Don't Lose Hope on Treating Your Melasma

frustrated patient with melasma seeking treatment Singapore. 
Many patients feel discouraged after years of unsuccessful treatments, but melasma can often be managed more effectively with the right diagnosis, treatment plan and guidance.

Before you give up on treating your melasma, I want you to know something.

You're not the only one who feels this way.

Just to give you an idea, some of the most emotional consultations I have are with patients who have been struggling with melasma for years.

Not weeks.
Not months.
But years.

Many of them sit down and tell me a very similar story.

"Doctor, I think I've tried everything already."

And I can understand why they feel exhausted.

When Melasma Starts Affecting More Than Just Your Skin

Melasma typically appears as patchy brown pigmentation on both sides of the face [1].

It often affects the:

What I often point out to patients is that melasma tends to appear symmetrically on the face. The patches can sometimes resemble the irregular borders of a map spanning across the skin.

Melasma is especially common among women above 40 years old [2] and individuals with darker skin types [3], including many Asian patients. While melasma itself typically does not pose physical health issues, its psychological impact is often much more significant than people realise [4]. Patients tell me things like:

"I feel like people only notice the pigmentation when they look at me."

"No matter how much makeup I use to cover it, I still see it."

"I don't feel as confident as I used to be."

Over time, that emotional burden can become just as frustrating as the pigmentation itself.

"I've Already Tried Everything"

This is probably the sentence I hear again and again. Many patients have already spent a substantial amount of time, money and effort trying to get rid of their melasma pigmentation.

They may have tried:

And yet, the melasma still seems to be there. After enough disappointments, it becomes easy to conclude:

"Maybe it is just me, nothing actually works."

But in many cases, that's not what's happening.

Why Some Patients Struggle to See Results

reasons why melasma treatment may not be working Singapore.
Lack of improvement does not always mean melasma is untreatable. Sometimes the diagnosis or treatment approach simply needs to be reassessed.

One of the biggest misconceptions about melasma is that poor results automatically mean the condition is untreatable.

Very often, the issue lies elsewhere.

Sometimes the pigmentation isn't actually melasma. Other times, the diagnosis is correct, but the treatment strategy isn't well-suited to the patient's skin.

In some cases, patients may be using products that are simply not potent enough [5] to address a medical skin condition like melasma. And occasionally, treatment may be stopped too early before meaningful improvement [6] has had a chance to occur.

This is why proper assessment and treatment planning matter so much.

Melasma Is Challenging, But It Is Not Hopeless

I won't pretend that melasma is the easiest pigmentation condition to treat.

It isn't.

Melasma is influenced by multiple factors, including:

Because of this, treatment often requires a combination of approaches rather than a single miracle solution.

But challenging does not mean impossible.

Over the years, I've seen many patients achieve significant improvement after finding the right treatment plan and sticking with it consistently.

Often, what they needed wasn't a completely new treatment. They simply needed the right diagnosis, the right treatment approach and the right guidance.

A Different Way to Think About Melasma

Sometimes patients view treatment as either a complete success or a complete failure. But melasma doesn't always work that way.

The goal isn’t necessarily to make the pigmentation disappear overnight. The goal is to:

When patients start viewing treatment as long-term management rather than a one-time cure, the journey often feels much more achievable.

What I Usually Tell Discouraged Patients

When a patient tells me they've almost given up, I usually tell them this:

"Don't judge your future results based solely on past disappointments."

Just because a previous treatment didn't work doesn't automatically mean all treatments will fail. And just because you've struggled with melasma for years, doesn't mean improvement is no longer possible. Sometimes the biggest breakthrough comes from finally understanding what your skin actually needs with the right guidance.

Final Thoughts

successful melasma treatment and improved skin confidence in Singapore.
Even long-standing melasma can often improve when treatment is guided by the correct diagnosis and a personalised management plan.

If you've been battling melasma for a long time and feel discouraged by previous treatments, don’t lose hope yet.

Melasma can certainly be challenging, but it is not a condition that patients simply have to accept and live with forever. In many cases, meaningful improvement is still possible with the right diagnosis, appropriate treatment, right guidance, and consistent maintenance.

If you're struggling with persistent melasma or facial pigmentation, seeking guidance from an experienced skincare doctor and medical team can help you better understand what's happening and identify a treatment strategy that is more suitable for your skin.

Frequently Asked Questions

Why does my melasma keep coming back after treatment?

Melasma is considered a chronic pigment condition. Even after successful treatment, triggers such as sun exposure, heat, hormones and skin inflammation can contribute to recurrence. This is why maintenance care is often important to control recurrence.

Does having melasma for many years make it harder to treat?

Long-standing melasma can sometimes be more challenging to manage, but duration alone does not determine treatment success. Many patients with years of pigmentation still can achieve noticeable improvement with an appropriate treatment plan.

Why do some treatments work for other people but not for me?

Melasma varies significantly between individuals. Factors such as skin type, pigment depth, hormonal influences, lifestyle and previous treatments can all affect how well a particular treatment works.

