Alternating ablative fractional laser and microneedling radiofrequency outperforms ablative fractional laser alone for acne scars.

Background: Moderate to severe acne scars pose a therapeutic challenge and often require multimodal treatments. Ablative fractional laser (AFL) and fractional microneedling radiofrequency (FMR) are commonly used, but their alternating application has not been fully studied.

Patients and methods: In this prospective, randomized, single-blind, split-face trial, 20 patients (Fitzpatrick III-IV) received four treatments at 4-week intervals: one facial side underwent alternating FMR (sessions 1, 3) and AFL (sessions 2, 4), while the contralateral side received AFL alone. Outcomes included Échelle d'Évaluation Clinique des Cicatrices d'Acné (ECCA) scores, sebum secretion, patient satisfaction, and adverse events over 24 weeks.

Results: Alternating therapy achieved superior ECCA score reduction (53.5% vs. 41.7%, p < 0.05) and significant sebum reduction (88.6 ± 12.9 to 81.3 ± 19.1 µg/cm², p < 0.05) compared to AFL alone. Patient satisfaction was higher in the alternating group (85% vs. 70%), despite greater procedural pain (VAS: 5.8 ±1.3 vs. 4.6 ±1.1, p < 0.05). Adverse events (transient erythema, crusting) were comparable between groups.

Conclusions: Alternating AFL and FMR is more effective than AFL alone for treating moderate to severe acne scars, offering better outcomes with acceptable safety. Larger studies and extended follow-up are needed.