Navigating Combined Laser Modalities Versus Monotherapy for Atrophic Acne and Postsurgical Scar Improvement: A Systematic Review and Network Meta‐Analysis

Background Combined laser protocols are increasingly used for atrophic acne and postsurgical scars, but no laser‐only network meta‐analysis has assessed these regimens within a focused laser‐versus‐laser framework. Objective To map randomized evidence for laser monotherapy and combined‐laser treatment, identify evidence gaps, and generate provisional treatment rankings. Methods PubMed, Europe PMC, OpenAlex, and ClinicalTrials.gov were searched from inception through April 2026. Eligible studies were randomized controlled trials comparing at least 2 laser modalities, either as monotherapy or in combination, for atrophic acne or postsurgical scars. Risk of bias was assessed with Cochrane RoB 2.0, and a random‐effects frequentist network meta‐analysis synthesized standardized mean differences and P ‐scores. Results Twenty‐six RCTs enrolling 771 participants across 14 laser nodes were included. Only 17 of 91 possible pairwise comparisons (19%) were supported by direct randomized evidence. The 4 combined‐laser regimens were each evaluated in a single RCT; the 5 trials contributing at least 1 combination‐versus‐monotherapy comparison enrolled 172 participants. The largest trial reported better Goodman‐Baron improvement with PDL plus nonablative fractional laser than with NAFL alone (standardized mean difference, approximately 0.56). In the main connected monotherapy network, picosecond Nd:YAG ranked highest ( P ‐score, 0.858), but certainty was very low. Overall risk of bias was low in 4 studies and showed some concerns in 22. Conclusion Evidence for combined‐laser scar treatment remains sparse and insufficient to recommend a specific dual‐laser regimen. This review mainly clarifies current evidence gaps and priorities for future comparative trials.