Can stress make melasma worse?

Stress is not considered a primary cause of melasma, but it may indirectly influence skin health and inflammatory processes that can affect skin conditions.

Is melasma permanent?

Melasma can be persistent, but it is not necessarily permanent. Many patients experience significant improvement with treatment, and with ongoing maintenance to sustain results.

How long does melasma treatment usually take?

Improvement often occurs gradually over a few weeks to a couple of months. The exact timeline depends on the severity of pigmentation, treatment method and individual response.

What is the biggest mistake patients make when treating melasma?

The biggest mistake is that patients assume it can only be treated by lasers only, as there are alternative treatment options including medical topical creams.

Should I continue treatment if previous treatments have failed?

If previous treatments have not produced the desired results, it may be worthwhile to relook into the diagnosis and treatment strategy, rather than assuming the condition is untreatable.

References

  1. Espósito, A. C. C., Cassiano, D. P., da Silva, C. N., Lima, P. B., Dias, J. A. F., Hassun, K., Bagatin, E., Miot, L. D. B., & Miot, H. A. (2022). Update on Melasma—Part I: Pathogenesis. Dermatology and Therapy, 12(9), 1967–1988. https://doi.org/10.1007/s13555-022-00779-x
  2. Fathabad, M. N., Raesi, R., Hushmandi, K., Hosseini, M., Soleimani, A., & Daneshi, S. (2024). Clinical and Epidemiological Features of Melasma in Women of Iran: A Cross-sectional Study. The Open Public Health Journal, 17(1). https://doi.org/10.2174/0118749445311116240603064645
  3. Mpofana, N., Chibi, B., Gqaleni, N., Hussein, A., Finlayson, A. J., Kgarosi, K., & Dlova, N. C. (2023). Melasma in people with darker skin types: a scoping review protocol on prevalence, treatment options for melasma and impact on quality of life. Systematic reviews, 12(1), 139. https://doi.org/10.1186/s13643-023-02300-7
  4. Platsidaki, E., Efstathiou, V., Markantoni, V., Kouris, A., Kontochristopoulos, G., Nikolaidou, E., Rigopoulos, D., Stratigos, A., & Gregoriou, S. (2023). Self-Esteem, Depression, Anxiety and Quality of Life in Patients with Melasma Living in a Sunny Mediterranean Area: Results from a Prospective Cross-Sectional Study. Dermatology and therapy, 13(5), 1127–1136. https://doi.org/10.1007/s13555-023-00915-1
  5. Shankar, K., Godse, K., Aurangabadkar, S., Lahiri, K., Mysore, V., Ganjoo, A., Vedamurty, M., Kohli, M., Sharad, J., Kadhe, G., Ahirrao, P., Narayanan, V., & Motlekar, S. A. (2014). Evidence-based treatment for melasma: expert opinion and a review. Dermatology and therapy, 4(2), 165–186. https://doi.org/10.1007/s13555-014-0064-z
  6. Shankar, K., Godse, K., Aurangabadkar, S., Lahiri, K., Mysore, V., Ganjoo, A., Vedamurty, M., Kohli, M., Sharad, J., Kadhe, G., Ahirrao, P., Narayanan, V., & Motlekar, S. A. (2014). Evidence-based treatment for melasma: expert opinion and a review. Dermatology and therapy, 4(2), 165–186. https://doi.org/10.1007/s13555-014-0064-z
  7. Melasma: Background, Pathophysiology, Etiology. (2019). EMedicine. https://emedicine.medscape.com/article/1068640-overview
  8. Liao, T., Luo, R., Deng, Y., Yang, H., & Du, Y. (2026). Targeting Melasma: Innovations in Pigment Deposition and Photoaging in Cosmetic Dermatology. Journal of cosmetic dermatology, 25(1), e70665. https://doi.org/10.1111/jocd.70665
  9. Espósito, A. C. C., Cassiano, D. P., da Silva, C. N., Lima, P. B., Dias, J. A. F., Hassun, K., Bagatin, E., Miot, L. D. B., & Miot, H. A. (2022). Update on Melasma-Part I: Pathogenesis. Dermatology and therapy, 12(9), 1967–1988. https://doi.org/10.1007/s13555-022-00779-x

Does DIY Skincare Really Work?

DIY skincare remedies have been used for centuries, but natural does not always mean safe or effective for every skin type.

There's a famous story that Queen Cleopatra supposedly bathed in goat's milk to maintain her beautiful complexion.

Whether that happened exactly as history tells it, we'll probably never know.

But what it does show is that people have been experimenting with skincare at home for thousands of years.

And thinking about it, not much has changed.

Today, instead of goat's milk, I see people trying:

At some point, it starts to feel like your kitchen has become a skincare laboratory.

And I understand the appeal.

These remedies are easily available, inexpensive and often promoted heavily on social media.

But the real question is: do they actually work?

