Microneedling Radiofrequency Versus Fractional Laser for the Treatment of Acne Scars: A Systematic Review with Descriptive Quantitative Synthesis

BACKGROUND: Atrophic acne scars remain a persistent therapeutic challenge in aesthetic dermatology. Fractional laser resurfacing is an established treatment, whereas microneedling radiofrequency (MNRF) has emerged as a minimally invasive option that may offer a favorable recovery profile in selected patients. OBJECTIVES: To compare the clinical efficacy, recovery profile, and safety of MNRF-based interventions with fractional laser-based comparators for atrophic acne scars. METHODS: PubMed and Web of Science were searched for randomized or comparative clinical studies evaluating MNRF-based treatment against fractional laser-based comparators. Fractional laser comparators were categorized according to tissue-interaction profile as ablative fractional CO2 laser, ablative fractional Er:YAG laser, or non-ablative erbium-glass fractional laser. Direct head-to-head comparisons and add-on combination protocols were examined separately. Risk of bias was assessed using the Cochrane RoB 2 tool, and ROBINS-I was used when nonrandomized comparative evidence was considered narratively. RESULTS: The search yielded 152 records. After screening and eligibility assessment, four split-face studies with fractional laser comparators met the predefined PICO criteria. Two studies reported final ECCA scores. One evaluated MNRF as an add-on to non-ablative fractional laser treatment, whereas the other directly compared MNRF with ablative fractional CO2 laser. Because these studies differed in clinical design and did not consistently provide paired split-face statistics, ECCA outcomes were summarized descriptively at the study level. Across the included evidence, MNRF-based protocols were associated with clinical improvement and may provide shorter recovery than some ablative laser approaches, although recovery and tolerability outcomes were interpreted separately from scar-remodeling efficacy. CONCLUSION: Current comparative evidence suggests that MNRF-based interventions can improve facial atrophic acne scars and may offer tolerability advantages in selected patients. However, the available evidence does not establish uniform efficacy superiority of MNRF over all fractional laser modalities. The findings should be interpreted cautiously because of the small number of eligible studies, heterogeneous comparators, distinct study designs, and inconsistent outcome reporting. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.