Objective To explore the effect of microneedle radiofrequency combined with compound acid on scar improvement in patients with facial acne scars. Methods A total of 80 patients with facial acne scars admitted to the Department of Aesthetic Dermatology, Guiyang Mebel Medical Beauty Hospital from March 2023 to March 2025 were selected, and they were divided into the control group and the observation group by the random number table method, with 40 patients in each group. The control group was treated with microneedle radiofrequency, and the observation group was treated with microneedle radiofrequency combined with compound acid. The scar improvement, skin elasticity indexes, pigment improvement, adverse reaction rate and patient satisfaction were compared between the two groups. Results After treatment, the scar improvement score of the observation group was higher than that of the control group (P <0.05). After treatment,the immediate elasticity, delayed elasticity, total elasticity and elasticity index of the observation group were better than those of the control group (P <0.05).The pigment improvement rate of the observation group (87.50%) was better than that of the control group (67.50%) (P <0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups (P >0.05).The patient satisfaction rate of the observation group was 95.00%, which was better than 77.50% of the control group (P <0.05). Conclusion The combined treatment of microneedle radiofrequency and compound acid for facial acne scars can effectively improve the appearance of scars, enhance skin elasticity, and promote the regression of hyperpigmentation. It has good safety and high patient satisfaction.