{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T14:11:57Z","timestamp":1790604717775,"version":"4.1.0"},"reference-count":66,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"vor","delay-in-days":21,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Photoderm Photoimm Photomed"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Needling\u2010based therapies and ablative fractional lasers are widely used for scar management, but their efficacy and safety remain uncertain. In this systematic review, we aimed to assess the safety and efficacy of both needling\u2010based therapy and ablative fractional laser therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This review followed PRISMA 2020 and the Cochrane Handbook. PubMed, Scopus, Web of Science, and Cochrane were searched from inception to 9 April 2026 without restrictions. Studies enrolling patients with scars of any etiology and comparing a needling\u2010based therapy with an ablative fractional laser were included. Randomized controlled trials (RCTs), non\u2010randomized trials, and cohort studies were eligible. Risk of bias was assessed using RoB 2, ROBINS\u2010I, and the Newcastle\u2013Ottawa Scale. Because of heterogeneity, findings were synthesized narratively, with exploratory random\u2010effects meta\u2010analysis where data were sufficiently comparable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty\u2010seven studies involving 1137 participants were included, comprising 17 RCTs, 2 non\u2010randomized comparative trials, and 8 cohort studies. Most studies evaluated atrophic or hypertrophic acne scars (18 studies; 870 patients), while fewer studies assessed striae (4 studies; 87 patients), burn or postburn scars (3 studies; 105 patients), and traumatic scars (2 studies; 75 patients). Both treatment categories improved scar appearance. In many comparisons of atrophic acne scars, ablative fractional lasers, particularly fractional CO\n                      <jats:sub>2<\/jats:sub>\n                      and, in some studies, Er:YAG systems, suggested greater improvement than microneedling. However, needling\u2010based therapies were associated with shorter downtime, better tolerability, and fewer pigmentary adverse effects. Microneedling radiofrequency appeared to provide efficacy closer to that of ablative lasers in several individual studies and demonstrated a more favorable safety profile. Recent combination regimens appeared promising.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Available evidence suggests that both modalities can improve scars. Ablative fractional lasers may offer greater efficacy, whereas needling\u2010based therapies may provide better tolerability and pigment safety. These conclusions should be interpreted cautiously because of clinical heterogeneity and the sensitivity of the exploratory pooled estimate to individual studies. Treatment selection should remain individualized according to scar type, patient priorities, and acceptable downtime.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>The protocol was registered in PROSPERO (CRD420261383840)<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/phpp.70121","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T19:36:00Z","timestamp":1790105760000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative Efficacy and Safety of Needling\u2010Based Therapies Versus Ablative Fractional Lasers for Scar Management: A Systematic Review and an Exploratory Meta\u2010Analysis"],"prefix":"10.1111","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-0143-7645","authenticated-orcid":false,"given":"Kholoud","family":"Almahzoum","sequence":"first","affiliation":[{"name":"Department of General Surgery Sheikh Jaber Al\u2010Ahmad Al\u2010Sabah Hospital, Ministry of Health  Kuwait City Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1666-4607","authenticated-orcid":false,"given":"Waleed","family":"Alfailakawi","sequence":"additional","affiliation":[{"name":"Kuwait Institute for Medical Specialization  Kuwait City Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2337-6588","authenticated-orcid":false,"given":"Abdullah M.","family":"Alharran","sequence":"additional","affiliation":[{"name":"College of Medicine and Medical Sciences Arabian Gulf University  Manama Kingdom of Bahrain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar W.","family":"Alrumaih","sequence":"additional","affiliation":[{"name":"School of Medicine The University of Jordan  Amman Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Retaj N.","family":"Hazaa","sequence":"additional","affiliation":[{"name":"School of Medicine The University of Jordan  