When considering acne scar treatments, many patients compare Fractional CO₂ Laser vs RF Microneedling as two leading options.
Both work by stimulating collagen to improve scar texture and skin smoothness, but they differ in method, downtime, and suitability for different scar types.
This guide explains how each treatment works, what results to expect, and how to decide which approach may be better for your skin.
Fractional CO₂ Laser vs RF Microneedling: Side-by-Side Comparison
Both Fractional CO₂ Laser and RF Microneedling belong to the broader group of energy-based skin resurfacing treatments.
While they share the same goal of stimulating collagen remodelling and improving scar texture, they differ in mechanism, recovery, and suitability.
Quick Comparison Table
| Feature | Fractional CO₂ Laser | RF Microneedling |
|---|---|---|
| Overview | Ablative laser that resurfaces skin and stimulates collagen | Microneedles deliver RF energy to remodel collagen beneath the skin |
| Best For | Boxcar scars needing strong resurfacing | Mixed scars, often considered more suitable for patients with darker skin tones (Fitzpatrick III–V) |
| Effectiveness | May produce visible improvements in fewer sessions for deeper scars | Gradual improvements over several sessions |
| Downtime | 3–5 days redness, swelling, crusting | 1–3 days mild redness, quick recovery |
| PIH Risk | Higher risk in Asian and darker skin | Lower risk, safer for Fitzpatrick III–V |
| Sessions | 5–10 sessions, spaced 4–8 weeks | 4–6 sessions, spaced 3–6 weeks |
| Comfort | Warm, stinging sensation | Prickling heat, generally better tolerated |
Overview of Each Treatment
Fractional CO₂ Laser: is a minimally ablative laser that creates controlled microthermal zones in the skin to trigger collagen renewal, smooth scar edges, and tighten tissue. It also treats fine lines, pigmentation, and skin irregularities. Sessions last 20–30 minutes with numbing cream, and recovery takes 3–5 days.
RF Microneedling (INFINI RF): combines microneedling with radiofrequency energy to remodel collagen and contract scar tissue. The device is FDA-approved and designed for use across different skin types. It is also used for wrinkles, sagging, and stretch marks. Recovery is typically 1–3 days after a numbed, doctor-led session.
Acne Scar Types Best Treated
Fractional CO₂ Laser: works best for boxcar scars with sharp edges and deeper depressions, and can also improve some rolling scars that need stronger resurfacing.
RF Microneedling (INFINI RF): is often considered suitable for mixed scars and for patients with darker skin types where there may be a higher risk of pigmentation. It can also help soften rolling scars while improving skin elasticity.
Treatment Effectiveness
Fractional CO₂ Laser: improvements may be noticeable after 1 session, with further benefits typically seen after 3–5 sessions. For severe scarring, up to 5–10 treatments may be needed. Results continue improving for up to 6 months as new collagen forms.
RF Microneedling (INFINI RF): delivers gradual improvements over 4–6 sessions, with visible skin tightening and scar softening over time. Its dual-action approach makes it safe and effective for ongoing collagen stimulation.
Downtime and Recovery
Fractional CO₂ Laser: downtime is typically 3–5 days, with redness, swelling, and light crusting. Proper aftercare — gentle cleansing, moisturiser, and strict sun protection — helps healing and reduces PIH risk.
RF Microneedling (INFINI RF): recovery is shorter at 1–3 days, with mild redness or pinpoint marks. Most patients resume daily activities within 24–48 hours with basic moisturising and sun care.
PIH Risk and Skin Type Considerations
Fractional CO₂ Laser: carries a higher risk of post-inflammatory hyperpigmentation (PIH), especially in Asian and darker skin tones. Careful settings and aftercare are essential.
RF Microneedling (INFINI RF): has a much lower PIH risk, making it the safer choice for Fitzpatrick skin types III–V and patients prone to pigmentation issues.
Number of Sessions Required
Fractional CO₂ Laser: most patients need 5–10 sessions spaced 4–8 weeks apart. Severe scars may require up to 10 treatments.
RF Microneedling (INFINI RF): typically requires 4–6 sessions spaced 3–6 weeks apart for gradual, consistent results.
