Guide · S3 Resurfacing vs RF microneedling
S3 Resurfacing vs RF microneedling matching the treatment to your acne scars
Fractional CO2 laser and RF microneedling are the two energy treatments most often compared for acne scars. Here is how Dr Sin Yong's S3 Resurfacing differs from RF microneedling by scar type, pigment risk in Asian skin, downtime and number of sessions.
Quick answer
- S3 Resurfacing is Dr Sin Yong's multi-depth fractional CO2 laser protocol for acne scars, and it usually suits scars with defined edges or depth, such as icepick, boxcar and deep rolling scars. RF microneedling suits shallow rolling scars, pores and general texture, and is often the first choice for skin that darkens easily.
- In a randomised split-face trial, one session of fractional CO2 laser and one session of RF microneedling improved acne scar texture by about the same amount at three months; CO2 caused more redness and skin disruption, while RF microneedling was rated more painful.
- The main trade-off in Asian skin is pigment. Ablative CO2 carries a higher risk of post-inflammatory hyperpigmentation (PIH) and about a week of crusting, while RF microneedling spares more of the surface and usually means one to three days of redness. Settings, skin preparation and sun protection lower the risk with either.
- Most faces have more than one scar type, so the two are often combined, sometimes with subcision. Both are medical treatments performed by Dr Sin Yong at IN Eternity Clinic, Pacific Plaza (Orchard MRT), priced at consultation.
Scar types
Start with the scar, not the machine
Depressed acne scars are usually grouped into three types. Icepick scars are narrow and deep, like large pores. Boxcar scars are wider with sharp edges and a flat floor. Rolling scars are broad, soft dips that look like shadows in side lighting, often tied down by fibrous bands under the skin.
Each type responds to different treatment. Lasers and RF act on the dermis and surface, but a tethered rolling scar will not lift until its bands are released, which is what subcision does. Icepick scars are often too deep and narrow for energy devices alone.
That is why Dr Sin Yong maps each face by scar type and depth before choosing. As his comparison puts it, the scar map decides the plan, not the device.
Side by side
S3 Resurfacing vs RF microneedling at a glance
| S3 Resurfacing (fractional CO2) | RF microneedling | |
|---|---|---|
| Energy | Ablative fractional CO2 laser, 10,600 nm, on the DEKA Tetra Pro | Radiofrequency released through fine needles, often insulated |
| What it does | Vaporises micro-columns of scarred skin and heats around them to rebuild collagen | Heats the dermis at a set depth while sparing most of the surface |
| Usually suits | Icepick, boxcar and deep rolling scars; scars that plateaued after other treatment | Shallow rolling scars, pores, texture; skin that pigments easily |
| Depth control | Depth and density set separately, scar by scar | Needle depth adjustable, about 0.5 to 3.5 mm on Secret RF |
| Typical downtime | About 5 to 7 days of swelling and fine crusts; pinkness for weeks | Redness and mild swelling for one to three days; faint grid marks |
| PIH risk in Asian skin | Higher; managed with cautious settings and sun avoidance | Lower, though not zero |
| Pain | Hot and tight afterwards, like strong sunburn | Often rated more painful during treatment |
| At IN Eternity Clinic | S3 Resurfacing, priced at consultation | RF microneedling, priced at consultation |
S3 Resurfacing
How S3 Resurfacing works: three phases, many depths
CO2 laser light at 10,600 nm is absorbed by water in the skin. Each microbeam vaporises a narrow column of tissue and leaves a thin heated zone around it, while bridges of untreated skin between the columns speed healing. The injury triggers new collagen and remodelling that continue for months.
S3 does not treat the face in one even pass. It works in three phases within a session: precise point-shots placed into individual scar pits to soften their edges and floors; a fractional pass across the scarred zones at depths and densities set by the scar map; and a third pass for further collagen stimulation with tightening across the treated area. Because the Tetra Pro sets depth and density separately, a deep boxcar scar and the normal skin beside it can receive different settings.
S3 is also step two of Dr Sin Yong's 4D Scar Reconstruction, after subcision has released tethered scars.
RF microneedling
How RF microneedling works
A grid of very fine needles enters the skin to a set depth, and a short burst of radiofrequency passes through the tissue around the tips. The tissue heats, creating small zones of controlled injury in the dermis surrounded by untouched skin, and collagen is remodelled over the following months.
