SNaFFL™ Scar Treatment (Subcision NanoFat Fractional Laser)
Acne scars affect more than just surface texture. In many patients, depressed scars persist because fibrous bands tether the skin to deeper tissue beneath the surface. These fibrous attachments pull the skin downward, creating shadows, uneven contours and visible depressions that may not fully respond to lasers, microneedling or skincare treatments alone.
Drawing from years of experience treating all types of scars (depressed, atrophic, hypertrophic to keloids) of varying severity, Dr Pearlie Tan developed and refined a treatment approach that combines structural scar release, regenerative NanoFat grafting and fractional CO2 resurfacing for depressed and tethered scars.
This combined approach is known as Subcision, NanoFat and Fractional Laser treatment (SNaFFL™). It combines scar release, regenerative fat grafting, and fractional CO2 resurfacing to address tethered scars across multiple skin layers.
The treatment is designed for patients with tethered acne scars, traumatic atrophic scars and other depressed scars where underlying fibrosis contributes to visible skin indentation.
What are tethered acne scars?
Tethered scars develop when inflammation from acne or skin injury damages deeper skin structures during healing. As scar tissue forms, fibrous bands may attach the skin to the underlying tissue.
This creates a pulling effect that causes the skin surface to remain depressed.
Tethered scarring is commonly seen in:
- Rolling acne scars
- Depressed boxcar scars
- Post-inflammatory acne scarring
- Depressed traumatic scars
- Depressed surgical scars
These scars are often structural rather than purely superficial. This means that even if skin texture improves after resurfacing treatments, the visible depression may persist if the underlying tethering remains intact.
Why do some acne and depressed scars persist despite laser treatment?
Laser resurfacing and collagen stimulation treatments primarily target the skin surface and upper dermal layers. However, when thick fibrotic scar bands continue pulling the skin downward, the structural depression may remain. This is one reason some patients notice only partial improvement despite undergoing multiple laser or skin resurfacing procedures.
For selected patients with tethered scars, releasing the fibrous attachments beneath the skin may help improve contour irregularities more comprehensively as part of a combined treatment approach.
Dr Pearlie’s scar release and regenerative
fat grafting technique (SNaFFL™)
Based on years of clinical experience treating all types of scars (acne, atrophic, depressed, traumatic, hypertrophic to keloids) of varying severity and depth, Dr Pearlie refined and developed a technique focused on both the structural and regenerative aspects of scar treatment.
The approach combines:
- Fat Harvest – Fat is harvested commonly from the lower abdomen or thighs under local anaesthesia. Patients are awake and are comfortable throughout the process.
- Mechanical release of tethered scar bands — Local anaesthesia is injected to the area of treatment. Using specialised sharp-tipped cannulas, fibrous bands anchoring the scar to deeper tissue are carefully cut and released beneath the skin. This allows the depressed scars to lift-off.
- Regenerative nanofat grafting — Using a specialised purification system, harvested fat is processed into refined nanofat and injected immediately following scar release. This technique creates a biological barrier that prevents the scar from re-tethering, while the high concentration of adipose-derived stem cells (ADSCs) works to regenerate your skin from the inside out for a significantly smoother and softer appearance.
- Fractional CO2 resurfacing (where appropriate) — Immediately after nanofat grafting, fractional CO2 resurfacing is done to aid in texture refinement and stimulate further collagen renewal. The intensity is adjusted according to severity of your scars, and some patients may require up to 60W of energy.
Because acne/depressed scars often involve multiple skin layers, treatment is customised according to scar type, fibrosis severity, skin thickness and previous treatments performed.
Structural release of fibrotic scar bands
During the procedure, specialised sharp-tipped cannulas are used beneath the skin to release fibrotic scar bands tethering the scar downward. This is essential in patients with dense fibrosis or longstanding tethered scars where thick adhesions are present.
Once these attachments are released, the skin is able to lift-off for the next step. The procedure is typically performed under local anaesthesia.
Why is NanoFat deposited after scar release?