The answer is a little more nuanced than a simple yes or no.

Why DIY Skincare Is So Popular

Part of the attraction is that many natural ingredients genuinely contain beneficial compounds, like:

So, when people say these ingredients have skin benefits, they're not completely wrong.

The problem is that there's a big difference between an ingredient having beneficial properties and it being an effective solution for a specific skin condition.

If DIY Skincare Have Worked Perfectly...

I sometimes joke with patients:

"If every fruit and vegetable have worked exactly as social media claims, beauty clinics would probably look more like fruit stalls."

But there's some truth behind the joke…

Because while certain ingredients may offer mild skincare benefits, many skin conditions involve much more complex processes underneath the surface.

Conditions such as melasma, acne, rosacea and eczema are medical conditions.

So they often require treatments that are specifically designed, tested and formulated to address those problems.

A slice of cucumber may feel refreshing… but it isn't going to replace evidence-based treatment for moderate acne or stubborn pigmentation.

The Biggest Risk Most People Don't Think About

Some DIY ingredients may irritate sensitive skin and potentially worsen existing skin concerns.

Interestingly, my biggest concern with DIY skincare isn't that it won't work. It's that sometimes it works too aggressively.

Many patients assume:

"It's natural, so it must be safe."

Unfortunately, that's not always true. Some commonly recommended DIY ingredients can actually irritate the skin [4].

To give you some ideas:

These ingredients may disrupt the skin barrier and trigger:

And once irritation develops, you can end up with a bigger problem than the one you started with.

A Scenario I See More Often Than You'd Think

A patient develops mild pigmentation.

They found an online post recommending lemon juice because it's "natural fruit acid."

They apply it repeatedly for days.

Instead of improving, the skin becomes red and irritated.

They now have pigmentation plus inflammation.

At this point, treatment often becomes more complicated than if they had simply left the skin alone.

This is why I always tell patients to be careful about blindly following skincare advice from social media.

So, is DIY Skincare Completely Useless?

Not at all! This is because some DIY ingredients may provide:

For people with healthy skin, certain DIY approaches may be reasonable when used with caution.

The keyword is reasonable.

DIY skincare should complement healthy skincare habits, not replace proper medical treatment when a genuine skin condition is present.

When Should Patients Be More Careful?

Patients with active acne, melasma or other chronic skin conditions should be cautious about experimenting with DIY skincare remedies.

If you have more problematic skin issues like,

I would generally be much more cautious about experimenting with DIY treatments.

These conditions are already prone to irritation. So, adding multiple homemade ingredients without understanding how they affect the skin can sometimes worsen the situation.

In these cases, it’s often safer to seek proper professional advice before trying random remedies.

What I Usually Tell Patients

I’ve nothing against DIY skincare. In fact, some patients enjoy it as part of their self-care routine eg putting on cucumber slices on your tired eyebags.

But it’s good to remember that: just because something is natural does not automatically make it safe.

It’s the same for viral trends. Something that goes viral online doesn’t automatically make it effective. Your skin doesn't care whether an ingredient came from a laboratory or a kitchen.

It only responds to how that ingredient interacts with your skin.

Final Thoughts

DIY skincare can sometimes support healthy skin, but more problematic skin concerns often require evidence-based treatment and professional guidance.

DIY skincare can be fun, accessible and occasionally beneficial.

However, it's important to approach it with realistic expectations and a healthy degree of caution, judgement, and personal responsibility.

If you choose to experiment with DIY remedies, educate yourself about the ingredients, pay attention to how your skin responds, stop immediately if irritation develops and see a doctor.

And if you're dealing with a more significant skin condition such as acne, melasma or persistent pigmentation, it's often better not to leave treatment to trial and error. Booking an appointment to seek advice from an experienced skincare doctor can help you avoid unnecessary setbacks and find a treatment plan that is both safe and effective.

Frequently Asked Questions

Is natural skincare always safer than medical skincare?

Not necessarily. Natural ingredients can still cause irritation, allergic reactions or skin barrier damage, particularly in people with sensitive skin.

Why does my skin react badly to DIY skincare when other people seem fine?

Everyone's skin responds differently. Factors such as skin type, allergies, existing skin conditions and the concentration of ingredients can influence how the skin reacts.

Can DIY skincare help with acne scars?

DIY remedies may improve hydration or temporarily soothe the skin, but they are generally unlikely to significantly improve established indented acne scars.

How can I tell if a skincare ingredient is backed by evidence?

Look for ingredients that have been evaluated in published clinical studies rather than relying solely on testimonials, influencer recommendations or viral social media content.

When should I stop using a DIY skincare remedy?

If you experience burning, stinging, persistent redness, swelling, itching or worsening skin problems, discontinue use and seek medical advice if symptoms persist.

Is homemade skincare suitable for sensitive skin?

Sensitive skin is often less predictable and more reactive. Homemade remedies should be approached cautiously, as even natural ingredients can trigger irritation in susceptible individuals. Recommendation is still to approach a skincare professional for guidance for your skin sensitivity.

