BACKGROUND: The 1,450 nm laser has been effective in treating acne. Microdermabrasion may help treat acne and reduce skin barriers to increase the delivery rate of topical anesthetics. OBJECTIVES: To evaluate the efficacy, safety, and pain associated with the treatment of inflammatory facial acne with the 1,450 nm laser alone versus microdermabrasion plus the 1,450 nm laser. METHODS: Twenty patients with facial acne were treated with the 1,450 nm laser alone and microdermabrasion plus the 1,450 nm laser in a randomized, split-face trial. RESULTS: Laser alone and microdermabrasion plus laser significantly reduced the total number of acne lesions. Mean reductions of 53.5% and 55.6% were found after three treatments for laser alone and microdermabrasion plus laser, respectively. Clinical improvement was maintained 12 weeks after the last treatment. Mean pain scores were 5.3±1.5 for microdermabrasion plus laser and 5.2±1.5 for laser alone. There was no statistical difference between treatment levels for efficacy or pain. There was an average 10% increase in sequential pain as the laser treatment progressed. CONCLUSION: The 1,450 nm laser is effective, well tolerated, and safe for treating facial acne. This small pilot study did not demonstrate increased clinical efficacy or decreased associated pain with the addition of microdermabrasion to treatment with the 1,450 nm laser. A larger study may be needed to demonstrate any additional benefit.