BACKGROUND The treatment of atrophic acne scars represents a therapeutic challenge. Recently, plasma gel has been introduced among treatment modalities. OBJECTIVE To compare the efficacy of platelet-rich-plasma 'fluid' versus 'gel' form combined with fractional CO(2) laser in the treatment of atrophic acne scars. METHODS Twenty-seven patients with atrophic acne scars were included. Treatment with fractional CO(2) laser plus plasma fluid/gel
was randomly assigned to the right/left sides of the face. Clinical and Optical Coherence Tomography (OCT) assessments were scheduled at baseline, one month, and three months after the last session. RESULTS There was a significant improvement in clinical assessment scores at third-month follow-up on the plasma gel- and plasma fluid-treated sides compared to those at the first-month follow-up (p < .001). Scar depth decreased significantly at third-month follow-up when compared to baseline on both plasma gel- and plasma fluid-treated sides (p < .001). The numerical pain score was significantly lower on the plasma fluid-treated side compared to the plasma gel-treated side (p = .004). CONCLUSION The use of platelet-rich plasma in combination with fractional CO(2) laser, both in fluid and gel form, produced significant results in the treatment of atrophic acne scars. Patients reported an immediate more noticeable effect with plasma gel. However, the fluid injection was less painful.