Acne scars

A 2021 meta-analysis concluded fractional CO2 is an effective option for atrophic acne scars, and a 2024 meta-analysis (418 patients) found it outperforms Er:YAG fractional laser on effective response rate. A 2026 meta-analysis of 8 RCTs (249 patients) also found it superior to RF microneedling for scar improvement and satisfaction. Typical courses are 2 to 4 sessions 4 to 8 weeks apart, with improvement commonly in the 25 to 75 percent range depending on scar type.

A 2022 meta-analysis of 12 randomized controlled trials (414 participants) found microneedling monotherapy produced a statistically significant improvement in atrophic acne scars, though the pooled effect was modest. A 2024 network meta-analysis of RCTs found combining microneedling with peels or other agents outperforms either alone, and rated microneedling the most tolerable option for pain. Most protocols in these trials used 3 to 6 sessions spaced about 4 weeks apart.

A 2025 systematic review of 16 studies (481 patients, including 6 RCTs) concluded RF microneedling is likely effective as monotherapy for atrophic acne scars over a typical 3 to 4 session course. However, a 2026 meta-analysis of 8 randomized trials (249 patients) found fractional CO2 laser produced greater scar improvement and higher patient satisfaction than RF microneedling, so it is a solid second-line choice, often picked for darker skin where CO2 carries more pigmentation risk.

PRP's best facial use is as an adjunct: a 2022 systematic review and meta-analysis found adding PRP to ablative fractional CO2 laser improved atrophic acne scar outcomes and shortened downtime versus laser alone. Evidence for PRP by itself on scars is much weaker; the value is in combination with resurfacing or microneedling.