References

  1. Surjushe, A., Vasani, R., & Saple, D. G. (2008). Aloe vera: a short review. Indian journal of dermatology, 53(4), 163–166. https://doi.org/10.4103/0019-5154.44785
  2. Yaghoobi, R., Kazerouni, A., & Kazerouni, O. (2013). Evidence for Clinical Use of Honey in Wound Healing as an Anti-bacterial, Anti-inflammatory Anti-oxidant and Anti-viral Agent: A Review. Jundishapur journal of natural pharmaceutical products, 8(3), 100–104. https://doi.org/10.17795/jjnpp-9487
  3. OyetakinWhite, P., Tribout, H., & Baron, E. (2012). Protective mechanisms of green tea polyphenols in skin. Oxidative medicine and cellular longevity, 2012, 560682. https://doi.org/10.1155/2012/560682
  4. Slomski, A. (2022). Almost All ‘Natural’ Skin Care Products Contain Contact Allergens. JAMA, 328(17), p.1677. doi:https://doi.org/10.1001/jama.2022.18440

Does Treating Melasma Have to Be Expensive?

Many patients assume melasma treatment is extremely expensive, but treatment costs can vary significantly depending on the approach used.

One legit concern I hear often during consultations has nothing to do with the pigmentation itself.

It's the cost of treatment.

Sometimes, before we even start discussing treatment, patients will ask:

"Doctor, be honest with me... am I about to spend a fortune treating this?"

I totally understand where that concern comes from.

Many people have heard stories from friends, colleagues or online about patients spending several thousands or even tens of thousands of dollars trying to treat their melasma, without much improvement.

After hearing enough of those stories, it's easy to assume that treating melasma automatically means signing up for expensive laser packages.

But the reality is often much more nuanced than that.

Not Every Melasma Patient Starts With Lasers

One of the biggest misconceptions about melasma treatment is that lasers are always the first step. In reality, many patients can begin with much simpler and more cost-effective treatments.

In fact, during consultations, I often spend more time discussing daily skincare and sun protection than lasers.

Why?

Because melasma is a chronic pigment condition influenced by multiple factors [1], including:

So, addressing these factors often forms the foundation of treatment.

A Common Starting Point for Many Patients

Medical creams and proper sun protection are often important first steps in melasma management.

For many patients, melasma treatment is actually much simpler than they expect. Instead of immediately jumping into lasers, we often start with prescription topical creams [2], a personalised skincare routine and consistent daily sun protection.

We also spend time identifying and managing triggers that may worsen pigmentation, such as excessive sun exposure, heat or skin irritation.

These approaches can be very effective when used appropriately and consistently, and are often considerably more affordable than jumping straight into device-based treatments like lasers.

Many patients are pleasantly surprised to learn that meaningful improvement can begin with these relatively straightforward measures, without the need for more intensive treatments right away. And often, patients can achieve meaningful improvement without needing lasers.

Why Do We Hear So Many Expensive Melasma Stories?

Usually, these stories involve patients who:

  • Have more severe melasma 
  • Have undergone multiple treatment attempts with different clinics 
  • Have done laser packages repeatedly  
  • Have been managing melasma for many years 

Those experiences certainly exist. But they don't necessarily represent every patient's journey.

It's a bit like hearing about someone who needed major dental work and assuming everyone with a toothache will require the same treatment.

The severity of the condition matters.

The treatment matters.

And perhaps most importantly, the approach matters.

When Lasers May Become Part of the Plan

Laser treatments may be considered when melasma is more stubborn, extensive or resistant to conservative treatment.

Now, that doesn't mean lasers never have a role. They absolutely do!

For some patients, lasers may be considered when:

Laser treatments are generally more expensive than topical therapies, which is often where many of the "horror stories" about treatment costs originate.

But even then, treatment decisions should be based on what your skin actually needs, not what social media suggests you need.

A Scenario I Often See

Imagine two patients with melasma.

The first patient notices the pigmentation relatively early and seeks treatment promptly.

The second patient waits several years, during which the pigmentation gradually darkens and becomes more established and even deep in the skin.

Even though both have melasma, their treatment journeys may look very different.

The earlier patient may respond well to topical treatment and sun protection.

The latter patient may require a more intensive treatment plan.

This is one reason why early assessment often can be beneficial.

What I Usually Tell Patients About Cost

When discussing melasma treatment, I encourage patients to think about OUTCOMES rather than price alone.

Because the most expensive treatment is not necessarily the best treatment. And the cheapest treatment may not deliver the desired results or outcomes.

The goal is to find a treatment plan that:

Often, that means starting conservatively and escalating only if necessary.

Final Thoughts

Melasma treatment can often begin with simple, evidence-based approaches before considering more intensive procedures.

Melasma treatment does not necessarily have to cost a fortune.

For many patients, management can begin with prescription creams, proper skincare and robust sun protection measures, and yet these simple and basic measures are often overlooked.

