The 2026 33-patient split-face trial found radiofrequency microneedling and fractional CO2 laser improved atrophic acne scars to a similar degree. Atrophic scars are depressed marks left by collagen loss after inflamed acne, and radiofrequency microneedling delivered faster healing with fewer pigment problems. Common forms include ice-pick, boxcar and rolling scars.
It gives people with facial scars a practical trade-off rather than a clear winner. Both sides improved, but the radiofrequency side healed faster and caused fewer pigment changes. The issue affects adolescents and adults with facial atrophic scars.
Medical information disclaimer: This article is for general educational purposes only and does not provide medical advice, diagnosis, or treatment. Always consult a physician or other qualified health professional about symptoms, medications, tests, or treatment decisions.
Table of Contents
- What did the 33-patient trial test?
- How do healing and pigment risk compare?
- Which option fits your priorities?
- What are the limits of this evidence?
What did the 33-patient trial test?
Li et al. treated one cheek with radiofrequency microneedling and the other with fractional CO2 laser in the same patients. Thirty-three patients enrolled and 30 completed the comparison, according to the U.S. National Library of Medicine PubMed record the PubMed trial record.
Doctors scored scars with ECCA, which grades the number and severity of atrophic scars. Mean scores fell from 54.73 to 30.53 with radiofrequency microneedling and from 53.67 to 31.03 with CO2. The between-treatment difference was not significant, according to the U.S. National Library of Medicine PubMed abstract the PubMed abstract.
How do healing and pigment risk compare?
Radiofrequency microneedling produced faster recovery and fewer pigmentary side effects in the same patients. Patients also reported higher safety satisfaction at every follow-up. They reported higher efficacy satisfaction after the first session.
Fractional CO2 removes tiny columns of skin, so redness, crusting and swelling often last longer. Radiofrequency microneedling heats deeper tissue through tiny needles with less surface injury. This difference matters most for work, school and social plans during recovery.
Which option fits your priorities?
People who want quicker healing and lower dark-mark risk may reasonably discuss radiofrequency microneedling first. That concern is strongest for pigment-prone skin, where post-inflammatory darkening is more likely.
People seeking maximal remodeling may accept CO2 downtime and pigment risk. Bring recent photos and a list of current retinoids, acids and acne medicines. Ask what to pause, what to use for sun protection, and when to call about blistering or spreading pigment.
- Ask about expected days of redness, peeling and sun avoidance for each device.
- Share your history of dark marks after acne, burns or procedures.
- Ask how scar type, skin tone and schedule affect sessions, settings and aftercare.
What are the limits of this evidence?
The trial was small and exploratory, with only 30 people finishing both treatments. A finding of no significant difference may reflect limited statistical power rather than proven equivalence.
A March 2026 meta-analysis of eight randomized trials with 249 patients reached a different balance. It found fractional CO2 gave greater scar-remodeling improvement and higher Likert satisfaction than microneedling radiofrequency. The mean difference was 0.32, according to the Journal of Cosmetic Dermatology via Wiley the Wiley meta-analysis.
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