In head-to-head studies, radiofrequency (RF) microneedling and fractional CO2 laser improved atrophic acne scars by a similar amount. RF microneedling usually comes with shorter recovery and less risk of dark patches (post-inflammatory hyperpigmentation), which matters most for people with medium to deep skin tones. A fractional CO2 laser is a well-established option too, but expect more downtime. The right choice depends on your scar type, skin tone and how much recovery time you can take, so an in-person assessment with a qualified provider is the real first step.
Written by the AestheticsGuide editorial team. This article has not yet been medically reviewed. Read how this guide is written.
How each treatment works
RF microneedling (devices include Morpheus8 and others) uses fine needles to make tiny channels in the skin and delivers radiofrequency heat beneath the surface. This triggers the skin’s healing response and new collagen production. A large review found that this remodelling is slow and progressive and keeps improving for up to six months after treatment. [REVIEW]
Fractional CO2 laser vaporises microscopic columns of skin, including the surface layer, which also drives collagen remodelling. Because it affects the surface more, healing usually involves more crusting and peeling.
For how conventional and RF microneedling differ, including the FDA’s safety communication on RF devices, see our microneedling guide.
What the studies show
Similar improvement. In a 2026 randomized, evaluator-blinded split-face trial, 30 patients had RF microneedling on one side of the face and fractional CO2 on the other (three sessions, eight weeks apart). Acne scar scores fell by a similar amount on both sides, with no significant difference between treatments. [TRIAL]
Faster recovery with RF microneedling. In that same trial, the RF microneedling side had shorter redness, pain, swelling and scab duration. [TRIAL]
Less pigmentation risk. No post-inflammatory hyperpigmentation was seen on the RF microneedling side, while it appeared after about 19% of CO2 sessions. [TRIAL] An earlier comparative study of 50 patients found comparable scar improvement (about 61% vs 63%), with crusting in every CO2 patient at one week and none in the RF microneedling group. [PMC]
Darker skin types. The Dermatologic Surgery review concluded RF microneedling can be used safely in people with darker skin phototypes. [REVIEW]
These are small studies, and results vary from person to person. Nobody can promise a specific outcome.
Side by side
| Question | RF microneedling | Fractional CO2 laser |
|---|---|---|
| Scar improvement in comparison studies | Similar | Similar |
| Typical recovery | Redness and swelling for a few days | Crusting and peeling, often over a week or more |
| Pigmentation risk in studies | Lower | Higher |
| Sessions in studies | Usually around 3 | Usually around 3 |
Which might suit you?
RF microneedling may suit you if you have medium to deep skin, can’t take much time off, or prefer a gentler recovery. CO2 laser may be discussed if you have lighter skin and your provider thinks a more resurfacing approach fits your scars.
Some scars (for example deep “ice pick” scars) may need other treatments alongside either option, such as subcision or TCA CROSS, so ask about a combined plan.
How to choose a provider
- Look for a board-certified dermatologist or plastic surgeon, or a clinic where one supervises treatment.
- Ask how many acne scar patients they treat, and which device they use.
- Ask how they adjust settings for your skin tone.
- Ask to see the clinic’s own, consented patient photos.
- Get a written plan with the number of sessions and the total cost upfront.
Cost
Prices vary widely by city, device and number of sessions. We haven’t listed figures here because we only publish prices we’ve verified. Ask for an itemised quote at consultation.
Frequently asked questions
Is RF microneedling better than CO2 laser for acne scars?
Not clearly better at improving scars. Studies show similar results, but RF microneedling had shorter recovery and less pigmentation risk. [TRIAL]
How many sessions will I need?
Studies commonly used about three sessions spaced several weeks apart. Your provider will advise based on your scars.
When will I see results?
Some change can appear within weeks, but collagen remodelling continues for up to six months. [REVIEW]
Is RF microneedling safe for dark skin?
Research suggests it can be used safely in darker skin types, with lower pigmentation risk than CO2 laser in comparison studies. Choose an experienced provider. For a fuller look at the evidence, see Is RF microneedling safe for darker skin?
What is the downtime?
For RF microneedling, studies report redness and swelling lasting a few days. CO2 laser usually involves crusting and a longer recovery.
Related guides
Sources
Medical statements on this page come from the published research below. This article has not yet been medically reviewed.
- Dermatologic Surgery. Review of radiofrequency microneedling (doi:10.1097/dss.0000000000002972).
- Journal of Dermatological Treatment, 2026. Randomized, evaluator-blinded split-face trial of RF microneedling vs fractional CO2 laser for acne scars (doi:10.1080/09546634.2026.2687842).
- Comparative study of RF microneedling and fractional CO2 laser for acne scars (PMC8423204).