Comparative efficacy, recovery, and pigmentary safety of radiofrequency microneedling and fractional carbon dioxide laser for facial atrophic acne scars: a prospective randomized split-face trial.

Abstract

To compare efficacy, recovery, pigmentary safety, and patient-reported outcomes of radiofrequency microneedling (RFMN) and fractional carbon dioxide laser (FCO₂) for facial atrophic acne scars. In this prospective, randomized, split-face, evaluator-blinded exploratory trial, 33 patients were enrolled, and 30 completed the study. Each facial side was assigned to RFMN or FCO₂. Three treatment sessions were performed at 8-week intervals. The primary endpoint was the change in Echelle d'Evaluation Clinique des Cicatrices d'Acné (ECCA) score. Secondary outcomes included physician-rated improvement, satisfaction, Dermatology Life Quality Index, pain, recovery-related outcomes, and adverse events. Both modalities significantly improved acne scars over time. Mean ECCA scores decreased from 54.73 to 30.53 with RFMN and from 53.67 to 31.03 with FCO₂, without a significant between-treatment difference. Physician-rated improvement was comparable. RFMN showed higher efficacy satisfaction after the first session and higher safety satisfaction at all follow-up assessments. RFMN was associated with shorter erythema, pain, swelling, and scab-detachment durations and fewer post-inflammatory hyperpigmentation events. Both treatments improved facial atrophic acne scars in this exploratory split-face sample. RFMN offered faster recovery, fewer pigmentary events, and higher safety satisfaction.