Comparative evaluation of polydioxanone threads, microneedling with platelet-rich plasma, fractional carbon dioxide laser, and subcision in the management of atrophic postacne scars

Abstract

Atrophic postacne scarring remains a challenging dermatologic condition with significant psychological and cosmetic implications. Various treatment modalities have been developed to stimulate collagen remodeling and improve skin texture, yet the optimal approach remains uncertain. To compare the efficacy and safety of polydioxanone (PDO) threads, microneedling combined with autologous platelet-rich plasma (PRP), fractional carbon dioxide (CO 2 ) laser, and subcision − in the management of atrophic postacne scars. A randomized pilot clinical study was conducted on 24 patients (12 females and 12 males) aged 18–40 years with atrophic acne scars. Participants were randomly assigned into four equal groups ( n =6 each): group A (PDO threads), group B (PRP with microneedling), group C (fractional CO 2 laser), and group D (subcision). Clinical outcomes were assessed using the Goodman and Baron Qualitative Global Scarring Grading System before treatment, and at 1- and 3-month posttreatment. Improvement degrees, side effects, and patient satisfaction were also evaluated. All groups showed significant improvement in Goodman and Baron scores after 3 months ( P <0.05). After 3 months, the mean percentage of improvement was 40.0±23.98% for threads, 50.8±18.8% for PRP, 50.8±20.6% for fractional laser, and 55.8±26.3% for subcision, with no statistically significant difference among groups ( P =0.700). All four modalities significantly improved atrophic acne scars, with fractional CO 2 laser and subcision showing the highest improvement percentages. PDO threads and PRP offered less downtime and fewer side effects.