Combined Fractional CO₂ and Pulsed Dye Laser Therapy for Scar Treatment: A Systematic Review and Meta-analysis

Background: Pathological scars, particularly hypertrophic and keloid types, often pose significant cosmetic and functional challenges. Although fractional CO₂ lasers and pulsed dye lasers have individually shown promise in scar treatment, their combined efficacy remains underexplored. Methods: Following preferred reporting items for systematic reviews and meta-analyses guidelines and registered in PROSPERO (CRD42024619973), a comprehensive search across 6 databases identified studies involving patients treated with combined fractional CO₂ laser and pulsed dye laser for scars of various etiologies. Inclusion criteria focused on clinical outcomes such as scar thickness, vascularity, pliability, and pigmentation, assessed via validated tools such as the Vancouver Scar Scale, Patient and Observer Scar Assessment Scale, and Observer Scar Assessment Scale. Nine studies, involving a total of 247 patients, were included. Meta-analyses were performed using a random-effects model. Results: The combination therapy significantly improved scar appearance across multiple scales. The pooled mean differences were −18.09 for the Patient and Observer Scar Assessment Scale, −19.44 for the Observer Scar Assessment Scale, and −3.80 for the Vancouver Scar Scale, all of which were statistically significant ( P < 0.0001). Improvements were consistent across pigmentation, vascularity, texture, and patient satisfaction, with minimal adverse effects reported. Heterogeneity was high, but it did not impact the direction of the findings. Conclusions: Combining fractional CO₂ and pulsed dye lasers offers superior outcomes in scar remodeling compared with monotherapy, improving both functional and aesthetic aspects with a favorable safety profile. Future studies should focus on standardizing treatment protocols and exploring long-term outcomes to optimize clinical use.