Objective To analyze the effect of gold microneedle radiofrequency combined with recombinant human epidermal growth factor (EGF) on scar severity in patients with acne scar. Methods A total of 108 patients with acne scar who visited Guangzhou Yestar Medical Aesthetic Hospital from June 2022 to December 2024 were selected, and they were divided into the control group and the observation group by the random number table method, with 54 patients in each group. The control group was treated with gold microneedle radiofrequency, and the observation group was treated with gold microneedle radiofrequency combined with EGF. The clinical efficacy, skin physiological parameters, scar severity, adverse reaction rate and incrustation time were compared between the two groups. Results The total effective rate of the observation group (96.30%) was higher than that of the control group (81.48%) (P <0.05). The skin water content of the observation group after treatment was higher than that of the control group, and the transepidermal water loss was lower than that of the control group (P <0.05). The scar base depth and VSS score of the observation group after treatment were lower than those of the control group (P <0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P >0.05). The incrustation time of the observation group was shorter than that of the control group (P <0.05). Conclusion Gold microneedle radiofrequency combined with EGF in the treatment of acne scar can improve the clinical symptoms, effectively repair the skin barrier function, and reduce the severity of scars. It can also shorten the incrustation time, improve treatment efficiency, and has good safety.