Objective To investigate the efficacy and safety of gold microneedle combined with blade needle in the treatment of facial acne depressed scar. Methods A total of 60 patients with facial acne depressed scar admitted to Wuhan Yestar Medical Beauty Hospital from August 2023 to September 2024 were selected and divided into the control group and the observation group by the random number table method, with 30 patients in each group. The control group was treated with gold microneedle radiofrequency, and the observation group was combined with blade needle on the basis of the control group. The treatment effect, skin physiological indicators (transepidermal water loss and stratum corneum hydration) and adverse reactions were compared between the two groups. Results The total effective rate of treatment in the observation group (96.67%) was higher than that in the control group (73.33%) (P <0.05). After treatment, the transepidermal water loss in the two groups was lower than that before treatment, and the stratum corneum hydration was higher than that before treatment. Compared with the control group, the transepidermal water loss in the observation group was lower, and the stratum corneum hydration was higher (P <0.05). There was no significant difference in the adverse reaction rate between the two groups (P >0.05). Conclusion Gold microneedle combined with blade needle treatment can improve the efficacy of facial depressed acne scar, enhance skin moisturizing function, and does not increase the risk of adverse reactions.