If you're concerned about the cost of treating melasma, a proper consultation can help clarify what your skin actually needs and whether more conservative options may be appropriate before considering more advanced treatments.

Frequently Asked Questions

Is melasma treatment covered by insurance?

In most cases, melasma treatment is considered a cosmetic or aesthetic concern rather than a medically necessary condition, so insurance coverage is often limited. Coverage policies can vary depending on the insurer and individual plan, so individuals should check with their respective insurers beforehand.

How many consultations are usually needed before starting treatment?

Many patients can begin treatment after an initial assessment, although few monthly follow-up visits are typically recommended to monitor progress and adjust the treatment plan when necessary.

Is it more cost-effective to treat melasma early?

In some cases, early intervention may help prevent pigmentation from becoming more established, potentially reducing the need for more intensive treatment later on.

Can I start with creams and add lasers later?

Yes, many treatment plans are adjusted over time based on how the skin responds. Some patients begin with topical therapies and only consider lasers if additional improvement is needed.

Do more expensive treatments always produce better results?

Not necessarily. Treatment success depends on factors such as diagnosis, severity, skin type, treatment suitability, consistency, and the clinical experience of the skincare doctor. A more expensive treatment does not necessarily mean it is a more effective one.

Why do treatment costs vary between patients?

Factors such as the severity of pigmentation, treatment complexity, number of sessions required and the types of treatments used can all influence overall costs.

Is maintenance treatment usually required after improvement?

Melasma is often a long-term condition. Even after improvement, maintenance measures such as sun protection and basic skincare are commonly recommended to help reduce the risk of recurrence.

Should I choose treatment based on price alone?

Cost is an important consideration, but it should be balanced with safety, suitability, long-term treatment goals and most importantly outcomes.

In essence, a personalised treatment plan with the right doctor who can achieve the objective of clearing up your melasma significantly, should be the desired approach rather than choosing based solely on the lowest price offered to you.

References

  1. Sathe NC, Launico MV. Melasma. [Updated 2026 Jan 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459271/
  2. González-Molina, V., Martí-Pineda, A., & González, N. (2022). Topical Treatments for Melasma and Their Mechanism of Action. The Journal of clinical and aesthetic dermatology, 15(5), 19–28. 
  3. Graupe, K., Verallo-Rowell, V., Verallo, V., & Zaumseil, R. P. (1996). Combined use of 20% azelaic acid cream and 0.05% tretinoin cream in the topical treatment of melasma. Journal of Dermatological Treatment, 7(4), 235–237. https://doi.org/10.3109/09546639609089556

Acne Marks or Acne Scars? Here’s How to Tell the Difference

Post-acne marks and mild textural acne scarring on the cheek, with areas of uneven skin tone and texture.

Acne marks and acne scars may look similar, but they are different skin conditions that would require different approaches.

“Doctor, are these acne scars?”

This is probably one of the most common questions I hear during consultations for acne patients.

Many patients point to the spots left behind after their pimples have healed and immediately assume they have permanent acne scars.

I totally understand why.

Once acne starts to clear, it’s natural to focus on whatever remains. Whether it’s a red mark, a brown spot or a small depression in the skin, many people simply refer to everything as an “acne scar.”

But here’s the important thing. Acne marks and acne scars are actually two different conditions.

Knowing the difference matters because they develop differently, improve differently and would require totally different treatment approaches.

I remember one patient who came into my clinic convinced she had severe acne scarring after a recent breakout.

After examining her skin, I reassured her that what she was seeing were mostly acne marks rather than true scars.

She looked relieved.

“Doctor, so these aren’t permanent?”

In her case, no.

With time and appropriate skincare, many of those marks were expected to fade gradually.

And actually, that’s reassuring news for many patients.

What Are Acne Marks?

Acne marks are areas of temporary skin discoloration that remain after a pimple has healed. Unlike scars, the surface of the skin usually remains smooth.

The change is mainly in the colour rather than the skin texture.

Acne marks may appear:

These colour changes occur because inflammation during acne temporarily affects the skin and its healing process. Fortunately, acne marks often improve gradually over time as the skin repairs itself.

For some people, this process may take several weeks, while for others it can take several months depending on age, skin tone, the severity of inflammation and sun exposure.

Acne marks are flat areas of discoloration that would gradually fade as the skin heals.

Can Acne Marks Be Treated?

One question I hear quite often is:

“Doctor, do I just have to wait?”

The answer is—not necessarily.

Although many acne marks gradually fade on their own, some patients prefer to speed up the process, particularly if the marks are numerous or affect their confidence.

Depending on the individual, treatment may include topical creams that target pigmentation or redness, as well as selected laser treatments that help improve the appearance of persistent marks.

The most important thing, however, is preventing new acne from forming. If new breakouts continue to occur, fresh marks may appear before the older ones have had time to fade.

Then What Are Acne Scars?

