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

TL;DR

This study finds that combining non-ablative fractional laser with radiofrequency microneedling does not significantly improve acne scar treatment compared to laser alone.

Contribution

A meta-analysis comparing combined FMR+FL therapy to FL monotherapy for acne scars, revealing no significant overall benefit.

Findings

Combination FMR+FL therapy showed no significant improvement over FL alone in acne scar treatment.

A borderline benefit was observed when FMR was combined with ablative fractional laser.

High heterogeneity suggests variability in study results and outcomes.

Abstract

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.

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