Comparing Combined Non-ablative Fractional Laser and Radiofrequency Microneedling Versus Non-ablative Fractional Laser Alone for Acne Scar Treatment: A Meta-Analysis

The combination of fractional microneedling radiofrequency (FMR) and fractional laser (FL) is a popular multimodal treatment for atrophic acne scars, yet its superiority over FL monotherapy remains uncertain based on conflicting primary studies. This meta-analysis aimed to synthesize evidence from randomized split-face trials comparing the efficacy of combined FMR+FL versus FL alone. A systematic search identified five eligible studies comprising 116 patients. Pooled odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated for primary outcomes, including achievement of 50-75% improvement, change in the Échelle d'Évaluation Clinique des Cicatrices d'Acné (ECCA), also known as the Acne Scar Grading Scale, and patient-assessed global improvement. The overall analysis showed no significant advantage for combination therapy across all outcomes (improvement OR: 1.22, 95% CI: 0.70-2.12, p=0.48; ECCA MD: -6.47, 95% CI: -21.68-8.73, p=0.40; Global improvement MD: 0.36, 95% CI: -0.22-0.94, p=0.22). Substantial heterogeneity was noted for ECCA (I²=91%) and patient improvement (I²=83%). Subgroup analysis indicated a borderline significant benefit for the FMR+ablative fractional laser (AFL) combination (OR: 2.76, 95% CI: 0.99-7.71, p=0.05) but not for FMR+non-ablative fractional laser (NAFL). Current evidence does not conclusively support the routine use of combined FMR+FL over FL monotherapy for atrophic acne scars. A potential benefit may exist specifically when combining FMR with AFL, warranting further investigation in larger, standardized trials.