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Objectives: The aim of this case series is to assess the combined effect of pulsed dye laser (PDL), radiofrequency microneedling (RFM), and topical application of rose stem cell-derived exosomes on Asian-skinned patients with various acne severity, and to assess the safety profile of such combination. Introduction: Acne vulgaris is one of the most common facial disorders in adolescents, leading even up to adulthood. It is a condition that affects a person’s physical and psychosocial well-being. Failure to control inflammatory acne vulgaris tends to lead to scarring, further affecting one’s confidence and mental health. Treatment with energy-based devices and lasers can be challenging in darker-skinned patients, and results may be difficult to assess. Previous studies have shown that, individually, pulsed dye laser, radiofrequency microneedling, and topical exosomes are effective in reducing acne severity Materials / method: The study is a case series with 56 patients - 38 female, 18 male, aged 14-53, in a single center. The majority of patients had Fitzpatrick skin type IV (75%), while the remaining had skin type III (25%). Patients had moderate (IGA Grade 3) and severe (IGA Grade 4) inflammatory acne during the initial visit. Patients underwent combined treatment of PDL, non-insulated RFM, and exosomes. Most patients underwent combined treatment of the 3 modalities during single treatment sessions, while few had various combinations of the above modalities, with a range of 3-10 sessions, 2-4 weeks apart. Results: Photos and Visia were used for assessment. Results showed that combination therapy, whether single or split sessions, reduced inflammatory acne lesions and improved acne severity in patients. Patients in both moderate and severe classifications improved to mild severity, with some showing near-clear skin. Other parameters such as pore size/count, and redness also improved. A greater number of combined sessions generally led to a better outcome. No severe side effects were reported, with mild transient erythema as the most common side effect, indicating a favorable safety profile on Asian skin. Conclusion: Combination treatment with PDL, non-insulated RFM, and topical exosomes is safe and effective in treating inflammatory acne on Asian skin. It may be advantageous because of the combined outcome of the modalities, and each targeting a pathogenesis of inflammatory acne - PDL can control the bacteria causing acne and reduce the vascular component of inflammation; RFM reduces sebaceous gland size and sebum production; exosomes reduces inflammation and enhances skin-cell turnover. RFM also has benefits for pore-size reduction and scar resurfacing due to its collagen-building capabilities.