Platelet-rich plasma and ablative fractional carbon dioxide laser therapy for chronic scar management: a systematic review

Purpose Scarring following acne, burns, and trauma remains a significant clinical and psychosocial challenge. Despite increasing clinical use, there is no consensus on the efficacy and safety of Ablative Fractional CO₂ Laser (AFCL) combined with Platelet-Rich Plasma (PRP) across scar aetiologies. This systematic review evaluated the efficacy and safety of AFCL with PRP for chronic acne, traumatic, and burn scars. Methods MEDLINE (PubMed) and Embase (Ovid) were searched to 1 September 2025 using terms related to scars, fractional CO₂ laser, and platelet-rich plasma. Eligible studies included human subjects treated with AFCL (10,600 nm) and autologous PRP delivered topically or intradermally. Studies using platelet-rich fibrin, PRP gel, or non-synchronous administration were excluded. Risk of bias was assessed using RoB 2 and ROBINS-I. Results Seventeen studies (n = 420) met inclusion criteria. Nine (53%) were randomised studies, six (29%) non-randomised, and two (12%) retrospective. AFCL settings ranged from 10 to 30 W, dwell times 0.1–1.54 ms, and spot spacing 0.5–2.0 mm. PRP was predominantly prepared via double-spin centrifugation and delivered topically (47%) or intradermally (59%). AFCL+PRP showed superior efficacy to AFCL alone, with significant improvements in scar texture, pigmentation, erythema, and depth. Patient satisfaction was consistently higher with combination therapy, and topical PRP notably reduced downtime, suggesting accelerated repair and modulated inflammation. Conclusions AFCL combined with PRP enhances scar remodelling and patient outcomes while reducing complications. Heterogeneity in laser parameters, PRP preparation, and outcome measures limits direct comparison. Robust multicentre randomised trials are needed to establish parameter-specific guidelines for AFCL-PRP therapy.