Exploring the clinical studies of surgical acne scar management: a 10-year systematic review of modalities and outcomes

Acne scars are permanent sequelae of acne vulgaris, classified into hypertrophic, keloid, and atrophic types. Treatment strategies include non-invasive, minimally invasive, and invasive modalities. This systematic review evaluates clinical studies from the past decade on surgical and related interventions for acne scars. Using PRISMA guidelines, searches were conducted on PubMed, Scopus, and Epistemonikos with keywords related to "acne scar" and "surgical therapy." Twenty-four studies met the inclusion criteria out of 396 screened articles. The modalities examined encompass TCA CROSS, radiofrequency (RF) micro-needling, fractional microplasma RF, fractional bipolar RF, fractional CO₂ laser, erbium YAG (2940 nm), 1550 nm erbium, 1540 nm erbium glass, subcision, punch techniques, microdermabrasion, needling, platelet-rich plasma (PRP), hyaluronic acid fillers, hybrid energy devices, trifractional technology, and human adipose-derived stem cell exosomes (ASCE). Results demonstrated variable efficacy, with predominantly positive outcomes across modalities. Specific treatments showed better suitability for certain scar types; however, all carry potential risks of adverse effects, emphasizing the need for cautious application and patient management. Limitations include small sample sizes and heterogeneity among studies, which may affect the generalizability of findings. This review highlights the diversity of surgical and minimally invasive options for acne scar management, supporting tailored treatment approaches based on scar morphology and patient factors.