Amman Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dalal Ali","family":"Al\u2010Mutairi","sequence":"additional","affiliation":[{"name":"Kuwait Institute for Medical Specialization  Kuwait City Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulrahman Talal","family":"Alqallaf","sequence":"additional","affiliation":[{"name":"School of Medicine The University of Jordan  Amman Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8404-5856","authenticated-orcid":false,"given":"Bader N.","family":"Almutawaa","sequence":"additional","affiliation":[{"name":"Kuwait Institute for Medical Specialization  Kuwait City Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9542-7133","authenticated-orcid":false,"given":"Merwi S.","family":"Alhadeyah","sequence":"additional","affiliation":[{"name":"Kuwait Institute for Medical Specialization  Kuwait City Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2330-2030","authenticated-orcid":false,"given":"Abdulaziz Abdullah","family":"Alenezi","sequence":"additional","affiliation":[{"name":"Department of General Surgery Sheikh Jaber Al\u2010Ahmad Al\u2010Sabah Hospital, Ministry of Health  Kuwait City Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fanr F.","family":"Alraqum","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Kuwait University  Kuwait City Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1244-7769","authenticated-orcid":false,"given":"Ebraheem","family":"Albazee","sequence":"additional","affiliation":[{"name":"Otorhinolaryngology\u2010Head and Neck Surgery Kuwait Institute for Medical Specializations (KIMS)  Kuwait City Kuwait"},{"name":"Department of Otolaryngology\u2010Head and Neck Surgery Al\u2010Jahra Hospital  Al\u2010Jahra Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"e_1_2_15_2_1","doi-asserted-by":"publisher","DOI":"10.12788\/j.sder.2015.0125"},{"key":"e_1_2_15_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/wrr.12432"},{"key":"e_1_2_15_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102017\u2010021289"},{"key":"e_1_2_15_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40257\u2010021\u201000628\u20101"},{"key":"e_1_2_15_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/DSS.0000000000001166"},{"key":"e_1_2_15_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/wrr.12839"},{"key":"e_1_2_15_8_1","doi-asserted-by":"publisher","DOI":"10.2147\/CCID.S267192"},{"key":"e_1_2_15_9_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100037\u20101606096"},{"key":"e_1_2_15_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/DSS.0000000000001248"},{"key":"e_1_2_15_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00403\u2010020\u201002135\u20105"},{"key":"e_1_2_15_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocd.15572"},{"key":"e_1_2_15_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_15_14_1","volume-title":"Cochrane Database of Systematic Reviews","author":"Cumpston M.","year":"2019"},{"key":"e_1_2_15_15_1","unstructured":"EndNote\u2014The Best Citation & Reference Management Tool \u201cEndNote \u201d accessed February 14 2026 https:\/\/endnote.com\/."},{"key":"e_1_2_15_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13643\u2010016\u20100384\u20104"},{"key":"e_1_2_15_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"key":"e_1_2_15_18_1","doi-asserted-by":"crossref","unstructured":"J. A.Sterne M. A.Hern\u00e1n B. C.Reeves et\u00a0al. \u201cROBINS\u2010I: A Tool for Assessing Risk of Bias in Non\u2010Randomised Studies of Interventions \u201d (2016) https:\/\/doi.org\/10.1136\/bmj.i4919.","DOI":"10.1136\/bmj.i4919"},{"key":"e_1_2_15_19_1","doi-asserted-by":"publisher","DOI":"10.3390\/publications14010004"},{"key":"e_1_2_15_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/ebmental\u20102019\u2010300117"},{"key":"e_1_2_15_21_1","doi-asserted-by":"publisher","DOI":"10.18203\/issn.2455\u20104529.IntJResDermatol20203074"},{"key":"e_1_2_15_22_1","doi-asserted-by":"publisher","DOI":"10.1080\/09546634.2020.1729334"},{"key":"e_1_2_15_23_1","doi-asserted-by":"publisher","DOI":"10.4103\/idoj.idoj_96_24"},{"key":"e_1_2_15_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/JD9.0000000000000429"},{"key":"e_1_2_15_25_1","doi-asserted-by":"publisher","DOI":"10.36295\/ASRO.2020.231816"},{"key":"e_1_2_15_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.16266"},{"key":"e_1_2_15_27_1","doi-asserted-by":"publisher","DOI":"10.22034\/ijd.2021.234797.1123"},{"key":"e_1_2_15_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocd.14071"},{"key":"e_1_2_15_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/DSS.0000000000003227"},{"key":"e_1_2_15_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