Following the release of the tethered scar bands, processed and purified NanoFat is strategically placed in the released space beneath the scars.
This serves two intended purposes:
- Creating a soft tissue interface under the released fibrotic scar tissue to reduce the likelihood of scar re-adhesion
- Delivering adipose-derived stem cells (ADSCs) that will support collagen remodelling, for softer skin texture and a smoother appearance.
4 Pillars of Nanofat Regeneration
- Cellular Powerhouse: Nanofat is highly concentrated with adipose-derived stem cells (ADSCs) and essential growth factors that trigger deep tissue repair.
- Dermal Restoration: Unlike traditional fat grafting, nanofat focuses on biostimulation, improving skin elasticity and thickness by boosting natural collagen and elastin production.
- Vascular Support: It promotes neovascularisation, increasing blood flow to the treated area to revitalize dull skin and accelerate the healing of scarred or damaged tissue.
- Refined Texture: By working at a microscopic level, nanofat effectively smooths fine lines and softens the appearance of scars, restoring a youthful, healthy radiance to the skin’s surface.
Purification and processing of NanoFat
Dr Pearlie uses a specialized closed-circuit, sterile, cellular rinsing process that filters out non-essential components (excess oil, blood and impurities). This results in a purified ‘bio-filler’ rich in regenerative potential and free of contaminants. By avoiding harsh centrifugation or chemical additives, she ensures that only the most viable, highly concentrated regenerative elements are injected for skin rejuvenation.
In Singapore, fat harvesting for fat grafting is only performed by qualified MOH-accredited specialist Plastic Surgeons, as they have the background and training to perform these specialized procedures.
Fractional CO2 laser resurfacing after scar release
Depending on the scar severity and skin condition, fractional CO2 laser resurfacing incorporated as part of a combination treatment.
Dr Pearlie uses a high-output fractional CO2 laser platform capable of delivering up to 60W output, the same system she was using at Singapore General Hospital (SGH) and Sengkang General Hospital (SKGH). Higher energy ranges allow greater flexibility in treatment customisation across different scar depths and skin thicknesses.
Fractional resurfacing is commonly used alongside structural scar release to address:
- Surface texture irregularities
- Enlarged pores
- Uneven skin texture
- Residual superficial acne/depressed scarring
- Collagen remodelling
Because acne scarring is often multi-layered, combining structural release with resurfacing may help address both deep and superficial scar components.
Some acne scars persist because fibrous bands tether the skin downward and does not improve despite repeated treatments of laser or subcision alone Learn about scar release, NanoFat grafting and CO2 laser resurfacing.
What types of scars can the SNaFFL™ Scar Treatment address?
This treatment approach is suitable for:
- Rolling acne scars – rolling scars are commonly associated with fibrotic tethering beneath the skin.
- Depressed boxcar scars – certain depressed boxcar scars may contain scar adhesions contributing to visible indentation.
- Traumatic scars – injuries involving fibrosis beneath the skin may heal with tethered depressions.
- Surgical atrophic scars – some surgical scars become thinned out and adherent to underlying structures, appearing “dipped in”.
- Mixed scar patterns – many patients present with combinations of tethered, atrophic and textural scars requiring customised treatment planning.
What to expect for recovery after treatment
Recovery varies depending on the extent of treatment performed. Generally, patients may experience:
- Swelling
- Bruising
- Temporary tenderness
- Mild unevenness during healing
These effects usually improve gradually over days to weeks. Because collagen remodelling and regenerative healing occur progressively, scar improvement is typically gradual rather than immediate. Patients are usually advised to avoid excessive exercise and sweating and unnecessary manipulation of treated areas during early recovery.
Why is combination treatment
often necessary for acne scars?
Acne scarring rarely involves a single layer of the skin alone. Many patients have combinations of:
- Tethered scar bands
- Volume loss
- Textural irregularities
- Enlarged pores
- Superficial resurfacing concerns
For this reason, combination treatment is often necessary. Depending on the scar pattern, treatment may be combined with:
- Fractional resurfacing
- Collagen stimulation procedures
- Regenerative fat grafting
- Scar revision techniques
- Skin rejuvenation procedures
Treatment planning is individualised according to scar severity, skin condition and treatment goals.
