Abstract

Objectives: To determine whether the combination of microneedling with other agents is more effective than microneedling alone in terms of scar improvement, reduction in scar appearance, patient satisfaction, and adverse effects. Introduction: Acne scars are a common dermatological concern that can have a significant impact on an individual's self-esteem and quality of life. Despite the availability of various therapeutic interventions, achieving optimal outcomes in the treatment of acne scars remains a challenge due to the complex and diverse nature of scar tissue. Microneedling, a minimally invasive procedure that employs the use of fine needles to create controlled micro-injuries in the skin, has gained prominence as a treatment option for various dermatological conditions, including acne scars. Materials / method: Random-effects model meta-analysis utilizing the DerSimonian and Laird technique was conducted, which is based on the inverse variance method. The findings will be illustrated using forest plots. The heterogeneity of the comparisons was assessed using the Chi-square test (Cochran's Q), with a statistical significance level of p = 0.005 (p < 0.005) rejects the null hypothesis of homogeneity). We employed the I^2 statistic to determine the proportion of total heterogeneity beyond chance: less than 25% heterogeneity is considered low, 25% to 50% is moderate, and more than 50% is high. Results: From 18 randomized clinical trials, Microneedling alone demonstrated a significant average scar improvement of 45%, coupled with a high patient satisfaction rate of 70%. Among the combination therapies, Microneedling with Laser Therapy emerged as particularly noteworthy, exhibiting a statistically significant higher average scar improvement of 65% (95% CI: 60%–70%) compared to Microneedling Monotherapy (p = 0.02). The combination of Microneedling with Glycolic Acid Chemical Peels demonstrated a scar improvement of 55%. the combination with PRP average scar improvement of 60%. Conclusion: Among the combination therapies was the superior performance of Microneedling with Laser Therapy. The combination of Microneedling with Glycolic Acid Chemical Peels and with Platelet-Rich Plasma (PRP) also demonstrated considerable scar improvement. Our findings demonstrate the efficacy and versatility of microneedling, both as a monotherapy and in combination with other modalities, offering clinicians a guide for tailoring effective and patient-centered approaches to acne scar management.