With insulated needles, such as the bipolar 2 MHz Secret RF system Dr Sin Yong uses, the needle shaft is coated so heat is released mainly at the tip, below the surface. That is why RF microneedling is often chosen for medium to darker skin. In a Thai study of 26 patients with skin types III to V who completed three monthly sessions, the largest group to report 26 to 50 percent improvement at six months, with transient pigment change and no new scarring.
By scar type
Which suits which scar
These are general patterns. Scar age, skin type, acne control and how much downtime you can take all change the plan, which is set after examination under different lighting.
| Scar type | What it looks like | Usual first choice | Notes |
|---|---|---|---|
| Icepick | Narrow, deep pits like large pores | S3 point-shots; often with a focused chemical method such as TCA CROSS | Too deep and narrow for RF alone |
| Boxcar, deep | Wide, sharp-edged, flat-bottomed | S3 Resurfacing | Edges soften with point-shots, then collagen stimulation and tightening |
| Boxcar, shallow | Wide but shallow | S3, FSX Laser or RF microneedling | Choice depends on skin type and downtime |
| Rolling, tethered | Broad dips that do not flatten when the skin is stretched | Subcision first, then laser or RF | Energy alone rarely lifts tethered scars |
| Rolling, shallow | Soft, broad, shallow undulation | RF microneedling | Gentler option, lower pigment risk |
| Mixed scars | Several types on one face | Combined plan | The usual situation in practice |
Asian skin
PIH risk in Asian skin, and how to lower it
Post-inflammatory hyperpigmentation is the side effect people in Singapore worry about most, with reason. In a study of nine Chinese patients after one fractional CO2 treatment, PIH was seen in 55.5 percent at one month and 11.1 percent at six months. A separate study of fractional resurfacing in Asians found that energy, density and cooling settings change the PIH risk, and that adequate settings can lower it substantially.
RF microneedling releases most of its heat below the surface. A review of 35 studies in skin types III to VI found a low risk of scarring or lasting pigment change, mostly transient PIH, though many studies were of limited quality. That is why Dr Sin Yong often uses RF first on Fitzpatrick IV to V skin, while CO2 remains an option with tested settings.
- Control active acne first; ask about recent isotretinoin, as timing is reviewed individually.
- Do not treat while tanned or sunburnt.
- Expect conservative settings at the first session and sometimes a test area.
- Pause exfoliating acids, scrubs and retinoids for about a week before, as advised.
- Use broad-spectrum sunscreen daily and seek shade; Singapore's UV is high all year.
- Report any darkening early, so the plan and skincare can be adjusted.
Downtime and sessions
Downtime, sessions and spacing
No number of sessions is promised in advance; the scar map and how your skin responds decide it. Collagen remodelling continues for months after each session, so progress is judged over time, not in the mirror the next week.
| S3 Resurfacing | RF microneedling | |
|---|---|---|
| Numbing | Numbing cream for 45 to 60 minutes | Numbing cream beforehand |
| First days | Hot, tight skin; swelling peaks over about three days | Redness, warmth and mild swelling |
| Social downtime | About 5 to 7 days until fine crusts flake | Usually one to three days |
| Afterwards | Pinkness fading over weeks; strict sun protection | Make-up usually after the first day |
| Course | Planned individually; spaced weeks apart once the skin has settled | Often a series spaced weeks apart |
Evidence
What the research says, honestly
The only direct randomised comparison found that one session of fractional CO2 and one session of RF microneedling gave the same median one-point improvement in scar texture at three months in 15 patients. CO2 caused more redness and skin disruption in the first days, and RF microneedling was rated more painful. It was small and short, but it suggests the choice is more about scar type, skin and recovery than about one device being stronger.
A 2026 network meta-analysis of 56 randomised trials found that combination treatments generally did better than single ones for moderate-to-severe atrophic scars, with fractional CO2 plus subcision among the most consistently beneficial. Most trials were small split-face studies, and individual results vary.
Where to go
Acne scar treatment in our network
Both treatments are medical. Dr Sin Yong performs S3 Resurfacing on the DEKA Tetra Pro and RF microneedling at IN Eternity Clinic, 9 Scotts Road, #12-01 Pacific Plaza, beside Orchard MRT, and decides which suits each area after mapping your scars. Both are priced at consultation by the clinic; WhatsApp +65 8815 3008.
