Objective? To systematically evaluate the clinical efficacy and safety of recombinant mussel adhesive protein (rMAP) in wound repair following ablative CO? fractional laser treatment.Methods:? A total of 70 patients with atrophic acne scars who received treatment at the Laser and Physical Therapy Center of our hospital from March 2025 to March 2026 were enrolled and randomly divided into an observation group (n=35) and a control group (n=35) using a random number table. The observation group received CO? fractional laser combined with rMAP, while the control group received CO? fractional laser combined with medical collagen. Wound healing progress, immediate postoperative inflammatory response, skin barrier function [transepidermal water loss (TEWL), stratum corneum hydration, sebum content], VISIA imaging analysis, patient-reported subjective scores, and safety profiles were assessed throughout the study.Results:? Compared with the control group, the observation group exhibited significantly shorter crusting and desquamation times (P<0.05), along with a more pronounced resolution of acute postoperative inflammatory reactions (erythema, edema, exudation) (P<0.05). On day 7 (D7) postoperatively, TEWL in the observation group was significantly lower than that in the control group, whereas stratum corneum hydration and sebum content were significantly higher (P<0.05). On day 28 (D28), VISIA scores and Visual Analogue Scale (VAS) pain scores in the observation group were significantly lower than those in the control group, while comfort scores and overall treatment satisfaction were significantly higher (P<0.05). No severe adverse events were observed in either group, with no statistically significant intergroup difference in safety.Conclusion:? Recombinant mussel adhesive protein accelerates wound healing, mitigates immediate postoperative erythema, edema, and exudation, reduces TEWL, and promotes restoration of the skin barrier after ablative CO? fractional laser resurfacing. It also shows potential in reducing the risk of post-inflammatory hyperpigmentation and scar formation, with a favorable safety profile.