Ablative fractional carbon dioxide laser combined with autologous platelet-rich plasma in the treatment of atrophic acne scars: A systematic review and meta-analysis

Dermatol Ther. 2022 Dec;35(12):e15888. doi: 10.1111/dth.15888. Epub 2022 Oct 14.


Atrophic acne scars are the most common cutaneous seqaule of acne vulgaris, representing 80%-90% of all acne scars. Ablative fractional carbon dioxide (FCO2 ) laser is the gold standard treatment for atrophic scars. Additionally, platelet-rich plasma (PRP) is suggested to accelerate the healing process and collagen synthesis. The aim of the present systematic review and meta-analysis was to determine the efficacy and safety of PRP combined with Ablative FCO2 laser in the treatment of moderate to severe atrophic acne scars. Randomized controlled trials (RCTs) that have compared PRP in combination with ablative FCO2 laser to ablative FCO2 laser alone with respect to the efficacy and safety measures were included. We have systematically explored Embase, Medline, and CENTRAL databases via Ovid. The outcomes that our systematic review sought to evaluate were clinical improvement, patient satisfaction, and Goodman and Baron's qualitative acne scar score. The dichotomous outcomes were presented as odds ratio (OR) while the continuous outcomes were presented as standardized mean difference (SMD). Eleven RCTs that represents 313 participants were included. The combined use of laser and PRP showed a statistically significant clinical improvement and patient satisfaction compared to the use of laser alone (OR = 2.56, 95% CI 1.37-4.78 and OR = 3.38, 95% CI 1.80-6.34, respectively). Also, a significant improvement in Goodman and Baron's score was achieved by combining PRP with laser (SMD = -0.40, 95% CI -0.65 to -0.14). The combined treatment of laser and PRP was highly synergistic, effective, and safe in treating moderate to severe atrophic acne scars.

Keywords: ablative fractional carbon dioxide laser; acne scars; atrophic acne scars; autologous platelet-rich plasma.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Acne Vulgaris* / complications
  • Acne Vulgaris* / therapy
  • Atrophy
  • Carbon Dioxide
  • Cicatrix / diagnosis
  • Cicatrix / etiology
  • Cicatrix / therapy
  • Connective Tissue Diseases*
  • Humans
  • Lasers, Gas* / adverse effects
  • Platelet-Rich Plasma*
  • Treatment Outcome


  • Carbon Dioxide