Objective: Comparison of Clinical Efficacy, Safety, and Prognosis of Carbon Dioxide Laser and Fire Needle for Cystic Acne. Methods: Sixty patients with cystic acne who visited our hospital from August 2023 to February 2025 were selected. According to random assignment, they were divided into a control group and an experimental group, with 30 patients in each group. The control group was treated with fire needle therapy, while the experimental group received carbon dioxide laser treatment. Both groups required a total of 4 treatments, administered once every 14 days. We compared the total effective rate, cyst regression time, post-treatment pigmentation and scar incidence, pain scores, and patient satisfaction between the two groups. Results: The total effective rate of the experimental group was higher than that of the control group (P<0.05); the cyst regression time in the experimental group was shorter, and the rates of pigmentation and scarring were lower than those in the control group. Post-treatment pain scores were lower, and patient satisfaction was higher in the experimental group than in the control group (P<0.05). Conclusion: Carbon dioxide laser treatment for cystic acne has better clinical efficacy than fire needle therapy, can promote lesion regression, prevent adverse reactions, and demonstrates good safety.