Severity-Guided Micro-Plasma Radiofrequency With or Without Subcision for Facial Atrophic Scars: A Retrospective Comparative Cohort Study

OBJECTIVE: To compare physician-rated outcomes after micro-plasma radiofrequency (RF) alone versus filler-free subcision followed by micro-plasma RF for facial atrophic scars, and to explore whether baseline severity identified patients more likely to benefit from combined treatment. METHODS: We retrospectively analyzed 42 adults with facial atrophic scars treated at a single craniofacial scar center. Twenty-one patients underwent micro-plasma RF alone and 21 underwent subcision followed by micro-plasma RF. Two independent reviewers assessed baseline and final post-treatment photographs using Goodman-Baron grading and Investigator Global Assessment. The primary outcome was reviewer-average Goodman-Baron grade reduction. The primary adjusted model accounted for baseline Goodman-Baron grade, plasma RF sessions, and follow-up interval using HC3 robust CIs. RESULTS: The combined-treatment group had longer scar duration, higher baseline Goodman-Baron grade, and more severe scars. Median Goodman-Baron grade reduction was 2.0 after combined treatment and 1.5 after micro-plasma RF alone (median difference 0.5 grade; 95% CI: 0-1; P<0.001). In the primary adjusted model, combined treatment was associated with a 0.523-grade greater reduction (HC3 95% CI: 0.157-0.888; P=0.005). No postoperative adverse reactions were documented. CONCLUSIONS: Subcision followed by micro-plasma RF was associated with greater absolute physician-rated Goodman-Baron grade reduction, with the signal concentrated among more severe scars. These findings support exploratory severity-guided craniofacial scar treatment selection, but do not establish causal superiority, equivalence, or noninferiority.