/ddg.15873"},{"key":"e_1_2_15_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/lsm.23655"},{"key":"e_1_2_15_32_1","doi-asserted-by":"publisher","DOI":"10.3109\/14764172.2015.1063665"},{"key":"e_1_2_15_33_1","doi-asserted-by":"publisher","DOI":"10.3349\/ymj.2023.0234"},{"key":"e_1_2_15_34_1","doi-asserted-by":"publisher","DOI":"10.1002\/lsm.23349"},{"key":"e_1_2_15_35_1","doi-asserted-by":"publisher","DOI":"10.51253\/pafmj.v71i6.5444"},{"key":"e_1_2_15_36_1","doi-asserted-by":"publisher","DOI":"10.1097\/DSS.0000000000000951"},{"key":"e_1_2_15_37_1","doi-asserted-by":"publisher","DOI":"10.25258\/Ijpqa.17.1.17"},{"key":"e_1_2_15_38_1","doi-asserted-by":"publisher","DOI":"10.2340\/actadv.v105.43611"},{"key":"e_1_2_15_39_1","doi-asserted-by":"publisher","DOI":"10.4103\/JCAS.JCAS_65_19"},{"key":"e_1_2_15_40_1","doi-asserted-by":"publisher","DOI":"10.1080\/14764172.2018.1525749"},{"key":"e_1_2_15_41_1","doi-asserted-by":"publisher","DOI":"10.25259\/jcas_122_23"},{"key":"e_1_2_15_42_1","doi-asserted-by":"publisher","DOI":"10.1002\/lsm.23589"},{"key":"e_1_2_15_43_1","first-page":"389","article-title":"Evaluation of Therapeutic Outcomes of Fractional Carbon Dioxide Laser Versus Micro Needling in the Management of Atrophic Acne Scars: A Prospective Comparative Study","volume":"11","author":"Thakker D. B.","year":"2025","journal-title":"Journal of Contemporary Clinical Practice"},{"key":"e_1_2_15_44_1","doi-asserted-by":"publisher","DOI":"10.1111\/phpp.12716"},{"key":"e_1_2_15_45_1","doi-asserted-by":"publisher","DOI":"10.18231\/j.ijced.2021.009"},{"key":"e_1_2_15_46_1","doi-asserted-by":"publisher","DOI":"10.4103\/JEWD.JEWD_1_19"},{"key":"e_1_2_15_47_1","doi-asserted-by":"publisher","DOI":"10.22034\/ijd.2019.98372"},{"key":"e_1_2_15_48_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10103\u2010022\u201003694\u2010x"},{"key":"e_1_2_15_49_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocd.70765"},{"key":"e_1_2_15_50_1","volume-title":"StatPearls","author":"Verma N.","year":"2026"},{"key":"e_1_2_15_51_1","doi-asserted-by":"publisher","DOI":"10.1111\/ijd.70225"},{"key":"e_1_2_15_52_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.70033"},{"key":"e_1_2_15_53_1","doi-asserted-by":"publisher","DOI":"10.3390\/cosmetics11020051"},{"key":"e_1_2_15_54_1","doi-asserted-by":"publisher","DOI":"10.3390\/cosmetics11060193"},{"key":"e_1_2_15_55_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.55897"},{"key":"e_1_2_15_56_1","doi-asserted-by":"publisher","DOI":"10.1002\/lsm.23484"},{"key":"e_1_2_15_57_1","doi-asserted-by":"publisher","DOI":"10.1097\/DSS.0000000000000746"},{"key":"e_1_2_15_58_1","unstructured":"\u201cAcne Scars: Consultation and Treatment \u201d accessed April 24 2026 https:\/\/www.aad.org\/public\/diseases\/acne\/derm\u2010treat\/scars\/treatment."},{"key":"e_1_2_15_59_1","doi-asserted-by":"publisher","DOI":"10.25259\/IJDVL_572_2021"},{"key":"e_1_2_15_60_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eng.2023.05.009"},{"key":"e_1_2_15_61_1","doi-asserted-by":"publisher","DOI":"10.1093\/asjof\/ojad100"},{"key":"e_1_2_15_62_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10103\u2010024\u201004231\u20108"},{"key":"e_1_2_15_63_1","doi-asserted-by":"publisher","DOI":"10.1111\/dsu.0000000000000049"},{"key":"e_1_2_15_64_1","doi-asserted-by":"publisher","DOI":"10.1111\/dsu.0000000000000050"},{"key":"e_1_2_15_65_1","doi-asserted-by":"publisher","DOI":"10.1002\/lsm.23201"},{"key":"e_1_2_15_66_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00266\u2010023\u201003818\u2010w"},{"key":"e_1_2_15_67_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00403\u2010024\u201003256\u2010x"}],"container-title":["Photodermatology, Photoimmunology &amp; Photomedicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/phpp.70121","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/phpp.70121","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/phpp.70121","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T13:52:52Z","timestamp":1790603572000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/phpp.70121"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":66,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1111\/phpp.70121"],"URL":"https:\/\/doi.org\/10.1111\/phpp.70121","archive":["Portico"],"relation":{},"ISSN":["0905-4383","1600-0781"],"issn-type":[{"value":"0905-4383","type":"print"},{"value":"1600-0781","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]},"assertion":[{"value":"2026-05-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-01","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-22","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70121"}}