Abstract

Objectives: To evaluate the safety and efficacy of layered combination therapies for acne scarring in Asian skin, focusing on protocols designed to minimize PIH and optimize structural remodeling. Introduction: Acne scarring remains a common aesthetic concern in Asian patients, who present unique challenges due to higher melanin density and increased risk of post-inflammatory hyperpigmentation (PIH). Conventional monotherapies often yield suboptimal results or carry a high risk of adverse pigmentary changes. A multilayered and multimodal approach may provide a safer, more effective solution by addressing different scar components while minimizing side effects. Materials / method: A total of 20 patients with acne scars underwent combination therapy across multiple layers: (1) Non-insulated gold-plated RF microneedling with fractional pulse mode (FPM) for dermal neocollagenesis; (2) Subcision with a blunt cannula to release fibrotic bands; (3) Hybrid cooperative complex of HA injected mid-dermally to enhance hydration and elasticity; (4) Biostimulators (CaHA, PDO microspheres) in deeper layers for collagen induction and volumization. Sessions were performed every 4–6 weeks; efficacy assessed by GAIS, scar grading scales, and 3D photography. Results: This multimodal, multilayered approach demonstrated marked improvement in scar depth, texture, and overall dermal quality. Subcision effectively corrected tethered scars, while RF microneedling and HA improved remodeling and skin smoothness with minimal downtime. Biostimulators enhanced durability of results, providing natural contour improvement. Incidence of PIH was significantly lower compared to single-modality treatments. Patients reported high satisfaction with both natural outcomes and long-lasting improvements. Conclusion: A combination of subcision, fractional RF microneedling, hybrid HA, and biostimulators in a layered framework represents a safe and effective treatment paradigm for acne scarring in Asian patients. By addressing scars across multiple planes, this protocol achieves synergistic remodeling, natural facial contouring, and long-lasting results, while minimizing pigmentary risks common in darker skin types.