Acne scars are different because they involve structural changes within the skin itself. They usually develop after moderate to severe inflammatory acne damages deeper layers of the skin during healing.

Instead of leaving only a colour change, the healing process alters the skin’s texture. This is why acne scars can often be both seen and felt.

Unlike acne marks, they do not simply disappear with time.

What Do Acne Scars Look Like?

Acne scars come in different forms.

Some of the most common indented acne scars include:

At the end of the day, each scar type behaves differently, which is why treatment is usually individualised.

Acne scars involve changes in skin texture and may appear as indented or raised scars.

Why Do Acne Scars Need Different Treatments from Acne Marks?

One misconception I often hear is:

“Doctor, can I just use a cream for my scars?”

Unfortunately, creams alone usually cannot correct changes in skin texture once a scar has formed. This is because the problem lies deeper beneath the skin.

Depending on the type of acne scar, medical procedures may be recommended to improve its appearance.

For example:

The most appropriate treatment depends on the type, depth and severity of the scar rather than using the same procedure for everyone.

How Can You Tell the Difference at Home?

A simple way to tell the difference is to look at both the colour and the texture of your skin.

Acne marks are usually:

Acne scars are more likely to be:

If you are still unsure, a clinical assessment can help determine exactly what you're seeing and whether treatment is likely to be beneficial.

Final Thoughts

One thing I always remind my patients is this:

Not every spot left behind after acne is a scar.

In fact, many people who worry about permanent acne scars are actually dealing with temporary acne marks that gradually improve as the skin heals. True acne scars, however, involve changes in the skin’s structure and often require medical procedures to improve their appearance.

Understanding the difference helps you avoid unnecessary anxiety, set realistic expectations and choose the most appropriate treatment for the most optimal outcome. 

If you are unsure whether you are dealing with acne marks or acne scars, schedule a consultation with One Face Clinic for a personalised skin assessment and treatment plan.

References

  1. Goodman, G. J., & Baron, J. A. (2006). Postacne scarring: A qualitative global scarring grading system. Dermatologic Surgery.
  2. Fabbrocini, G., Annunziata, M. C., D'Arco, V., et al. (2010). Acne scars: Pathogenesis, classification and treatment. Dermatology Research and Practice.

LASERS ARE ALWAYS NEEDED TO TREAT PIGMENTATION?

Not all pigmentation requires laser treatment. In some cases, medical creams may be an appropriate first step. 

One of the commonest misconceptions I hear in the clinic is this:

"Doctor, I probably need a laser for my pigmentations, right?"

And yes, I understand why.

When you search online for pigmentation treatments in Singapore, you'll see countless advertisements for laser procedures. Before long, it starts to feel like lasers are the only solution available.

But here's something many patients are surprised to hear: not every pigmentation problem needs a laser.

In fact, some patients can achieve very good improvement with medical topical treatments alone. So, before you start researching laser packages or comparing machines you've never heard of, there's something important you should understand first.

It Depends on Where the Pigment Is Located

The depth of pigmentation often influences which treatment approaches are likely to be effective.

The skin isn't just one single layer.

It consists of different layers, but for simplicity, I usually explain it to patients using two main ones:

  • The epidermis (outer skin layer)
  • The dermis (deeper skin layer)

But why does this matter?

Because the location of the pigment often affects how we treat it.

Pigment that sits closer to the skin surface [1] may respond well to topical medical treatments. Meanwhile, pigment located deeper within the skin may require different approaches, including lasers in selected cases.

This is why understanding the diagnosis of the type of pigmentation comes first before deciding on treatment.

Some Pigmentation Conditions Can Respond Well to Medical Creams

Many superficial pigment conditions are influenced by excess melanin in the outer skin layer, such as:

Because the pigment sits relatively close to the surface, topical medical treatments can often reach the target area effectively.

This is where ingredients such as hydroquinone [2], tretinoin, azelaic acid and combination therapies [3] may play an important role.

And this is something patients are often surprised by! 

They expect me to immediately recommend a laser. Instead, I sometimes tell them:

"Let's try with creams first."

A Common Scenario I See

Laser treatment may be considered when pigmentation is deeper, more stubborn or less responsive to topical treatments.

A patient comes in with pigmentation across both cheeks.

She's already spent weeks researching laser treatments online.

She has screenshots of different laser machines saved on her phone.

She asks:

"Which laser should I choose?"

But after examining her skin, I explained that her pigmentation appears relatively superficial. Instead of recommending a laser immediately, we start with:

A few weeks later, her pigmentation became noticeably lighter, and the patient was pleasantly surprised and delighted.

No laser required.

Now, does this happen for everyone? Not always.

But it happens often enough that patients shouldn't assume lasers are automatically necessary from day one.

Why Lasers Are Sometimes Recommended

Of course, there are situations where lasers can be extremely useful, like:

In these situations, lasers may help achieve results that creams alone cannot.

The important point is that lasers should be selected because they're appropriate for the condition, not simply because they're available.

