Abstract
Acne scarring is a common cosmetic concern with significant psychosocial impacts. While fractional carbon dioxide (CO2) laser is a gold-standard treatment, its recovery time and side effects can limit patient compliance and overall efficacy. Platelet-rich plasma (PRP) contains high concentrations of growth factors that may accelerate tissue healing and synergistic collagen remodeling. This split-face randomized trial compared the efficacy and safety of fractional CO2 laser alone versus fractional CO2 laser combined with topical PRP for the treatment of moderate-to-severe atrophic acne scars. Forty patients underwent three treatment sessions at 4-week intervals. One side of the face was randomized to receive fractional CO2 laser followed by topical autologous PRP, while the contralateral side received the laser treatment followed by topical normal saline. Assessments included the quantitative global acne scarring grading system (ECCA scale), patient satisfaction scores, and downtime duration. Both modalities yielded significant improvements in scar appearance compared to baseline (p < 0.05). However, the combination therapy side exhibited a significantly greater reduction in ECCA scores (p = 0.012), faster resolution of erythema and edema (p < 0.001), and higher patient satisfaction compared to the laser-monotherapy side. These findings suggest that combining fractional CO2 laser with PRP enhances clinical efficacy, accelerates recovery, and improves patient satisfaction, making it a superior clinical approach for acne scar revision.
