructed scars need a planned sequence of several of these, in the right order, spaced for healing.
This structural approach is covered in depth on the 4D Scar Reconstruction page, with acne-specific planning under acne scar treatment and scar-type identification in the acne scar types guide.
Every scar consultation here starts by mapping each scar's type under directed lighting and stretch testing — because a single cheek commonly carries rolling, boxcar and icepick scarring together, and a plan that treats them identically wastes both sessions and skin. The sequence, the tools and the realistic scope of improvement are explained before anything is booked. Scars are reduced and remodelled; medicine does not erase them, and you deserve that honesty at the start.
Scar reconstruction in Singapore at Dr Sin Yong's practice is planned by scar structure: tethered and rolling scars are released by subcision before resurfacing, icepick tracts are treated with TCA CROSS, boxcar scarring is rebuilt with fractional CO2 laser, and keloids follow their own intralesional pathway. This information is educational and is not a substitute for a medical consultation.
Medically reviewed by Dr Sin Yong, MBBS (NUS), MRCS (Edinburgh) · Last updated 7 October 2026 · Editorial policy
It is the wrong tool for anyone hoping a scar can be removed completely, or for a raised keloid expected to respond to the methods used for depressed acne scars.
Expected effects depend on the step used: bruising and swelling around subcised scars, small crusts on points treated with TCA CROSS, and redness and flaking after fractional laser, all of which settle as the skin heals. Less common complications include post-inflammatory pigmentation, prolonged redness, infection, uneven healing, and a scar that looks different from the intended outcome or becomes raised, particularly in people prone to keloid. Combining steps carefully and staging them reduces these risks but cannot remove them. The risks of each step are explained before you agree, and a physician is available to manage any complication.
The fee for scar reconstruction depends on the number, type and area of scars treated, because rolling, boxcar, icepick and keloid scars each follow a different method. It also depends on the number of steps in the plan, such as subcision, TCA CROSS or fractional laser, the device and consumables used, and whether they are staged over time or combined. A written quote is given at consultation after the scars have been mapped, and the consultation decides whether treatment is advised at all.
How quotes work at this practice: how we quote.
A laser rebuilds surface texture but cannot cut a fibrous band, so tethered scars are released by subcision first.
A keloid is scar tissue that has overgrown its boundary, so it follows a separate intralesional pathway rather than methods built for depressed scars.
A fractional laser rebuilds surface texture but cannot cut a fibrous band. If a scar is tethered, the band re-anchors the surface after every resurfacing pass. Tethered rolling scars are therefore released first by subcision, a needle-based technique, so resurfacing has something to work on.
TCA CROSS places high-strength trichloroacetic acid precisely into icepick tracts, the deep, narrow scars, to collapse and rebuild them. Boxcar scarring with sharp walls follows a different route, using fractional CO2 laser, so each scar type is matched to its own tool.
No. A keloid is scar tissue that has overgrown its boundary, the opposite problem to a depressed acne scar. Keloids and hypertrophic scars follow a separate intralesional pathway rather than the subcision, resurfacing and rebuilding used for atrophic scars.
No. Scars are reduced and remodelled; medicine does not erase them. The sequence, the tools and the realistic scope of improvement are explained before anything is booked, so expectations are set honestly at the start.
Each scar is mapped by type under directed lighting, with stretch testing, before any plan is made. A single cheek commonly carries rolling, boxcar and icepick scarring together, so a plan that treats them identically would not match the structures involved.
The cost follows the plan rather than a fixed list. It depends on the number, type and area of scars, which steps are needed, such as subcision, TCA CROSS or fractional laser, the device and consumables used, and whether the steps are staged or combined. A written quote is given at consultation after the scars are mapped, and the consultation decides whether treatment is advised.
It is worth considering when scars are structural, such as rolling, boxcar or icepick scars, and you want them reduced and remodelled with realistic expectations. It is not a way to erase a scar, and a plan that treats every scar the same does not match the structures involved. Raised keloids follow a separate pathway. Assessment decides whether it suits you.
No duration is promised. Scars are reduced and remodelled over time, and the change holds differently depending on the scar type, the steps used, how your skin heals, sun exposure and whether new acne or injury occurs. Review timing, and whether any further step is advised, is set at consultation and adjusted after each stage rather than fixed in advance.
It is a staged process, and the change is gradual rather than immediate. Each step has its own recovery: bruising after subcision, crusts after TCA CROSS, redness and flaking after laser. Pigmentation, uneven healing and infection are less common risks. It reduces and remodels scars rather than erasing them, and some scars need a different pathway.
Every scar is mapped by structure before any treatment is proposed — rolling, boxcar, icepick, tethered or keloid.
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WhatsApp Dr Sin YongThe full structural protocol — subcision, TCA CROSS, fractional laser and injectables in sequence.
Acne-specific scar planning with the Tetra Pro CO2 platform.
When scar tissue overgrows — a different disease with different treatment.
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