Objective To explore the clinical effect of gold microneedle radiofrequency combined with microneedle therapy in the treatment of depressed acne scar and its effect on skin aesthetics and safety. Methods A total of 86 patients with depressed acne scar admitted to our hospital from August 2022 to May 2024 were selected and divided into conventional group (43 patients) and the experimental group (43 patients) by the random number table method. The conventional group was given microneedle therapy, and the experimental group was given gold microneedle radiofrequency combined with microneedle therapy. The skin improvement condition, treatment effect, aesthetic satisfaction and adverse reactions were compared between the two groups. Results The acne scar depth, skin smoothness and skin uniformity scores in the experimental group were lower than those in the conventional group (P <0.05). The total effective rate of treatment in the experimental group (97.67%) was higher than that in the conventional group (81.40%) (P <0.05). The aesthetic satisfaction in the experimental group (97.67%) was higher than that in the conventional group (79.07%) (P <0.05). There was no statistically significant difference in the incidence of adverse reactions between the experimental group (4.65%) and the conventional group (6.98%) (P >0.05). Conclusion The clinical effect of gold microneedle radiofrequency combined with microneedle therapy in the treatment of depressed acne scar is accurate. It can improve depressed acne scar, improve skin aesthetic satisfaction, and do not increase adverse reactions. It is worthy of clinical application.