Key facts
- Stage 0
- Control active acne and classify every scar by type, depth and tethering, including the stretch test
- Stage 1
- Subcision: release the fibrous bands holding rolling and tethered boxcar scars down
- Stage 2
- S3 Resurfacing Lift on fractional CO2: point-shot ablation into pits, then fractional passes over surrounding skin; TCA CROSS for ice-pick tracts
- Stage 3
- Polynucleotides placed focally into the scar bed to support remodelling between and after energy stages
- Maintenance
- Sun protection, review, and finer surface refinement such as the FSX Laser where residual texture remains
- Spacing
- Set by review of how the skin has healed, not by a fixed interval
What is the sequence, and why is it in that order?
The sequence is release, resurface, support, maintain, and it is in that order because each stage changes what the next one finds. It is the pathway behind 4D Scar Reconstruction, which addresses tethering, depth, surface texture and volume together rather than one at a time. Subcision comes first because resurfacing remodels skin in whatever position it finds it: laser a scar that is still held down by a fibrous band and the band keeps pulling it down afterwards. The S3 Resurfacing Lift follows once released scars have settled, so that the laser works on a floor that can rise. Polynucleotides are placed into the scar bed between and after the energy stages, when there is remodelling to support. Maintenance refines what remains and protects the result from new pigment.
Before any of this, active acne is brought under control and every scar is classified, because a programme run over skin that is still breaking out treats a moving target, and because the scar type decides which stages apply. The acne scar treatment page explains the three depressed scar types and why no single device treats all of them.
What does subcision do, and who skips it?
Subcision divides the fibrous bands that tether a scar to the tissue beneath it, so the scar floor is free to rise. Under local anaesthetic a needle or blunt cannula is passed beneath the scar in the subcutaneous plane and the band is released, with the skin surface left intact. Within the programme it is performed across a zone rather than scar by scar, and where a volume deficit sits beneath a released scar a collagen-stimulating filler may be placed into the released space at the same stage. The subcision page sets out how it is performed and what recovery involves.
The decision point is the stretch test. A finger on either side of the scar pulls the skin gently apart: a scar that flattens completely is a surface problem and does not need releasing; one that stays pinned is tethered and does. People whose scars are all ice-pick, all shallow boxcar with fixed walls, or all surface marks skip this stage and begin at the next. Bruising and swelling over the released zone are expected, and the next stage waits until the review shows they have settled.
“You can resurface a tethered scar indefinitely — the tether keeps pulling it down. Release comes first.”
Dr Sin YongOn why subcision comes before resurfacing
What does the S3 Resurfacing Lift do, and when does TCA CROSS join it?
The S3 Resurfacing Lift is Dr Sin Yong's fractional CO2 protocol on the DEKA SmartXide Tetra Pro. Rather than a uniform pass, precision point-shot ablations are placed into individual scar pits first, treating their walls and floor at depth, and fractional passes are then applied across the surrounding skin so that the whole surface remodels together. Density and depth are set for the person's skin type, because post-inflammatory pigmentation in Fitzpatrick III to V skin is the constraint the protocol is built around. The S3 Resurfacing Lift page describes the platform and what the healing phase involves.
TCA CROSS joins this stage for ice-pick scars: a high-strength trichloroacetic acid placed into the base of each narrow tract with a fine applicator, prompting the tract to rebuild from within, because a laser pass cannot reach the floor of a pit that is deeper than it is wide. Isolated scars that need punch techniques are referred to an appropriate surgical specialist rather than lasered repeatedly. The decision points here are skin type, how the released zone has healed, and whether isotretinoin is current or recent, which changes the timing of resurfacing and is weighed individually.
The Scar Repair Programme stage by stage| Stage | What it does | Decision point | Who skips it |
|---|
| Control and classify | Settles active acne; sorts scars by type, depth and tethering | Is acne controlled? Is isotretinoin current or recent? | No one |
| Subcision | Releases fibrous bands under rolling and tethered boxcar scars | Stretch test: does the scar stay pinned when the skin is pulled? | People whose scars flatten fully on stretching, or are all ice-pick |
| S3 Resurfacing Lift with TCA CROSS | Point-shot ablation into pits, fractional passes over skin; acid into ice-pick tracts | Skin type and pigment risk; has the released zone healed? | People with surface marks only, or who cannot accept the healing phase |
| Polynucleotides | Supports the healing bed between and after energy stages | Is there remodelling under way to support? | People seeking it as a stand-alone fix for structural scars |
| Maintenance | Sun protection, review, finer refinement with the FSX Laser | Is residual texture surface-level now? | No one; the length varies |
Where do polynucleotides fit, and what does maintenance mean?
Polynucleotides are placed focally into and around depressed scars after subcision and between resurfacing visits, to support fibroblast activity in the scar bed while remodelling is under way. The scar-grade preparation used here is described on the Rejuran S page. They are an adjunct rather than a stage that can stand alone: they do not release a band or rebuild a wall, so a person who wants polynucleotides without the structural stages is told plainly what they will and will not do. People with soft, shallow dips that were never tethered may have polynucleotides with energy treatment and skip subcision entirely.
Maintenance is the stage with no end date. It includes daily sun protection, since pigment is the commonest reason a resurfaced face looks worse rather than better, review of residual scars, and finer surface refinement where texture remains after the structural stages, for which Dr Sin Yong moves to the FSX Laser.
How are the stages spaced, and who should wait?
The stages are spaced by review. After each one the skin is examined for healing, pigment change and how the scars now sit, and the next stage is scheduled from that examination rather than from a fixed interval, which is why no number of visits or timetable is given at the start. The acne scar type checker is a useful first step for understanding which stages are likely to apply before a consultation.
The programme waits for active acne to be controlled, for recent isotretinoin to be discussed and timed, and for any infection, cold sore or inflamed skin in the area to settle. It is approached differently in people with a keloid tendency, since raised scars are managed on different principles. Risks are stage-specific: bruising and lumps after subcision, redness, crusting and pigment change after resurfacing, and swelling after injections; the complication care page explains what to do if something feels wrong. Singapore's rules prevent prices from being advertised, and the fee follows the stages the examination indicates, the area involved and how the plan is staged, quoted in writing after the consultation as the fee page explains.