Pain and Comfort
Fractional CO₂ Laser: feels like a warm, stinging sensation, even with numbing cream applied. Some patients report more discomfort due to its ablative nature.
RF Microneedling (INFINI RF): usually feels like prickling heat. With topical anaesthesia, most patients find it more tolerable than laser.
When Fractional CO₂ Laser May Be More Suitable
Fractional CO₂ Laser is often recommended for patients with deeper, well-defined scars, as it may produce visible improvements in fewer sessions.
- Best for boxcar scars and some rolling scars needing strong resurfacing
- Suitable for patients willing to accept 3–5 days of downtime
- Less ideal for those with a high risk of pigmentation or abnormal wound healing
When RF Microneedling May Be More Suitable
RF Microneedling is often chosen by patients who want effective results with minimal surface disruption.
- Best for mixed acne scars or shallower rolling scars
- Often considered more suitable for patients with darker skin tones, where the risk of PIH may be higher with ablative lasers.
- Short downtime of 1–3 days, making it easier for busy lifestyles
- Ideal for those preferring gradual improvements over multiple sessions
Combination Approach to Acne Scar Treatment
Since most patients have a mix of scar types, doctors often combine treatments for the best results.
- Subcision: releases tethered scars before laser or RF treatments
- TCA CROSS: targets ice-pick scars, followed by resurfacing
- Filler Support: restores volume under depressed scars
- Staged Plan: spreads treatments over months for safe, gradual improvement
A customised combination plan ensures that each scar type is treated effectively while balancing downtime and safety.
Cost of Fractional CO₂ Laser vs RF Microneedling Treatment
Fractional CO₂ Laser: treatments at Sozo Clinic start from SGD $450 per session. Most patients require 5–10 sessions, while severe scarring may need more.
INFINI RF Microneedling: treatments start from SGD $850 per session, with 4–6 sessions usually recommended. Costs are influenced by the use of single-use microneedle tips and specialised technology.
Both procedures are elective and not insurance-covered. Package rates may be available for patients undergoing multiple sessions.
Safety and Recovery
Fractional CO₂ Laser
- Controlled medical setting with protective eyewear, smoke evacuation, and sterile technique
- Recovery: 3–5 days of redness, swelling, and light crusting
- Aftercare: gentle cleansing, regular moisturiser, and daily sun protection
- Goal: support healing and minimise risk of PIH
RF Microneedling
- Conducted under sterile conditions with single-use needle tips
- Recovery: 1–3 days of mild redness or pinpoint marks
- Return to activities: usually within 24–48 hours
- Aftercare: avoid harsh skincare, apply gentle moisturisers, and use sun protection
At Sozo Aesthetic Clinic, both treatments are performed by Dr. Justin Boey, Medical Director, who has extensive experience in acne scar management.
He customises treatment settings based on scar type, skin tone, and medical history, ensuring safety and effectiveness in line with Ministry of Health (MOH) regulations.
Frequently Asked Questions (FAQ)
How soon can I see results?
Improvements are often noticeable after the first session. Long-term changes build gradually over several months as collagen remodels.
Can I wear makeup after treatment?
With RF Microneedling, makeup can usually be applied after 24–48 hours. After Fractional CO₂ Laser, most patients wait 5–7 days until the skin has healed.
Are results permanent?
Acne scar improvements are long-lasting, but natural skin ageing continues. Maintenance sessions may be recommended for best results.
Can I do these treatments if I still have active acne?
RF Microneedling is generally preferred for patients with ongoing breakouts, as it is less likely to aggravate the skin compared to ablative laser resurfacing.
Conclusion
Some acne scars respond best to aggressive resurfacing with Fractional CO₂ Laser, while others improve more safely with radiofrequency energy from RF Microneedling. Both are established methods supported by clinical use and research that remodel collagen in different ways to improve scar texture.
Because most patients present with a combination of scar types, a customised treatment plan is often needed. A doctor’s evaluation ensures the right balance between results, safety, and downtime.
For personalised, doctor-led acne scar treatments, visit Sozo Aesthetic Clinic, where treatment plans are customised based on scar type, skin tone, and medical history.