SkinRev Lab, at CityLink Mall #B1-28 by City Hall MRT, is a non-invasive centre. SKINTIGHT can soften surface texture with less recovery, and HydraFacial can help keep acne-prone skin clear, but neither reaches scar collagen in the dermis, so depressed scars still need a medical treatment. Active acne should be treated first.
Sources
References & sources
- Jacob CI, Dover JS, Kaminer MS. Acne scarring: a classification system and review of treatment options. J Am Acad Dermatol. 2001;45(1):109-117.
- Hendel K, Karmisholt K, Hedelund L, Haedersdal M. Fractional CO2-laser versus microneedle radiofrequency for acne scars: a randomized, single treatment, split-face trial. Lasers Surg Med. 2023;55(4):335-343.
- Chan NP, Ho SG, Yeung CK, Shek SY, Chan HH. Fractional ablative carbon dioxide laser resurfacing for skin rejuvenation and acne scars in Asians. Lasers Surg Med. 2010;42(9):615-623.
- Chan HH, Manstein D, Yu CS, et al. The prevalence and risk factors of post-inflammatory hyperpigmentation after fractional resurfacing in Asians. Lasers Surg Med. 2007;39(5):381-385.
- Vejjabhinanta V, Wanitphakdeedecha R, Limtanyakul P, Manuskiatti W. The efficacy in treatment of facial atrophic acne scars in Asians with a fractional radiofrequency microneedle system. J Eur Acad Dermatol Venereol. 2014;28(9):1219-1225.
- Syder NC, Chen A, Elbuluk N. Radiofrequency and radiofrequency microneedling in skin of color: a review of usage, safety, and efficacy. Dermatol Surg. 2023;49(5):489-493.
- Ou Y, An G, Liang J, et al. Laser, microneedling, and combination therapies for moderate to severe acne atrophic scars: a systematic review and network meta-analysis. Aesthetic Plast Surg. 2026;50(17):7308-7334.
Common questions
Your questions,
answered
Is CO2 laser or RF microneedling better for acne scars?
Neither is better for every scar. Fractional CO2, such as S3 Resurfacing, usually suits icepick, boxcar and deep rolling scars. RF microneedling suits shallow rolling scars and texture and carries a lower pigment risk. In a randomised split-face trial, one session of each improved scar texture by about the same amount.
Which is safer for Asian skin, CO2 laser or RF microneedling?
RF microneedling generally carries a lower risk of post-inflammatory hyperpigmentation because it spares more of the surface. Fractional CO2 can still be used safely in Asian skin with cautious settings, skin preparation and strict sun protection, but darkening after treatment is more common.
What is S3 Resurfacing?
S3 Resurfacing is Dr Sin Yong's acne scar protocol on the DEKA Tetra Pro fractional CO2 laser. It works in three phases, point-shots into individual scar pits, a fractional pass over scarred zones, and a third pass for further collagen stimulation with tightening, with depth and density set scar by scar.
How long is the downtime for fractional CO2 laser for acne scars?
Usually about five to seven days of swelling and fine crusts, with pinkness that fades over weeks. RF microneedling usually means one to three days of redness and mild swelling.
How many sessions do I need for acne scars?
It depends on the scar types, their depth and how your skin responds. A course is planned at consultation with sessions spaced weeks apart, and no fixed number is promised. Collagen keeps remodelling for months after each session.
Can I combine CO2 laser and RF microneedling?
Yes. Most faces have mixed scars, so different areas may get different treatments, and some plans alternate the two. Tethered rolling scars often need subcision first. Combination treatments generally performed better than single ones in a large network meta-analysis.
Does RF microneedling work for icepick scars?
Usually not on its own. Icepick scars are narrow and deep, so they tend to respond better to targeted CO2 point-shots or a focused chemical method such as TCA CROSS, often as part of a combined plan.
How much does acne scar treatment cost in Singapore?
It depends on the scar types, the area and the number of sessions. At IN Eternity Clinic, S3 Resurfacing and RF microneedling are priced at consultation after Dr Sin Yong has mapped the scars. When comparing, ask about the whole course.