Calcium Hydroxylapatite Combined with CO₂ Ablative Fractional Laser for Atrophic Acne Scars: A Randomized Controlled...

This study was to investigate the efficacy and safety of calcium hydroxylapatite (CaHA) filler injections combined with CO₂ ablative fractional laser (AFL) for atrophic acne scars.

A prospective, single-center, randomized controlled study was conducted on 160 participants, who were average randomly assigned to either an observation group (A) or a control group (B). Group A received two sessions of CaHA (1-month interval) after AFL 1 month, while Group B received AFL monotherapy. Efficacy was assessed by pre- and post-operation of standardized photographic images. Additionally, treatment-related adverse events (AEs) were documented.

Compared with baseline, the quantitative global scarring grading system scores decreased significantly in both groups (p < 0.001), with greater reduction observed in group A (p < 0.001). The acne scar rating scale analysis revealed the combination therapy's effectiveness across all scar subtypes (p < 0.001) and demonstrated comparable efficacy for boxcar and rolling scars (p = 1.000), both of which showed superiority to icepick scars (p < 0.001). Mild AEs are occurred in both group, such as pain, edema, crusting, and transient post-inflammatory erythema (PIE), CaHA injection may pose a risk of ecchymosis. Nevertheless, long-term PIE (lasting over 4 weeks) (p < 0.001) and post-inflammatory hyperpigmentation (p = 0.002) in group A exhibited significantly shorter healing times, accelerated healing by an average of 3.8 weeks and 3.7 weeks.

The combination of CaHA with AFL demonstrates both efficacy and safety for atrophic acne scars, particularly boxcar and rolling subtypes.

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