The Goal Is To Use the Right Treatment

The most effective pigmentation treatment is not always the most aggressive one. Choosing the right treatment for the particular pigmentation often leads to better and more sustainable results.

I often remind my patients that:

The goal isn't to use the most “popular or advertised” treatments, instead, it’s to use the right treatment.

Sometimes that includes lasers.
Sometimes it doesn't.

And sometimes the best results come from combining several approaches. When treatment is properly matched to the type of pigmentation, patients often achieve better outcomes with fewer unnecessary procedures.

What I Usually Tell Patients Before They Start Treatment

Before discussing lasers, I always want to answer a more important question:

"What exactly are we treating?"

Because once we understand the type of pigmentation, how deep it is, what's causing it and how your skin behaves, the treatment plan often becomes much clearer.

And usually, the first step isn't a laser at all.

Final Thoughts

The best pigmentation treatment is not always the most aggressive one. It is the one that matches your skin condition and treatment goals.  

Many patients assume pigmentation treatment automatically means lasers.

But depending on the type and depth of pigmentation, topical medical treatments may sometimes be a more appropriate first-line approach.

The key is getting the diagnosis right before deciding on treatment.

If you're considering treatment for pigmentation and aren't sure whether you need creams, lasers or a combination of both, a proper assessment at One Face Clinic can help determine the most suitable approach for your skin.

Frequently Asked Questions

If creams can work, are lasers still needed?

Lasers are still needed in selected patients, particularly when pigmentation is deeper or less responsive to topical treatments. The decision to use the most appropriate treatment depends on the diagnosis and the clinical experience of the skincare doctor.

How do doctors determine whether pigmentation is superficial or deep?

Assessment is usually based on the appearance of the pigmentation, clinical examination and, in some cases, specialised diagnostic tools. Factors such as colour, pattern and distribution can provide clues about how deeply the pigment is located.

Is it better to start with topical creams before considering lasers?

In many cases, yes. Starting with conservative treatment like topical creams may allow doctors to assess how the pigmentation responds while minimising unnecessary procedures. However, the most appropriate approach depends on the specific pigmentation being treated.

Can pigmentation recur after successful treatments?

Even when pigmentation improves significantly, ongoing triggers such as sun exposure, hormones or skin inflammation can still contribute to recurrence. Thus post-treatment maintenance care and robust sun protection measures are important to minimise recurrence, regardless of the treatment method used, be it topical creams or lasers.

Can prescription pigmentation creams be used for long-term use?

Some prescription creams are only for short-term use, while others may be suitable for longer periods under medical supervision. The treatment plan often changes over time depending on how the skin responds.

Do darker skin tones respond differently to pigmentation treatment?

Darker skin types may be more prone to certain pigmentary conditions and can sometimes react differently to treatments, be it creams or lasers. This is one reason why personalised treatment planning is important when managing pigmentation concerns for such skin types.

Can multiple types of pigmentation exist at the same time?

Yes,  patients can have more than one pigmentation condition on the same face concurrently. For example, melasma may occur together with sun spots or post-inflammatory hyperpigmentation, which can make diagnosis and treatment planning more complex. Thus it is important that the skincare doctor has the relevant clinical experience in treating such multiple pigmentations.

References

  1. Bastonini, E., Kovacs, D., & Picardo, M. (2016). Skin Pigmentation and Pigmentary Disorders: Focus on Epidermal/Dermal Cross-Talk. Annals of dermatology, 28(3), 279–289. https://doi.org/10.5021/ad.2016.28.3.279
  2. Fabian, I. M., Sinnathamby, E. S., Flanagan, C. J., Lindberg, A., Tynes, B., Kelkar, R. A., Varrassi, G., Ahmadzadeh, S., Shekoohi, S., & Kaye, A. D. (2023). Topical Hydroquinone for Hyperpigmentation: A Narrative Review. Cureus, 15(11), e48840. https://doi.org/10.7759/cureus.48840
  3. González-Molina, V., Martí-Pineda, A., & González, N. (2022). Topical Treatments for Melasma and Their Mechanism of Action. The Journal of clinical and aesthetic dermatology, 15(5), 19–28. 
  4. Gaffey MM, Johnson AB. Laser Treatment of Pigmented Lesions. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560613/

Why I Have a Love-Hate Relationship with Acne Scar Subcision

Indented acne scars can create uneven skin texture after acne heals. The most suitable treatment depends on the type, depth and severity of the scars.

Acne scar subcision releases the tight fibrous bands beneath indented scars, allowing them to level up.

“Personally, I have a love-hate relationship with acne scar subcision.”

That usually gets a laugh from my patients.

They look at me and ask,

“Doctor...how can you both love and hate the same treatment?”

And honestly, it’s a fair question.

Because despite performing subcision regularly, every time I prepare for the procedure, I know exactly what's coming.

It’s physically demanding.

It requires patience.

It takes up quite a bit of time.

And by the end of the session, my hands are usually much more tired than after many other treatments.

