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

Objective 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.Methods 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.Results 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.Conclusions Both treatments improved facial atrophic acne scars in this exploratory split-face sample. RFMN offered faster recovery, fewer pigmentary events, and higher safety satisfaction.