The Efficacy and Safety of Ablative Fractional CO 2 Laser Combined With Topical Minoxidil for Male Androgenetic Alopecia: A Randomized Clinical Trial

Introduction Minoxidil is a primary treatment for male androgenetic alopecia (AGA), but its slow onset and limited effectiveness, especially in restoring the frontal hairline in basic M‐type AGA, often result in poor adherence. We investigated whether combining minoxidil with ablative fractional CO 2 laser, which enhances transdermal absorption and the follicular environment, could improve outcomes. This study assesses the efficacy and safety of this combination therapy in overcoming these challenges. Methods A total of 178 male patients with basic M‐type AGA were randomized into two treatment arms: the combination therapy arm (application of 5% minoxidil twice daily; monthly ablative fractional CO 2 laser treatment for 24 weeks) and the monotherapy arm (application of 5% minoxidil twice daily for 24 weeks). Follow‐ups were conducted at baseline, 12 weeks, and 24 weeks after treatment. Results Out of 178 patients randomized (89 in each arm), 156 completed 24 weeks (combination: 83; monotherapy: 73). The combination therapy significantly improved terminal hair density, diameter, investigator assessments, and patient satisfaction compared to monotherapy (all p < 0.001). Trichoscopic analysis showed better hair density diversity, perifollicular pigmentation, honeycomb pattern, and double hair units in the combination arm (all p < 0.025). No serious treatment‐related adverse events occurred in either group. Conclusions The combination of ablative fractional CO 2 laser and topical minoxidil is more effective than topical minoxidil monotherapy in promoting frontal hairline regrowth, with faster response time and comparable safety profiles. Trial Registration: Chinese Registry of Clinical Trials: ChiCTR2300070840.