But despite all that...

I still genuinely enjoy performing subcision.

Because when it's done for the right patient, the improvements can be extremely satisfying, not just for me as the doctor, but even more importantly, for the patient.

Warning: The following demonstration may contain medical scenes that some viewers may find uncomfortable.

Why Are Some Acne Scars Indented?

Before understanding subcision, it helps to understand why acne scars become depressed in the first place.

Many patients assume the scar is simply “a dent.”

But underneath the skin, there’s actually much more happening.

After severe inflammation from acne heals, tough fibrous bands can develop beneath the scar.

These bands tether the skin downwards, like tiny ropes pulling the surface inward.

Even though the skin has healed, those attachments continue to hold the scar down.

Tethered acne scars occur when fibrous bands beneath the skin pull the surface downward, creating visible depressions and uneven texture.

This is why certain acne scars remain depressed for years.

And, no amount of skincare can remove these fibrous attachments because they're located much deeper beneath the surface.

What Exactly is Subcision?

Subcision releases the fibrous bands beneath depressed acne scars, allowing them to be elevated and thus improving skin texture. Treatment is tailored to the type and severity of scarring.

Subcision is a medical procedure designed to release these fibrous bands. During the procedure, a specialised needle is carefully inserted beneath the skin.

The needle is then gently moved underneath the scar to dissect through the fibrous attachments that are tethering the skin down.

Once these bands are released, the skin is no longer being pulled inward.

Over time, healing occurs in this newly released space, and collagen production may further improve the appearance of the scar [1].

Although the idea of placing a needle beneath the skin sounds intimidating, the area is first numbed with local anaesthesia to allow maximum comfort during the procedure.

Why I Love Subcision

If you have ever asked me what makes subcision so rewarding, the answer is actually very simple.

The results can be incredibly satisfying.

I remember one young gentleman who had struggled with acne scars for many years.

Whenever we discussed his concerns, he would always point to the same few deep scars on his cheeks. Those scars bothered him far more than the rest of his face. After examining him, I explained that these particular scars appeared tethered beneath the skin.

Following subcision, those scars gradually became much shallower and less obvious. When he returned for review, the first thing he said was,

“Doctor, my face finally feels smoother when I wash it. It doesn’t look like the surface of the moon anymore!”

And, gratifying comments like that make all the effort worthwhile.

Not every scar disappears 100% of course, but even 50% improvement is quite obvious already.

Seeing patients become more uplifted and confident because their scars no longer dominate their attention is one of the most rewarding parts of my work.

Why I Hate Subcision

Now comes the other side of the story.

Subcision is hard work.

Unlike treatments where a machine performs most of the work, subcision depends almost entirely on the doctor's hands.

Depending on the number of scars being treated, the procedure can also be quite time-consuming.

By the end of a session, my hands have usually done countless of repeated, controlled movements.

It’s physically tiring.

But it’s also one of those procedures where taking shortcuts simply isn't an option. Each scar deserves careful attention. That’s exactly why good subcision procedures require patience.

Is Subcision Suitable for Every Acne Scar?

Not necessarily.

Not every acne scar should be treated with subcision.

In reality, acne scars come in different forms.

Subcision tends to work best for rolling scars and other depressed scars that are tethered beneath the skin [2]. However, scars such as narrow ice-pick scars or sharply defined boxcar scars may require different treatment approaches.

This is why it is important to assess the type of scar before recommending any procedure.

The treatment should fit the scar, not the other way around.

Rolling, boxcar and ice pick scars are different types of atrophic acne scars, each with a distinct shape and depth. Identifying the scar type helps determine the most suitable treatment approach.

Does One Subcision Session Remove Acne Scars Completely?

This is another question patients commonly ask. And, it really depends.

Many patients often have different scar types on the same face. For this reason, subcision is frequently combined with other acne scar treatments as part of a personalised treatment plan.

The goal isn’t necessarily perfection.

It's about meaningful improvement that looks natural and continues to improve over time.

Final Thoughts

So yes...

I still have a love-hate relationship with acne scar subcision.

I may moan about how physically demanding it can be.

But I love the improvements it can achieve for the right patient.

One thing I always remind my patients is that successful acne scar treatment isn’t about choosing the newest or most expensive procedure. It’s about choosing the treatment that best addresses the underlying cause of the scar.

When deep scars are tethered beneath the skin, simply treating the surface may not be enough.

Often, those hidden fibrous bands need to be released first before the skin has the opportunity to heal more smoothly.

If you are bothered by indented acne scars and would like to know whether subcision is appropriate for your skin, schedule a consultation with One Face Clinic for a personalised assessment and treatment plan.

References

  1. Goodman, G. J. (2011). Management of post-acne scarring: What are the options for treatment? American Journal of Clinical Dermatology.
  2. Alam, M., Omura, N. E., Kaminer, M. S. (2005). Subcision for acne scarring: Techniques and outcomes. Dermatologic Surgery.