Objective To explore the effect of gold microneedle radiofrequency therapy in the treatment of facial acne scar and its impact on scar severity and pain level of patients. Methods A total of 98 patients with facial acne scar admitted to Nanjing Drum Tower Hospital from November 2022 to August 2024 were selected as the research subjects, and they were divided into the control group and the observation group by the random number table method, with 49 patients in each group. The control group was treated with CO. fractional laser, and the observation group was treated with gold microneedle radiofrequency therapy. The scar severity, pain level, clinical efficacy and adverse reactions were compared between the two groups. Results The acne scar weighted score in the observation group after 8, 16 and 24 weeks of treatment was lower than that in the control group (P <0.05). The immediate pain score in the observation group after the 1st, 2nd and 3rd treatments was lower than that in the control group (P <0.05). The total effective rate of treatment in the observation group (97.96%) was higher than that in the control group (81.63%) (P <0.05). The incidence of adverse reactions in the observation group (4.08%) was lower than that in the control group (18.37%) (P <0.05).Conclusion Gold microneedle radiofrequency has a better effect in the treatment of patients with facial acne scar. It is helpful to improve the severity of acne scars, reduce the pain level during treatment. It is safe and worthy of clinical application.