How much does a SNaFFL™ Scar Treatment cost in Singapore?
The cost of SNaFFL™ Scar Treatment varies depending on several factors:
- Extent and severity of scarring — patients with more widespread tethering or deeper fibrosis may require more extensive treatment, which can affect the overall cost.
- Components included — treatment may combine scar release, NanoFat grafting and fractional CO2 resurfacing. The combination used is customised to each patient’s scar pattern, and cost reflects the components performed.
- Number of sessions — some patients may benefit from a single comprehensive session, while others with more complex scarring may require staged treatment over time.
SNaFFL™ Scar Treatment pricing starts from $3,000. A detailed cost breakdown will be provided following your consultation with Dr Pearlie, once your scar type and treatment plan have been assessed.
Book a consultation
At Pearl Plastic Surgery, treatment planning is customised according to the extent and severity of scarring. Because tethered scars often involve structural changes beneath the skin, a detailed assessment is important to determine whether scar release, regenerative NanoFat grafting and fractional resurfacing may be appropriate for you.
If you have persistent depressed scars that have not improved satisfactorily with previous treatments, a consultation with Dr Pearlie can help you better understand the underlying causes of your scarring and the treatment options available.
Book an appointment with us to discuss your concerns and for a personalised treatment plan.
Find out more about SNaFFL™ Scar Treatment
Frequently Asked
Questions
Is the procedure painful?
Local anaesthesia is typically used to improve comfort during treatment.
Is this treatment only for acne scars?
No, the technique may also be suitable for selected traumatic or surgical depressed scars involving tethering beneath the skin.
Can old acne scars still be treated?
Yes, even longstanding acne scars may still respond to treatment. Outcome varies depending on scar type, fibrosis severity and skin condition.
Will one treatment completely remove scars?
Improvement varies depending on scar type, severity and healing response.
Why is NanoFat used after scar release?
NanoFat will help reduce re-adhesion of released scar tissue while providing skin regeneration through adipose-derived stem cells (ADSCs) that improves skin quality and texture.
What causes tethered acne scars?
Tethered acne scars develop when inflammation damages deeper skin structures during healing, leading to the formation of fibrous scar bands beneath the skin.
Can depressed acne scars improve without surgery?
Some mild acne scars may improve with non-surgical treatments such as lasers, collagen stimulation procedures or skin resurfacing. However, scars with deeper tethering beneath the skin may require structural scar release techniques.
Why combine scar release with fractional resurfacing?
Scar release addresses structural tethering beneath the skin, while resurfacing targets superficial texture irregularities and stimulates collagen remodelling.
Is acne scar subcision the same as scar release?
Subcision is one method of releasing tethered scar bands beneath the skin. Different scar release techniques may vary in instrumentation, treatment depth and accompanying regenerative treatments.
Is fractional CO2 laser suitable for all acne scars?
Fractional CO2 resurfacing will help improve texture and superficial scarring, but deeper tethered scars often require additional structural treatment beneath the skin.
Is fat grafting for acne scars safe?
Fat grafting should be performed by a trained Plastic Surgeon using safe techniques of fat harvesting and careful processing of fat. Suitability and risks are assessed individually during consultation.
How many sessions are needed?
The number of sessions varies depending on scar severity, fibrosis and treatment goals.
How long does acne scar recovery take?
Initial swelling and bruising may improve over several days to weeks, while collagen remodelling and scar improvement continue gradually over time.
Can acne scars come back after treatment?
Acne scars themselves do not “return”, but released scar tissue may gradually re-adhere during healing in some cases. This is one reason regenerative fat grafting and placement is incorporated after scar release.
Is SNaFFL™ Scar Treatment covered by insurance or Medisave?
SNaFFL™ Scar Treatment is a cosmetic procedure and is not covered by Medisave or insurance. Please speak with our team during your consultation to discuss payment options.
Pearl Plastic Surgery